Summary of benefits .................................................................................................................................................................. 39 List of benefits ............................................................................................................................................................................... 42 Acupuncture .............................................................................................................................................................................. 42 Ambulance ................................................................................................................................................................................. 42 Applied Behavior Analysis (ABA) Therapy ................................................................................................................... 43 Autism treatment .................................................................................................................................................................... 44 Bariatric surgery ....................................................................................................................................................................... 44 Behavioral health .................................................................................................................................................................... 44 Breast health screening tests ............................................................................................................................................. 47 Care management .................................................................................................................................................................. 47 Chiropractic physician services ......................................................................................................................................... 48 Dental services.......................................................................................................................................................................... 48 Diabetes care supplies .......................................................................................................................................................... 49 Diabetes Control Program .................................................................................................................................................. 50 Diabetes education ................................................................................................................................................................ 50 Diabetes Prevention Program (DPP) .............................................................................................................................. 51 Diagnostic tests, laboratory, and x-rays ....................................................................................................................... 51 Dialysis ......................................................................................................................................................................................... 52 Durable medical equipment (DME), supplies, and prostheses........................................................................... 52 Emergency room ..................................................................................................................................................................... 54 End-of-life counseling .......................................................................................................................................................... 55 Family planning services ...................................................................................................................................................... 55 Foot care, maintenance ........................................................................................................................................................ 56 Gender affirming care ........................................................................................................................................................... 56 Genetic services ....................................................................................................................................................................... 56 Headaches, chronic migraine or chronic tension type ........................................................................................... 56 Hearing care (diseases and disorders of the ear) ..................................................................................................... 57 Hearing exam and hearing aids (instruments) .......................................................................................................... 57 Home health care .................................................................................................................................................................... 58 Hospice care .............................................................................................................................................................................. 59 Hospital services ...................................................................................................................................................................... 60 Knee arthroplasty, total ........................................................................................................................................................ 61 Mammogram and Digital Breast Tomosynthesis (DBT) ........................................................................................ 62 Massage therapy ..................................................................................................................................................................... 62 Mastectomy and breast reconstruction ........................................................................................................................ 63 Mental health ............................................................................................................................................................................ 63 Naturopathic physician services ....................................................................................................................................... 63 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 9