ALERT! The member pays the full cost for noncovered prescription drugs. If the member purchases covered prescription drugs from a non-network pharmacy, the plan pays under the normal prescription drug benefit as described in the following sections: “What you pay for prescription drugs,” “How the prescription drug cost-limit works,” and “Your prescription drug out-of-pocket limit.” Prescriptions purchased from an excluded pharmacy will not be covered. See the definition of “Excluded pharmacy.” Respite care Respite care is continuous care of more than four hours a day to give caretakers temporary relief from caring for a member who is homebound or in hospice. The plan covers these services at 100 percent of the allowed amount after you meet your medical deductible, up to 14 visits per the member’s lifetime. Death with Dignity The Washington Death with Dignity Act allows terminally ill adults seeking to end their life to request lethal doses of prescription drugs. These terminally ill patients must be Washington residents who have less than six months to live. For more information about this Act, see chapter 70.245 RCW. Care described under this Act includes services covered by UMP, subject to standard plan requirements. If you have questions about medical services UMP covers, contact UMP Customer Service. If needed, UMP may assign a case manager to support you. If you have questions about prescription drugs UMP covers, contact WSRxS Customer Service. If your current provider is unable to meet your needs, or if you need assistance in finding a provider for these services, visit End of Life Washington’s website at endoflifewa.org. End of Life Washington is a community resource available to support the public in finding available providers. For more information about the Death with Dignity Act, visit: • The Department of Health’s website at doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct. • The Washington State Hospital Association’s website at wsha.org/for-patients/end-of-life/. Hospital services ALERT! Many services provided in a hospital setting require preauthorization, notice, or both. Failure to request or receive preauthorization, or to notify the plan, may result in complete denial of claims. See the “Limits on plan coverage” section for how preauthorization and notice work. This benefit covers hospital accommodations and inpatient, outpatient, and ambulatory care services, supplies, equipment, and prescribed drugs to treat covered conditions. Room and board is limited to the hospital’s average semiprivate room rate, except where a private room is determined to be medically necessary. Some services require preauthorization. Visit the UMP Policies that affect your care webpage for the list of these services, or contact UMP Customer Service. See Directory for link and contact information. 60 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage