Prescription drug Diabetes care supplies listed below are only covered under your plan’s prescription drug benefit according to the tier shown on the UMP Preferred Drug List (see “The UMP Preferred Drug List” section for more information): • Insulin syringes • Lancets • Test strips • Continuous glucose monitors To be covered, you must get a written prescription for these supplies and purchase them from a pharmacy. Limits, such as quantity limits or preauthorization, may apply. To find out the tier of a diabetes care supply, check the UMP Preferred Drug List online by visiting the UMP Prescription drug coverage webpage or contact WSRxS Customer Service (see Directory for link and contact information). You save money and avoid having to submit your own claims when you purchase these diabetes care supplies from a WSRxS network pharmacy. Locate a network pharmacy by visiting the UMP Prescription drug coverage webpage or contact WSRxS Customer Service. For more information, see “Exceptions covered" on page 89. Diabetes Control Program TIP: The Diabetes Control Program is not subject to your medical deductible and is offered at no additional cost for UMP (non-Medicare) members age 18 or older. For non-Medicare members age 18 or older with a diagnosis of diabetes, the plan offers the Diabetes Control Program administered by the Care Management Program at Regence. Case managers are trained to help you reduce the risk of complications of diabetes by tracking and controlling blood sugar, cholesterol levels, blood pressure, and weight in a series of quarterly consultations. The plan offers the Diabetes Control Program at no additional cost to members. You may find out if you have diabetes by visiting your primary care provider for a blood sugar laboratory test. If you qualify for the Diabetes Control Program, you may self-refer by calling Regence at 1-866-543- 5765 (TRS: 711). Diabetes education Support network provider type: You must use a UMP Plus–PSHVN provider or a covered provider within the support network to receive network level benefits (see description in the “Support network providers” section). The plan covers diabetes self-management training and education, including nutritional therapy by registered dieticians. When diabetes education includes nutritional therapy, the nutritional therapy services are not subject to the 12-visit lifetime limit stated under “Nutrition counseling and therapy” on page 64. 50 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage