Noncovered services Noncovered services refers to any medical service that is not covered by the plan. Some services may be medically necessary, yet still are not covered. See the “What the plan does not cover” section. When the HTCC determines that a service is not covered, then the service is not covered by the plan. Nonduplication of benefits Nonduplication of benefits is how UMP coordinates benefits when UMP is your secondary coverage. When another plan is primary (pays first), that plan pays their normal benefit. UMP then pays up to the amount we would have paid if UMP had been the primary plan. If the primary plan pays as much or more than the normal UMP benefit, UMP pays nothing. UMP does not pay the rest of the allowed amount. See examples on page 120. Non-network pharmacy A non-network pharmacy does not contract with WSRxS. See page 96 for what happens if you use a non-network pharmacy to purchase covered prescription drugs. Non-network pharmacies do not include excluded pharmacies (see the definition of “Excluded pharmacy”). Nonprescription alternative A nonprescription alternative includes an over-the-counter drug, dietary supplement, herbal supplement, vitamin, mineral, medical food, or medical device that you may buy without a prescription that has similar safety, efficacy, and ingredients as a prescription drug. Nonprescription drug A nonprescription drug includes an over-the-counter drug, dietary supplement, herbal supplement, vitamin, mineral, medical food, or medical device that you may buy without a prescription. Normal benefit The plan’s normal benefit is the dollar amount the plan would normally pay if no other group health plan had the primary responsibility to pay the claim for a benefit. Occupational injury or illness An occupational injury or illness is one resulting from work that is for pay or profit. Orthognathic and Telegnathic surgery Orthognathic surgery is surgery to correct conditions of the jaw and face related to structure, growth, or TMJ disorders, or to correct orthodontic problems that cannot be easily treated with braces. Telegnathic surgery means skeletal advancement to enlarge and stabilize the pharyngeal airway to treat obstructive sleep apnea. Out-of-network provider(s) An out-of-network provider is a health care provider that is: • In the Regence BlueShield service area, but is not contracted as part of Regence BlueShield’s PPO network; or • In the Regence BlueShield service area, but is outside the geographic service area for the core and support networks, or not contracted with your UMP-Plus network; or 182 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage