• Pay your copays, coinsurance, and deductibles promptly. • Refund promptly any overpayment made to you or for you. • Report to the plan any outside sources of health care coverage or payment. • Return your completed Multiple Coverage Inquiry form you receive from the plan in a timely manner to prevent delay in claims payment. • Understand how to contact the plan for more information and help with any covered service or information described in this COC. • Understand how UMP coverage coordinates with other insurance coverage you may have, including Medicare. • Understand your plan benefits, including what is covered, preauthorization and notice requirements, and other information described in this COC. Information available to you We support the goal of giving you and your family the detailed information you need to make the best possible health care decisions. See the Directory pages at the beginning of this booklet for links and contact information. You may find the following information in this COC: • Benefit exclusions, reductions, and maximums or limits (see the “What the plan does not cover” section) • Clear explanation of complaint and appeal procedures (see the “Complaint and appeal procedures” section) • Definition of terms (see the “Definitions” section) • List of covered expenses (see the “List of benefits” section) • Policies regarding prescription drug coverage and how the plan adds and removes drugs from the UMP Preferred Drug List (see “The UMP Preferred Drug List” and the “Guidelines for prescription drugs UMP covers” sections) • Preventive health care benefits that are covered (see the “Preventive care” benefit and page 89) • Process for preauthorization, notice, or review (see the “Limits on plan coverage” section and page 98) You may find the following on the UMP website or by contacting UMP Customer Service: • Accreditation information, including measures used to report the plan’s performance, such as consumer satisfaction survey results or Healthcare Effectiveness Data and Information Set (HEDIS) measures • Clinical coverage criteria applicable to health care services and supplies that require preauthorization • Description and justification for provider compensation programs, including any incentives or penalties intended to encourage providers to withhold services • General reimbursement or payment arrangements between the plan and network providers • Information on the plan’s care management programs • Notice of privacy practices (includes plan policy for protecting the confidentiality of health information; see “Confidentiality of your health information” on page 136) • Online directory of network providers, including both primary care providers and specialists • Procedures to follow for consulting with providers 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 135