• Educating members about their care options, benefits, and coverage, as well as helping members make educated decisions regarding their health care. • Supporting members with coordination of care needs. • Proactively identifying members who may benefit from care management. • Performing a comprehensive assessment of care needs and potential gaps in care. • Developing a plan of care that can help with behavioral health, social service needs and barriers to care. • Works with members and their family to set goals that reflect the member’s needs and priorities. How to get started Providers may refer members likely to benefit from care management support. Members can also self- refer by calling Regence at 1-866-543-5765 (TRS: 711) for information about care management services provided by PSHVN. Case management as a condition of coverage An HCA or plan medical director may review medical records and determine that your use of certain services is potentially harmful, excessive, or medically inappropriate. Based on this determination, the plan may require you to participate in and comply with a case management plan as a condition of continued benefit payment. Chiropractic physician services See the “Spinal and extremity manipulations” benefit. Dental services ALERT! Dentists and other dental providers are not included in the UMP provider network, even if they are listed in the Regence provider directory. The plan does not cover most dental services. For example, dental implants, orthodontic services, and treatment for damage to teeth or gums caused by biting, chewing, grinding, or any combination of these are not covered. However, your PEBB dental plan may cover these services. Refer to your dental plan’s COC, found on the HCA website at hca.wa.gov/erb, for more information. What is covered by the plan The plan covers oral surgery and other dental services under the medical benefit when they are considered medical. Oral surgery and dental services are considered medical if the condition being diagnosed and treated is either one which is not connected to the teeth and/or gums or is related to a disease or illness that affects the whole body. These medical services may be performed by a dentist or medical professional provider. You can find examples of these medical services in the Regence Medical Policy Administrative Guidelines to Determine Dental vs Medical Services by visiting the UMP Policies that affect your care webpage (see Directory for link). You pay 20 percent of the allowed amount for covered dental services unless otherwise stated, and the provider may balance bill you. Note: UMP is not affiliated with the Uniform Dental Plan (UDP). If you are enrolled in UDP, contact UDP for information about services covered under your dental plan. Visit the HCA website at hca.wa.gov/erb and select “Contact” to find UDP contact information. 48 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage