Special rate The plan’s special rate is for services that have unique payment rules. These rules are described in the table (see the “How much you pay for covered services” column) located in the “Types of services” section. Specialty drugs Specialty drugs are high-cost injectable, infused, oral, or inhaled prescription drugs or products that require special storage or handling and are subject to additional rules. Specialty drugs are identified on the UMP Preferred Drug List. See page 99 for information on how specialty drug prescriptions are handled. Specialty providers and services Specialty providers and services are providers or services designated by the plan that are paid at the network rate when included in the support network. See page 19 for a list of provider types and services covered. Standard rate The plan’s standard rate depends on the provider’s status: • PCPs, including naturopaths: ▪ You pay $0 for most services. The plan pays 100 percent of the allowed amount. Note: When you see a PCP in your network for primary care services, you pay $0 for office visits. Related services, like x-rays or labs that you receive during a primary care visit, may be subject to your medical deductible and coinsurance. • Specialty providers in the core or support network: You pay 15 percent of the allowed amount after you pay your medical deductible. The plan pays 85 percent of the allowed amount. • Out-of-network providers: You pay 50 percent of the allowed amount after you meet your medical deductible. You pay all charges billed to you above the allowed amount (known as balance billing). The plan pays 50 percent of the allowed amount. Standard reference compendium Standard reference compendium refers to any of these sources: • The American Hospital Formulary Service Drug Information • The American Medical Association Drug Evaluation • The United States Pharmacopoeia Drug Information • Other authoritative compendia as identified from time to time by the U.S. Secretary of Health and Human Services State Agency State agency means an office, department, board, commission, institution, or other separate unit or division, however designated, of the Washington state government. It includes the legislature, executive branch, and agencies or courts within the judicial branch, as well as institutions of higher education and any unit of state government established by law. 190 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage