Contact UMP Customer Service to ask if a medical service is covered as preventive. Contact WSRxS Customer Service for questions about preventive prescription drugs. The following specific services are covered as preventive: • Chlamydia and gonorrhea testing in sexually active women ages 24 and younger, and for women age 25 or older who are at increased risk for infection. • Counseling and screening for HIV, counseling and screening for interpersonal and domestic violence, and counseling for sexually transmitted infections. • Education and counseling regarding contraception. • Human Papillomavirus (HPV) testing for women age 30 or older, once every three years. For additional services covered as preventive, see the following benefits: “Family planning services,” “Mammogram and Digital Breast Tomosynthesis (DBT),” and “Obstetric and newborn care.” Covered immunizations You pay the standard rate for covered immunizations that are not considered preventive. The plan covers immunizations listed on the Centers for Disease Control and Prevention (CDC) applicable immunization schedule (children, adolescents, adults) for U.S. residents. For a list of immunizations covered as preventive, visit the CDC website at cdc.gov/vaccines/schedules/index.html or contact UMP Customer Service. Some covered immunizations are classified as “may be recommended” by the CDC depending on medical condition or lifestyle. For those immunizations to be covered as preventive, you must meet the criteria specified on the CDC schedule. Immunizations covered under the preventive rate are not subject to your medical deductible. Covered immunizations given by the providers listed under the “Where to get immunizations” section below are paid under the preventive care benefit. If you see an out-of-network provider for covered preventive immunizations, you pay 50 percent of the allowed amount and the provider may balance bill you. Flu shots and COVID-19 vaccines are paid at 100 percent regardless of the provider’s network status. TIP: The plan covers flu shots and COVID-19 vaccines listed on the applicable CDC immunization schedule. For a list of immunizations covered as preventive, find a link to the CDC immunization schedules at the CDC website at cdc.gov/vaccines/schedules/index.html or contact UMP Customer Service. Where to get immunizations You pay $0 for immunizations covered under the preventive care benefit when received from a: • Network provider • Network vaccination pharmacy (Many network pharmacies have vaccination pharmacists who may give covered preventive immunizations to members. Contact a network pharmacy ahead of time to make sure the pharmacy has the vaccine you need. Present your UMP member ID card at the pharmacy counter for billing before receiving a vaccine.) • Public health department The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations. Exception: COVID-19 vaccines are covered when required for employment. 68 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage