Scientific evidence Scientific evidence means scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff. Scientific evidence also refers to findings, studies, or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes. However, scientific evidence does not include published peer-reviewed literature sponsored to a significant extent by a pharmaceutical manufacturing company or medical device manufacturer or a single study without other supportable studies. Scope of practice Scope of practice refers to the services a provider may perform and bill for, based on the provider’s professional license as issued by local authorities. For example, some provider types may prescribe prescription drugs, and some may not. Screening Screening refers to services performed to prevent or detect illness in the absence of disease or symptoms. Secondary coverage When you are covered by more than one group health plan, you have secondary coverage that may pay a part or the rest of a provider’s bill after your primary payer has paid. See the “If you have other medical coverage” section for more information on how this plan coordinates benefits. Skilled nursing care Skilled nursing care is services from licensed nurses in your own home or in a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home. Skilled nursing facility A skilled nursing facility is an institution, or part of an institution, that provides skilled nursing care 24 hours a day and is classified as a skilled nursing facility by Medicare. Medicaid-eligible, long-term care facilities are not necessarily skilled nursing facilities. SmartHealth SmartHealth is a voluntary wellness program offered by the PEBB Program that allows eligible subscribers to qualify for wellness incentives. Employees who waive medical enrollment and eligible retirees who defer PEBB retiree insurance coverage are not eligible to qualify for the incentive. Qualifying for the wellness incentive during the 2023 plan year reduces the subscriber’s 2024 plan year medical deductible by $125 to $0 if the subscriber is still eligible to participate in the wellness incentive program. Qualifying for the wellness incentive during the 2024 plan year reduces the subscriber’s 2025 plan year deductible by $125 to $0 if the subscriber is still eligible to participate in the wellness incentive program and is enrolled in the 2025 plan year. More details on eligibility and program requirements are on HCA's SmartHealth webpage at hca.wa.gov/pebb-smarthealth. 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 189