Cost-share Cost-share means the amount you pay for a service, supply, or prescription drug. This may be a deductible, coinsurance, copay, or amounts not covered by the plan. Custodial care Custodial care is care primarily to assist in activities of daily living, including institutional care primarily to support self-care and provide room and board. Custodial care includes, but is not limited to, help in walking, getting into and out of bed, bathing, dressing, feeding and preparing special diets, and supervising prescription drugs that are ordinarily self-administered. Deductible, medical Your medical deductible is a fixed dollar amount you must meet each calendar year for health care expenses before the plan starts paying for covered services. You pay the first $125 per member in medical expenses to your providers ($375 maximum if you have a family of three or more on one account). Only expenses covered by the plan apply to your deductible. For example, if you receive LASIK surgery (see exclusion on 109), the plan does not apply this payment to your medical deductible. Some services are not subject to this deductible (see the “Summary of benefits” section). See the “What you pay for medical services” section for details on how your medical deductible works. Dependent A dependent is an eligible spouse, state-registered domestic partner, child, or other eligible family member as described in “Dependent eligibility” (see the “Eligibility for subscribers and dependents” sections on page 140 and 155) that is either covered by or eligible to be covered by the plan under the subscriber’s account. Detoxification Detoxification is a medically supervised treatment program for individuals with alcohol or drug intoxication, designed to rid the body of toxic substances and manage withdrawal symptoms. Developmental delay Developmental delay is a significant lag in reaching developmental milestones as expected during infancy and early childhood. The cause may be present at birth or acquired after birth from a disease or disorder of the body, an injury, a disorder of the mind or emotions, or harmful effects of the surrounding environment. Only a physician or other provider may diagnose a developmental delay. Durable medical equipment (DME) Durable medical equipment (DME) is: • Designed for prolonged use. • For a specific therapeutic or clinical purpose, or to assist in the treatment of an injury or illness. • Medically necessary (meeting all plan medical necessity criteria). • Primarily and customarily used only for a medical purpose. See page 109 for examples of equipment that is not covered. 172 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage