See the “Your prescription drug out-of-pocket limit” section for annual limits to covered prescription drug costs. Prescription drug Prescription drug means a drug approved by the FDA that can be dispensed only with an order given by a properly authorized person. The designation of a medication as a prescription drug is made by the FDA. Prescription drug benefit Prescription drug benefit refers to services subject to the prescription drug coinsurance. See the “What you pay for prescription drugs” section for a description of how this works. Prescription drug out-of-pocket limit See the “Out-of-pocket limit, prescription drug” definition. Preventive care Preventive care means those services described by the Public Health Services Act, Section 2713: • Covered immunizations recommended by the CDC. • Evidence-informed preventive care and screenings for women as described in HRSA Guidelines in accordance with 45 CFR §147.130 (a)(iv). • Evidence-informed preventive care screenings for infants, children, and adolescents supported by the Health Resources and Services Administration (HRSA). Services with an A or B rating by the U.S. Preventive Services Task Force. Preventive rate Covered preventive services are not subject to your medical deductible. The plan’s preventive rate depends on the provider’s status: • Primary care and specialty providers in the core or support network: You pay $0. The plan pays 100 percent of the allowed amount. • Out-of-network providers: You pay 50 percent of the allowed amount. You pay all charges billed to you above the allowed amount (known as balance billing). The plan pays 50 percent of the allowed amount. Primary care provider (PCP) A primary care provider (PCP) is a physician (see the “Physician services” definition), nurse practitioner, or physician assistant who provides, coordinates, or helps a member access a range of health care services. See page 19 for a list of specialties that may be a primary care provider. Primary payer The primary payer is the insurance plan that processes the claim first when a member has more than one group insurance plan covering the services and the plans must coordinate benefits. 186 2024 UMP Plus–UW Medicine ACN (PEBB) Certificate of Coverage