without your informed consent in states that allow you to waive the federal balance billing protections. When you receive emergency services you pay the network cost-sharing amount regardless of the network status of the provider or facility and cannot be balance billed. Mental health The plan covers mental health services for members with neuropsychiatric and mental health conditions. Marriage or family counseling is not covered. The amount the plan pays depends on the provider’s network status (see the “Finding a health care provider” section and page 35). See below for details about coverage for substance use disorder treatment. Inpatient ALERT! Your provider must notify the plan as soon as possible after you are admitted to a facility, but not later than 24 hours after you are admitted when you receive inpatient services. If the plan is not notified of inpatient treatment, the plan may not cover the treatment. Inpatient treatment is subject to clinical review. Services are considered inpatient when you are admitted to a facility. This may include either psychiatric inpatient hospitalization or care at a residential treatment facility. The plan must preauthorize non- emergency inpatient services. See the “Limits on plan coverage” section for details. Your provider must notify the plan as soon as possible after you are admitted to a facility, but no later than 24 hours after you are admitted to a: • Hospital • Residential treatment facility Contact UMP Customer Service about preauthorization requirements. Visit UMP Policies that affect your care webpage for a list of services that require plan notice. See Directory for link and contact information. You pay an inpatient copay for facility charges at a network facility (see the “Copay” section). Professional services (for example, doctors) may be billed separately from the facility charges. The plan pays the inpatient rate unless it is for emergency services. All covered professional services are paid based on the allowed amount. Outpatient ALERT! See page 43 for preauthorization requirements related to Applied Behavior Analysis (ABA) Therapy services. You pay the standard rate for outpatient mental health services. You pay based on the allowed amount and the network status of the provider. Most outpatient mental health services do not require preauthorization. Visit the UMP Policies that affect your care webpage for a list of services that require plan notice. Your provider must notify the plan as soon as possible, but not later than 24 hours after the following services are initiated: • Intensive Outpatient Therapy • Partial Hospitalization Program (PHP) 2024 UMP Plus–UW Medicine ACN (PEBB) Certificate of Coverage 45