• Over-the-counter products not approved by and registered with the FDA • Reversal of voluntary sterilization • Treatment of fertility or infertility, including direct complications resulting from such treatment Foot care, maintenance Maintenance foot care includes services such as toenail trimming and corn or callous removal or trimming. These services are covered only for a diagnosis of diabetes and when provided by an approved provider type. The plan does not cover maintenance foot care provided outside the diagnosis of diabetes. Gender affirming care With a diagnosis of gender dysphoria, the following services are covered at the standard rate for outpatient services and at the inpatient rate for inpatient services: • Covered surgical services • Non-surgical services, including, but not limited to, hormone therapy, office visits, mental health counseling, and tests This is not a complete list of medical and surgical treatments of gender dysphoria in transgender individuals. For more information on gender affirming care, visit the UMP Policies that affect your care webpage to find the clinical criteria for gender affirming care (see Directory for link). Some services and prescription drugs associated with gender dysphoria may require preauthorization. Genetic services Covered genetic tests require preauthorization. With preauthorization, the plan covers medically necessary, evidence-based genetic testing services. Some genetics tests are not covered. For information about genetic services related to the fetus during pregnancy, see “Services for obstetric and newborn care” on page 62. Contact UMP Customer Service with any questions. Headaches, chronic migraine or chronic tension type The plan only covers the treatment of chronic migraine with OnabotulinumtoxinA (Botox) when both the following criteria are met: • The condition has not responded to at least three prior pharmacological prophylaxis therapies from two different classes of prescription drugs; and • The condition is appropriately managed for medication overuse. Botox injections must be discontinued when: • The condition has shown inadequate response to treatment (defined as less than 50 percent reduction in headache days per month after two treatment cycles); or • The member has received a maximum of five treatment cycles. The following treatments are not covered: • Treatment of chronic tension-type headaches with Botox or acupuncture; and • Treatment of chronic migraine or chronic tension-type headaches with massage, trigger point injections, transcranial magnetic stimulation, or manipulation/manual therapy (such as chiropractic services). 2024 UMP Select (PEBB) Certificate of Coverage 51