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 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 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. Special rate The plan’s special rate is for services that have unique payment rules. These rules are described in the table (see the “How much you pay for covered services” column) located in the “Types of services” section. Specialty drugs Specialty drugs are high-cost injectable, infused, oral, or inhaled prescription drugs or products that require special storage or handling and are subject to additional rules. Specialty drugs are identified on the UMP Preferred Drug List. See page 101 for information on how specialty drug prescriptions are handled. Standard rate The plan’s standard rate depends on the provider’s status: • Preferred providers: You pay 20 percent of the allowed amount after you meet your medical deductible. The plan pays 80 percent of the allowed amount. • Participating providers: You pay 40 percent of the allowed amount after you meet your medical deductible. The plan pays 60 percent of the allowed amount. • Out-of-network providers: You pay 40 percent of the allowed amount after you meet your medical deductible. You pay all charges billed to you above the allowed amount (known as balance billing). The plan pays 60 percent of the allowed amount. Standard reference compendium Standard reference compendium refers to any of these sources: • The American Hospital Formulary Service Drug Information • The American Medical Association Drug Evaluation • The United States Pharmacopoeia Drug Information • Other authoritative compendia as identified from time to time by the U.S. Secretary of Health and Human Services 194 2024 UMP Select (PEBB) Certificate of Coverage