The plan covers immunizations listed on the Centers for Disease Control and Prevention (CDC) applicable immunization schedule (children, adolescents, adults) for U.S. residents. For a list of immunizations covered as preventive, visit the CDC website at cdc.gov/vaccines/schedules/index.html or contact UMP Customer Service. Some covered immunizations are classified as “may be recommended” by the CDC depending on medical condition or lifestyle. For those immunizations to be covered as preventive, you must meet the criteria specified on the CDC schedule. Immunizations covered under the preventive rate are not subject to either your medical or your prescription drug deductibles. Covered immunizations given by the providers listed under the “Where to get immunizations” section below are paid under the preventive care benefit. If you see an out-of- network provider for covered preventive immunizations, you pay 40 percent of the allowed amount and the provider may balance bill you. Flu shots and COVID-19 vaccines are paid at 100 percent regardless of the provider’s network status. TIP: The plan covers flu shots and COVID-19 vaccines listed on the applicable CDC immunization schedule. For a list of immunizations covered as preventive, find a link to the CDC immunization schedules at the CDC website at cdc.gov/vaccines/schedules/index.html or contact UMP Customer Service. Where to get immunizations You pay $0 for immunizations covered under the preventive care benefit when received from a: • Preferred or participating provider • Network vaccination pharmacy (Many network pharmacies have vaccination pharmacists who may give covered preventive immunizations to members. Contact a network pharmacy ahead of time to make sure the pharmacy has the vaccine you need. Present your UMP member ID card at the pharmacy counter for billing before receiving a vaccine.) • Public health department The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations. Exception: COVID-19 vaccines are covered when required for employment. TIP: If you get a vaccine from an out-of-network provider, submit your claim to Regence BlueShield as a medical claim (see the “Billing and payment: submitting a claim” section). If you get a vaccine from an out-of-network pharmacy, submit your prescription drug claim to WSRxS (see the "Submitting a claim for prescription drugs" section). If you use an out-of-network provider or an out-of-network pharmacy, services will be paid at the out-of-network rate and you may be balance billed. Vaccines from an excluded pharmacy will not be covered. See the definition of “Excluded pharmacy.” Radiology Preauthorization is required for all non-emergency diagnostic imaging. Providers should obtain preauthorization before scheduling or performing any elective outpatient imaging service. Examples of imaging tests that require a preauthorization are: 66 2024 UMP Select (PEBB) Certificate of Coverage