Prescriptions mailed, or orders placed in December but not filled until January 1 or after, are subject to your prescription drug deductible applicable on the date the prescription is processed. Because of increased volume at the end of the year, prescriptions submitted to the network mail-order pharmacies in December may not be processed during the current plan year. If there is a shortage of a specific prescription drug that UMP’s network mail-order pharmacies cannot control, and it does not have the quantity you ordered, the network mail-order pharmacies will contact you to discuss your options for obtaining your prescription(s). ALERT! Some Durable Medical Equipment (DME) items are not available through UMP’s network mail-order pharmacies. You will need to get them through a network retail pharmacy or preferred DME provider. How to get the plan discount Be sure to fill your prescriptions at a network pharmacy and show your ID card at the pharmacy counter. If you do, you pay for covered prescription drugs based on the allowed amount (WSRxS’ standard reimbursement). If you do not show your UMP member ID card at a network pharmacy or you use a non- network pharmacy, then you may be charged a higher amount. If the amount charged is more than the UMP allowed amount, you will pay the difference in addition to your coinsurance. Prescriptions purchased from an excluded pharmacy are not covered. If you have more than one insurance plan and UMP is your secondary insurance, show both plan member ID cards at the pharmacy and make sure they know which plan pays first so the pharmacy may bill the plans in the correct order. Non-network pharmacies: Retail You will save money when you buy your prescriptions at network retail pharmacies and network mail- order pharmacies. You may buy your prescriptions (except specialty drugs) at a non-network retail pharmacy, but you will pay more if you do. If you get your prescriptions filled at a non-network retail pharmacy, the following applies: • You need to submit your claim to WSRxS for reimbursement (see the “Submitting a claim for prescription drugs” section). • You do not get the plan discount. • You will pay the difference between the allowed amount and what the pharmacy charges, and it will not apply to your prescription drug deductible or prescription drug out-of-pocket limit. Claims for covered insulins must be submitted to WSRxS for reimbursement before they can apply to your prescription drug deductible. • The plan pays the allowed amount for prescription drugs covered by the plan, whether from a network or non-network retail pharmacy, under the coinsurance percentages as shown in the “What you pay for prescription drugs” section. • The prescription cost-limit (see the “What you pay for prescription drugs” section) does not apply. • Non-network pharmacies will not know if a prescription drug must be preauthorized, has a quantity limit, or has other coverage limits. If you purchase a drug from a non-network pharmacy and limits apply, the plan may not cover or reimburse it. • Prescriptions purchased from an excluded pharmacy will not be covered. See the definition of “Excluded pharmacy.” 98 2024 UMP Select (PEBB) Certificate of Coverage