• Amounts paid toward covered Tier 2 prescription drugs. • Amounts paid toward supplies designated as Tier 2 and covered under the prescription drug benefit. • Amounts paid toward covered insulins. What does not apply to your deductible 1 • Amounts exceeding the allowed amount paid to non-network pharmacies. • Coinsurance amounts paid for Value Tier or Tier 1 prescription drugs except for covered insulins. • Costs for medical services, including prescription drugs covered under the medical benefit. • Costs for prescription drugs not covered by the plan (see “Prescription drugs and products UMP does not cover”). • Costs for prescription drugs purchased from excluded pharmacies (see “Excluded pharmacy” in the “Definitions” section). What you will pay for after reaching your deductible • Any prescription drugs or other products not covered by the plan (see “Prescription drugs and products UMP does not cover”). • Charges exceeding the allowed amount from a non-network pharmacy. • Coinsurance amounts paid for all tiers except preventive. • Costs for other enrolled members who have not met their prescription drug deductible (and the family maximum has not been met). Where you pay your deductible You pay your prescription drug deductible at any pharmacy. Your prescription drug deductible must be met before the plan begins paying benefits for Tier 2 drugs except for covered insulins. Network pharmacies will know if you’ve met your prescription drug deductible, or if it does not apply to your prescription. This means that you pay only the amount remaining after the plan pays. If you use a non-network pharmacy (see page 98) you must pay the billed charges for the drug and submit a paper claim for reimbursement of the allowed amount. Prescriptions purchased from an excluded pharmacy are not covered (see “Excluded pharmacy” in the “Definitions” section). Your coinsurance for prescription drugs ALERT! See page 54 for special prescription drug coverage while in hospice care. 1 Non-network pharmacies may charge more than the allowed amount for prescription drugs. You are responsible for paying this amount in addition to your coinsurance. Prescriptions purchased from an excluded pharmacy are not covered. 2024 UMP Select (PEBB) Certificate of Coverage 93