See the “Preauthorizing medical services” section for more information about requesting medical services preauthorization from the plan. Where to send your network waiver request UMP Member Appeals Regence BlueShield PO Box 1106 Lewiston, ID 83501-1106 If you have questions about the network waiver process, contact UMP Customer Service. ALERT! If a network waiver is approved, you must still pay your cost-share for most medical services. Services provided under an approved network waiver are subject to your medical deductible and out-of-pocket limit. Network waivers for ongoing services may require periodic review. Out-of-area services Regence BlueShield has a variety of relationships with other Blue Cross and/or Blue Shield Licensees. Generally, these relationships are called “Inter-Plan Arrangements.” These Inter-Plan Arrangements work based on rules and procedures issued by the Blue Cross Blue Shield Association. Whenever you access health care services outside of the geographic area Regence BlueShield services, the claim for those services may be processed through one of these Inter-Plan Arrangements. The Inter-Plan Arrangements are described below. When you receive care outside of Regence BlueShield’s service Area, you may receive it from Providers as described below. Providers contracted with the local Blue Cross and/or Blue Shield Licensee in that geographic area ("Host Blue") as a preferred provider are paid at the preferred provider level and will not bill you for balances beyond any deductible, copayment and/or coinsurance for covered services. Providers that contract with the Host Blue as a participating provider are paid at the participating provider level and will not bill you for balances beyond any deductible, copayment and/or coinsurance for covered services. Some providers (out of network providers) don't contract with the Host Blue. The section below explains how the Plan pays these different kinds of providers. BlueCard® Program Under the BlueCard® Program, when you access covered services within the geographic area served by a Host Blue, Regence will remain responsible for doing what was agreed to in the contract. However, the Host Blue is responsible for contracting with and generally handling all interactions with its preferred or participating providers. When covered services are received outside the Regence’s service area and the claim is processed through the BlueCard® Program, the amount you pay for covered services is calculated based on the lower of: • The billed covered charges for your covered services; or • The negotiated price that the Host Blue makes available to Regence. Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to your health care provider. Sometimes, it is an estimated price that considers special arrangements with your health care provider or provider group that may include types of settlements, incentive payments, 20 2024 UMP Classic (PEBB) Certificate of Coverage