6. You pay your provider the amount due, if any. After you’ve met both your Medicare and UMP Classic deductibles, you will not pay anything for most claims. If you have not received any paperwork on a health care service within three months, contact your provider’s billing office and ask if they have sent the claim. Neither Medicare nor UMP Classic may process a claim they have not received. While you are welcome to contact UMP Classic and ask, if we have not received the claim, we will not have any record of the service. Why you might get a COB savings check from UMP Classic At the beginning of the year, you must first satisfy your Medicare and UMP Classic deductibles to receive coordination of benefits (COB) savings. Once you have satisfied these deductibles in full and receive more health care services during the year, UMP Classic usually pays less than its normal benefit when it is a secondary payer to Medicare. The difference between what UMP Classic pays as the secondary plan and what UMP Classic would have paid had it been the primary payer, is your COB savings. UMP Classic keeps track of how much you’ve paid out of pocket during the year. If your Medicare coverage generates COB savings, we may send you a “COB savings check” to pay you back for the out-of- pocket expenses you paid earlier in the year. UMP Classic does not reimburse you for more than you paid out of pocket. See the “How UMP Classic and Medicare work together” section for examples. How UMP Classic prescription drug coverage works with Medicare FOR MORE INFORMATION: See the “Your prescription drug benefit” section for complete information about your prescription drug coverage. Use network pharmacies that bill Medicare Part B directly ALERT! UMP’s network mail-order pharmacies cannot bill Medicare for diabetes care supplies when Medicare is your primary coverage. To find a Medicare-approved mail-order pharmacy for diabetes care supplies, contact Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY: 1- 877-486-2048). Most prescription drugs or supplies covered under Medicare Part B are paid as medical. When paying secondary to Medicare Part B, UMP Classic also pays under the medical benefit. Therefore, these charges are subject to your medical deductible. For those drugs and medical supplies covered under your prescription drug benefit, we recommend that you choose a network pharmacy that may bill Medicare Part B directly to get the most from your prescription drug coverage. Medicare Part B does cover a few drugs and supplies for specific purposes. Note: Medicare Part B quantity restrictions may apply. Medicare accepts claims only from pharmacies, not from individuals. If Medicare covers a prescription drug or supply and the pharmacy does not send the claim to Medicare first for payment, UMP Classic will deny the claim. To find a network retail pharmacy, see the pharmacy locator on the UMP Prescription drug coverage webpage or contact WSRxS Customer Service (see Directory for link and contact information). 132 2024 UMP Classic (PEBB) Certificate of Coverage