walking, getting into and out of bed, bathing, dressing, feeding and preparing special diets, and supervising prescription drugs that are ordinarily self-administered. Deductible, medical Your medical deductible is a fixed dollar amount you must meet each calendar year for health care expenses before the plan starts paying for covered services. You pay the first $250 per member in medical expenses to your providers ($750 maximum if you have a family of three or more on one account). Only expenses covered by the plan apply to your deductible. For example, if you receive LASIK surgery (see exclusion on 114), the plan does not apply this payment to your medical deductible. Some services are not subject to this deductible (see the “Summary of benefits” section). See the “What you pay for medical services” section for details on how your medical deductible works. Your medical and prescription drug deductibles are separate: Medical services do not apply to your prescription drug deductible. Prescription drug purchases do not apply to your medical deductible. See “Prescription drug deductible” starting on page 94. Deductible, prescription drugs Your prescription drug deductible is a fixed dollar amount you must meet each calendar year for Tier 2 prescription drugs before the plan starts paying benefits for these drugs. Covered insulins are not subject to your deductible. You pay the first $100 per member in prescription drug charges ($300 maximum for a family of three or more on one account). Only expenses for Tier 2 drugs covered by the plan apply to your deductible. For example, if you receive a prescription for a drug for cosmetic purposes (see exclusion on page 112), the plan does not apply the cost of a noncovered drug to your deductible. What you pay (coinsurance) for Value Tier and Tier 1 drugs does not apply to your prescription drug deductible. Your prescription drug and medical deductibles are separate: Prescription drug purchases do not apply to your medical deductible. Medical services do not apply to your prescription drug deductible. See “Prescription drug deductible” on page 94. Dependent A dependent is an eligible spouse, state-registered domestic partner, child, or other eligible family member as described in “Dependent eligibility” (see the “Eligibility for subscribers and dependents” sections on page 153 and 168) for information about dependents of a retiree or survivor that is either covered by or eligible to be covered by the plan under the subscriber’s account. Detoxification Detoxification is a medically supervised treatment program for individuals with alcohol or drug intoxication, designed to rid the body of toxic substances and manage withdrawal symptoms. Developmental delay Developmental delay is a significant lag in reaching developmental milestones as expected during infancy and early childhood. The cause may be present at birth or acquired after birth from a disease or disorder of the body, an injury, a disorder of the mind or emotions, or harmful effects of the surrounding environment. Only a physician or other provider may diagnose a developmental delay. Durable medical equipment (DME) Durable medical equipment (DME) is: 2024 UMP Classic (PEBB) Certificate of Coverage 185
UMP Classic COC (2024) Page 185 Page 187