• Review prescription drug policies and programs. How to use this certificate of coverage For general topics, check the table of contents. For an overview of the most common benefits, see the “Summary of benefits” section. The summary also shows: • How much you will pay. • The page numbers where you may learn more about a benefit. To look up unfamiliar terms, see the “Definitions” section. Section for Medicare retirees See the “For retirees enrolled in Medicare and UMP Classic” section just for retirees enrolled in Medicare. Throughout the rest of this certificate of coverage (COC), look for the blue text boxes like the one below. They indicate information specific to Medicare retirees. FOR MEDICARE RETIREES: Information specifically for Medicare retirees. About UMP Classic Uniform Medical Plan (UMP) Classic is a self-insured Preferred Provider Organization (PPO) health plan. UMP is offered through the Washington State Health Care Authority’s (HCA’s) Public Employees Benefits Board (PEBB) Program. UMP is administered by Regence BlueShield and Washington State Rx Services (WSRxS). All prescription drugs, services, or other benefit changes may require approval by the PEB Board. Approval takes place when benefits are procured for the next calendar year. This plan is available only to people eligible for coverage through the PEBB Program. See the “Eligibility and enrollment” section for more information. This plan is designed to keep you and your enrolled dependents healthy and provide benefits in case of injury or illness. Review this certificate of coverage (COC) carefully so you may get the most from your health care benefits. Accumulators Insurance accumulators may transfer when a subscriber changes their enrollment from one UMP plan to another UMP plan mid-year during a special open enrollment (SOE). When a subscriber enrolled in a PEBB Program UMP plan changes their own enrollment to another PEBB Program UMP plan (meaning the subscriber continues to be the subscriber on the new PEBB Program UMP Plan) during an SOE, the amounts already accrued toward medical and pharmacy deductibles, out- of-pocket limits, and benefit limits (see definition of “Limited benefit”) will transfer to the new PEBB Program UMP plan. These accumulators will also transfer for any member on the subscriber’s account who changes UMP plans with the subscriber. When a subscriber enrolled in a SEBB Program UMP plan changes their enrollment to a PEBB Program UMP plan (meaning the subscriber continues to be the subscriber on the new PEBB Program UMP Plan) during an SOE, the amounts already accrued toward the medical and pharmacy deductibles and the out- 14 2024 UMP Classic (PEBB) Certificate of Coverage