ALERT! You may attest for an exemption to the PEBB tobacco use premium surcharge if you or a dependent are tobacco-free for two months, enroll in the tobacco cessation program (for members age 18 or older), or access the information and resources aimed at teens in Smokefree Teen (for members ages 13 through 17). Visit the HCA website at hca.wa.gov/erb for details about the surcharge. Smokefree Teen UMP members ages 17 and under may access tobacco cessation support services through the Smokefree Teen program online at teen.smokefree.gov or by calling 1-800-QUIT-NOW (784-8669) (TRS: 711). Transplants You must receive preauthorization from the plan for all transplants (except kidney and cornea). This benefit covers services related to transplants, including professional and facility fees for inpatient accommodation, diagnostic tests and exams, surgery, and follow-up care. Donor coverage If a UMP member receives an organ, eye, or tissue donation from a live donor, the plan pays the standard rate for the donor’s covered expenses as primary, regardless of any other coverage the donor may have. Covered donor expenses include costs to remove the donor’s organ and treat complications directly resulting from the donor’s surgery. Urgent care See the “Emergency room” benefit for care during a medical emergency. If you need immediate care or need care when your usual provider is closed, and your situation is not a medical emergency, you may use urgent care facilities to receive care at a lower cost than an emergency room. You do not pay the emergency room copay for urgent care services. These services are paid at the standard rate, according to the provider’s network status. Visit the UMP Provider search to find preferred urgent care facilities (see Directory for link). Virtual care Telemedicine services Telemedicine is the delivery of health care services through audio and visual technology, allowing real- time communication between the member at the originating site and a provider for the purpose of diagnosis, consultation, or treatment. Telemedicine includes audio-only telemedicine. Telemedicine does not include the use of fax or email. “Store and forward technology” is a term used for the transfer of a member’s medical information from one health care provider to another at a distant site, which results in medical diagnosis and management of the covered person. The purpose of telemedicine and store and forward technology is diagnosis, consultation, or treatment of the member. It does not include the use of fax or email. If you see a network provider, telemedicine services are paid at the network rate. If you see an out-of- network provider, telemedicine services are paid at the out-of-network rate. The plan covers store and forward technology and telemedicine from authorized originating sites under the medical benefit if: • The plan provides coverage for the service when provided in person by the provider; • The service is medically necessary; 2024 UMP Classic (PEBB) Certificate of Coverage 77