Type of service Higher benefits with UMP Important information preferred provider? Medicare” on page 131 to learn why this is important. Services covered by UMP Yes See “What UMP Classic covers Classic but not by Medicare that Medicare does not” starting on page 130 to see which services apply. Use the provider search on the UMP website (see Directory for link) or contact UMP Customer Service to find a preferred provider. Massage therapy Yes UMP Classic pays for massage therapy services only when the provider is preferred. Prescription drugs Yes You must also choose pharmacies that participate in and may bill Medicare Part B directly. See “Use network pharmacies that bill Medicare Part B directly” on page 132 for more information. When providers do not accept Medicare When services are covered by Medicare, you must see providers who accept Medicare for the services to be covered by Medicare and UMP Classic. If your provider is not contracted with Medicare or has chosen to “opt out” of participating in Medicare, UMP Classic will not cover services by that provider, even if the provider is in the Regence or Blue Card network (preferred) for UMP Classic members (see the “Finding a health care provider” section). Providers that opt out of Medicare are supposed to have you sign a private contract before providing services, but you are responsible for all costs even if you did not sign a contract. When you pay: How billing works Most of the time, you pay only after both Medicare and UMP Classic have processed your claim. Here is how it typically works: 1. Your provider bills Medicare. 2. Medicare processes the claim and sends you a Medicare Summary Notice (MSN). An MSN may also be called an Explanation of Medicare Benefits (EOMB). The MSN tells you how much Medicare paid on your claim. 3. Medicare then sends the claim to UMP Classic for processing. You do not need to submit a claim form or other paperwork to UMP Classic. 4. UMP Classic processes the claim and sends you an Explanation of Benefits (EOB). The EOB tells you how much UMP Classic and Medicare paid, plus how much you owe the provider. 5. You receive a bill from your provider for any remaining amount due. To confirm that the provider has credited your account with both Medicare and UMP Classic payments: ◦ Note the allowed amount on the Medicare MSN. ◦ Subtract both Medicare’s and UMP Classic’s payments from that amount. This should match the bill from your provider. 2024 UMP Classic (PEBB) Certificate of Coverage 131