If you want to file an appeal which will be processed within 30 days, do the following: File the request in writing with VSP. See the Directory pages at the beginning of this booklet for contact information. Your appeal request will be processed within 30 days from the date your request is received. If you want to file an expedited appeal, which will be processed within 24 hours, do the following: • File an oral or written request for an expedited appeal. Specifically state that "I am requesting an expedited appeal," or "I believe that my health could be seriously harmed by waiting 30 days for a normal appeal." • To file a request orally, contact VSP Member Services. VSP will document the oral request in writing. See the Directory pages at the beginning of this booklet for contact information. Help with your appeal: If you decide to appeal and want help with your appeal, you may have your doctor, a friend, lawyer, or someone else help you. There are several groups that can help you. If you are covered by Medicare, you may contact the Medicare Rights Center toll free at 1-888-466-9050 (TRS: 711). You may also contact the National Institute on Aging at 1-800-222-2225 (TRS: 711) to request the phone number of your local Area Agency on Aging or Health Insurance Counseling and Assistance Program (HICAP). Your prescription drug benefit FOR MEDICARE RETIREES: If Medicare is your primary coverage, see the “How UMP Classic prescription drug coverage works with Medicare” section for important information. See the Directory for prescription drug contact information. Your plan’s prescription drug benefit is managed by a partnership of companies known as Washington State Rx Services (WSRxS): • Preauthorization, appeals, and customer service: Moda Health • Network mail-order pharmacies: ▪ Costco Mail-Order Pharmacy ▪ Postal Prescription Services (PPS) ▪ Note: The plan does not cover prescription drugs purchased through mail-order pharmacies located outside the U.S. • Network specialty drug pharmacy: Ardon Health Visit the UMP Prescription drug coverage webpage to: • Find a link to the UMP Preferred Drug List and the Drug Price Check tool. • Find a link to your online pharmacy account. • Find information on mail-order and specialty drugs. • Learn about submitting prescription drug claims. • Locate network pharmacies or network vaccination pharmacies. • Review prescription drug policies and programs. 2024 UMP Classic (PEBB) Certificate of Coverage 87