Nutrition counseling and therapy ................................................................................................................................... 62 Obstetric and newborn care ............................................................................................................................................... 62 Office visits ................................................................................................................................................................................. 64 Orthognathic and Telegnathic surgery ......................................................................................................................... 65 Pain and joint management, interventional ............................................................................................................... 65 Prescription drugs................................................................................................................................................................... 65 Preventive care ......................................................................................................................................................................... 65 Radiology .................................................................................................................................................................................... 67 Second opinions ...................................................................................................................................................................... 68 Skilled nursing facility ........................................................................................................................................................... 68 Sleep therapy ............................................................................................................................................................................ 69 Spinal and extremity manipulations............................................................................................................................... 70 Spinal injections ....................................................................................................................................................................... 70 Spinal surgery ........................................................................................................................................................................... 70 Spine care in the Centers of Excellence (COE) Program ........................................................................................ 70 Substance use disorder ........................................................................................................................................................ 73 Surgery ......................................................................................................................................................................................... 73 Temporomandibular joint (TMJ) disorder treatment ............................................................................................. 74 Therapy: Habilitative and Rehabilitative ...................................................................................................................... 74 Tobacco cessation services ................................................................................................................................................. 75 Transplants ................................................................................................................................................................................. 77 Urgent care ................................................................................................................................................................................ 77 Virtual care ................................................................................................................................................................................. 77 Vision care (diseases and disorders of the eye) ........................................................................................................ 79 Your routine vision benefits ........................................................................................................................................................ 79 Finding a routine vision provider ......................................................................................................................................... 79 Adults (age 19 or older) ............................................................................................................................................................ 80 Children (under age 19) ............................................................................................................................................................. 84 Vision claims administration .................................................................................................................................................. 86 Vision complaints and appeals .............................................................................................................................................. 86 Your prescription drug benefit .................................................................................................................................................. 87 The UMP Preferred Drug List ................................................................................................................................................. 88 How UMP decides which prescription drugs are preferred ..................................................................................... 90 Guidelines for prescription drugs UMP covers .............................................................................................................. 90 What you pay for prescription drugs ................................................................................................................................. 92 How the prescription drug cost-limit works ................................................................................................................... 96 Your prescription drug out-of-pocket limit..................................................................................................................... 97 10 2024 UMP Classic (PEBB) Certificate of Coverage