How much you may pay when UMP pays second When you see preferred providers under UMP, you will owe only the balance of the UMP allowed amount after your primary plan and UMP pay benefits for covered services. Your cost will usually be higher if you see out-of-network providers. See the “Sample payments to different provider network status” section for examples. The examples in the table below assume that you have met your medical deductible. Situation Example Preferred UMP UMP Other UMP You pay provider allowed normal plan pays your charge amount benefit pays provider UMP is EXAMPLE 1: $200 $100 $85 N/A $85 $15 primary, When UMP (85% of other plan is pays first (or is $100) secondary the only plan) UMP is EXAMPLE 2: $200 $100 $85 $80 $5 $15 secondary, The other plan other plan is pays less than primary the normal UMP benefit UMP is EXAMPLE 3: $200 $100 $85 $85 $0 $15 secondary, The other plan other plan is pays as much primary as (or more than) the normal UMP benefit Contact UMP Customer Service for help with any questions if you are covered by more than one plan. Submit secondary claims promptly All health plans have a “timely submitting” deadline. The timely submitting deadline for UMP is 12 months from the date of service. If a claim is not submitted within the plan’s timely submitting deadline, UMP will deny it. If your primary plan delays payment on a claim, you must still submit to UMP within the submitting deadline to prevent denial of the claim. UMP may try to contact your primary plan for their benefit payment information or may estimate it to provide timely processing of your secondary benefit. Adjustments may be made when the primary plan pays their portion of your claim. Notifying your providers of any change to your coverage will help avoid errors and delays in processing of claims (see the “Billing and payment: submitting a claim” section). How diabetes care supplies are covered when UMP pays second FOR MEDICARE RETIREES: If Medicare is your primary health coverage, see “Diabetes care supplies when Medicare pays first” on page 129 for information on how claims for diabetes care supplies are processed. UMP covers diabetes care supplies under the prescription drug benefit. If you get your supplies from a pharmacy, ask if the pharmacy can bill both your primary plan and UMP. If your pharmacy does, you do 2024 UMP Classic (PEBB) Certificate of Coverage 125