Where to buy your prescription drugs .............................................................................................................................. 98 Limits on your prescription drug coverage ................................................................................................................... 101 What to do if the plan denies coverage .......................................................................................................................... 107 Prescription drugs and products UMP does not cover ............................................................................................ 107 Limits on plan coverage .............................................................................................................................................................. 108 Preauthorizing medical services ......................................................................................................................................... 108 General information from UMP Customer Service ..................................................................................................... 111 What the plan does not cover .................................................................................................................................................. 111 If you have other medical coverage ...................................................................................................................................... 121 Coordination of benefits ........................................................................................................................................................ 122 Contact UMP and WSRxS ....................................................................................................................................................... 122 Who pays first ............................................................................................................................................................................. 122 For retirees enrolled in Medicare and UMP Classic ........................................................................................................ 127 Are you a Medicare retiree? .................................................................................................................................................. 127 How UMP Classic and Medicare work together .......................................................................................................... 127 When you pay: How billing works ..................................................................................................................................... 131 Why you might get a COB savings check from UMP Classic ................................................................................. 132 How UMP Classic prescription drug coverage works with Medicare ................................................................ 132 Where to go for more information ................................................................................................................................... 133 Billing and payment: submitting a claim ............................................................................................................................. 133 Submitting a claim for medical services.......................................................................................................................... 134 Submitting a claim for prescription drugs ..................................................................................................................... 135 False claims or statements ..................................................................................................................................................... 136 Complaint and appeal procedures ......................................................................................................................................... 137 What is a complaint (aka: grievance)? ............................................................................................................................. 137 How to submit a complaint (aka: grievance) ................................................................................................................ 137 What is an appeal? .................................................................................................................................................................... 137 The appeals process ................................................................................................................................................................. 138 Complaints about quality of care ....................................................................................................................................... 142 Appeals related to eligibility................................................................................................................................................. 142 Where to send complaints or appeals ............................................................................................................................. 142 When another party is responsible for injury or illness ................................................................................................ 143 Occupational injury or illness (workers’ compensation) claims ........................................................................... 143 Legal rights and responsibilities ......................................................................................................................................... 143 Fees and expenses ..................................................................................................................................................................... 144 Services covered by other insurance ................................................................................................................................ 145 Motor vehicle coverage .......................................................................................................................................................... 145 2024 UMP Classic (PEBB) Certificate of Coverage 11