◦ Medical or surgical treatment of the eyes 129. Vision services and supplies: ◦ The plan does not cover services or supplies that are not medically necessary: • Plano lenses (less than a ± .50 diopter power). • Two pair of glasses instead of bifocals. • Services and/or materials not described as covered under this vision benefit. 130. Vitamin D screening and testing as part of routine screening 131. Weight control, weight loss, and obesity treatment: ◦ Non-surgical: Any program, drugs, services, or supplies for weight control, weight loss, or obesity treatment. Exercise or diet programs (formal or informal), exercise equipment, or travel expenses relating to non-surgical or surgical services are not covered. Such treatment is not covered even if prescribed by a provider, except as covered under "Bariatric surgery" (see page 39), “Diabetes Control Program” (see page 46), “Diabetes Prevention Program” (see page 46), “Nutrition counseling and therapy” (see page 62), or “Preventive care” (see page 65). ◦ Surgical: Any bariatric surgery procedure, any other surgery for obesity or morbid obesity, and any related medical services, drugs, or supplies, except when approved by preauthorization review. 132. Whole exome sequencing for: ◦ Uncomplicated autism spectrum disorder, developmental delay, mild to moderate global developmental delay. ◦ Other circumstances (e.g. environmental exposures, injury, infection) that reasonably explain the constellation of symptoms. ◦ Carrier testing for “at risk” relatives. ◦ Prenatal or pre-implantation testing. 133. Workers’ compensation: When a claim for workers’ compensation is accepted, all services related to that injury or illness are not covered, even if some services are denied by workers’ compensation 134. Transcranial Magnetic Stimulation (TMS) for treatment of: ◦ Obsessive-compulsive disorder (OCD) ◦ Generalized anxiety disorder (GAD) ◦ Posttraumatic stress disorder (PTSD) ◦ Smoking cessation ◦ Substance use disorder (SUD) If you have questions about whether a certain service or supply is covered, contact UMP Customer Service. If you have other medical coverage FOR MEDICARE RETIREES: Different rules apply to members who have Medicare as their primary payer (see “How UMP Classic and Medicare work together”). 2024 UMP Classic (PEBB) Certificate of Coverage 121