• Designed for prolonged use. • For a specific therapeutic or clinical purpose, or to assist in the treatment of an injury or illness. • Medically necessary (meeting all plan medical necessity criteria). • Primarily and customarily used only for a medical purpose. See page 113 for examples of equipment that is not covered. Effectiveness Effectiveness means the extent to which a specific intervention, procedure, service, level of service, supply, prescription drug, or drug dose may reasonably be expected to produce the intended results and to have expected benefits that outweigh potential harmful effects under real-world circumstances. Efficacy Efficacy is the extent to which a specific intervention, procedure, service, supply, or prescription drug produces the desired effect under ideal conditions (in a controlled environment under lab circumstances). Elective contact lenses Elective contact lenses are covered lenses under the frame limit in lieu of coverage for eyeglasses. Emergency See the “Medical emergency” definition. Emergency fill Emergency fill is a process where the plan covers a limited amount of a prescription drug on an emergency basis while the plan processes your drug preauthorization request. Employer group Employer group for the Public Employees Benefits Board (PEBB) Program means those counties, municipalities, political subdivisions, the Washington health benefits exchange, tribal governments, and employee organizations representing state civil service employees obtaining employee benefits through a contractual agreement with the health care authority (HCA) to participate in benefit plans developed by the PEB board. Employer group for the School Employees Benefits Board (SEBB) Program means an employee organization representing school employees and a tribal school as defined in RCW 28A.715.010, obtaining employee benefits through a contractual agreement with the health care authority (HCA) to participate in benefit plans developed by the SEB board. Employing agency Employing agency means a division, department, or separate agency of state government, including an institution of higher education; a county, municipality, or other political subdivision; and a tribal government covered by chapter 41.05 RCW. Enrollee Enrollee means a person who meets all eligibility requirements and is enrolled in PEBB benefits, and for whom applicable premium payments have been made. 186 2024 UMP Classic (PEBB) Certificate of Coverage