Business day Business days are Mondays through Fridays, except for legal holidays observed by Washington State. Calendar day A calendar day is any day of the week regardless of whether it is observed as a legal holiday by Washington State. Calendar year A calendar year is January 1 through December 31. Chronic migraine A chronic migraine is having a headache on 15 or more days per month of which eight or more days are a migraine. Clinical review Clinical review is when the plan has a clinical professional review medical records related to treatment to determine if treatment is medically necessary. Coinsurance Coinsurance is the percentage of the allowed amount you must pay the provider on claims for which the plan pays less than 100 percent of the allowed amount. This includes most medical services and prescription drugs. Continuation Coverage Continuation Coverage means the temporary continuation of PEBB benefits available to enrollees under the Consolidated Omnibus Budget Reconciliation Act (COBRA), the Uniformed Services Employment and Reemployment Rights Act (USERRA), or PEB Board policies. Coordination of benefits (COB) For members covered by more than one group health plan, coordination of benefits (COB) is the method the plan uses to determine which plan pays first, which pays second, and the amount paid by each plan. See description and examples in the “If you have other medical coverage” section. Copay Copay is a set dollar amount you pay when receiving specific services, treatments, or supplies, such as chiropractic, acupuncture, massage therapy, inpatient hospitalization, or emergency room visits. Cost-share Cost-share means the amount you pay for a service, supply, or prescription drug. This may be a deductible, coinsurance, copay, or amounts not covered by the plan. Custodial care Custodial care is care primarily to assist in activities of daily living, including institutional care primarily to support self-care and provide room and board. Custodial care includes, but is not limited to, help in 184 2024 UMP Classic (PEBB) Certificate of Coverage