Partial Hospitalization Program Partial Hospitalization Program (PHP) is an outpatient program that is provided under the supervision of an attending psychiatrist or psychiatric extender. PHP is intended to provide treatment on an outpatient basis, does not include boarding or housing, and is intended to provide treatment interventions in a structured setting, with patients returning to their home environments each day. PHP is a minimum of five hours per day, five days per week. Participating provider A participating provider is: • Contracted with Regence BlueShield but is not in your plan’s preferred network, and they cannot balance bill you. • Considered out of network for your plan, except for the following services: ▪ Covered preventive services. ▪ Mental health or substance use disorder. ▪ Emergency services for a medical emergency (including air ambulance). Peer-reviewed medical literature Peer-reviewed medical literature is scientific studies printed in journals or other publications in which original manuscripts are published only after being critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts. Peer-reviewed medical literature, for example, does not include information from health-related websites or in-house publications of pharmaceutical manufacturers. Pharmacy & Therapeutics (P&T) Committee Pharmacy & Therapeutics (P&T) Committee is a group of providers and other health care professionals who review prescription drugs and make recommendations on the status of prescription drugs on the UMP Preferred Drug List (see “The UMP Preferred Drug List” section for more information). Physician services Physician services are health care services provided or coordinated by a licensed medical physician, such as a: • Doctor of osteopathic medicine (D.O.) • Medical doctor (M.D.) • Naturopathic physician (N.D.) Find the complete list of covered provider types on the UMP website at ump.regence.com/pebb/benefits/providers/covered-providers. Plan Plan, as referred to in this document, means Uniform Medical Plan Consumer-directed Health Plan (UMP CDHP), a self-insured PPO plan offered by the PEBB Program. In the eligibility sections (see “Eligibility for subscribers and dependents on page 140 or 155), “plan” may include other plans not sponsored by the PEBB Program. In the “If you have other HDHP coverage” section, “plan” may mean any health insurance coverage. 2024 UMP CDHP (PEBB) Certificate of Coverage 185
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