If you use Find a Doctor by searching as a guest, you will only see preferred providers. You can confirm a provider’s network status before your visit by using the provider search or contacting UMP Customer Service. Preferred providers are in the Preferred Provider Organization (PPO) network that applies to UMP CDHP members. ALERT! Some providers are preferred at one practice location but not another (example: urgent care clinics). Contact UMP Customer Service if you have any questions about the network status of a provider at a specific location. • You pay 15 percent of the allowed amount after you meet your deductible. The plan pays 85 percent of the allowed amount. • You pay $0 for covered preventive care services, including covered immunizations. The plan pays 100 percent of the allowed amount. • The provider cannot bill you for charges above the allowed amount. • When you are signed in to your Regence account the online provider directory labels preferred providers with a bar icon and “category 1” like this: • If you see a preferred provider, you will not have to file a claim if the plan is your primary coverage. • When you receive nonemergency services at a network hospital, network hospital outpatient department, network critical access hospital, or network ambulatory surgical center in Washington State, you pay the network rate and cannot be balance billed regardless of the network status of the provider. For nonemergency services performed at one of these facilities outside of Washington State, you still pay the network rate, but in some states, an out-of-network provider may be allowed to ask you to waive some of your balance billing protections. ALERT! Some services and supplies are not covered by the plan (see the “What the plan does not cover” section) or have benefit limits. If you receive services or supplies that are not covered by the plan or you exceed your benefit limit, you will pay for those services or supplies, even if you see preferred providers. Contact UMP Customer Service to find out if a service or supply is covered. Participating providers contract with Regence BlueShield or another BlueCard® network as a participating provider. • You pay 40 percent of the allowed amount after you meet your deductible. The plan pays most covered services at 60 percent of the allowed amount. • You pay $0 for covered preventive care services, including covered immunizations. The plan pays 100 percent of the allowed amount. • The provider cannot bill you for charges above the allowed amount. 16 2024 UMP CDHP (PEBB) Certificate of Coverage