• The Summary of Benefits and Coverage (SBC) • When the plan may retroactively deny coverage for preauthorized medical services The following are available through your Regence account or by contacting UMP Customer Service: • Medical claims history and medical deductible status • Online directory of network providers, including both primary care providers and specialists The following are available on the UMP Prescription drug coverage webpage or by contacting WSRxS Customer Service: • The UMP Preferred Drug List • Clinical coverage criteria applicable to prescription drugs that require preauthorization (through your online prescription drug account) • Prescription drug claims history (through your online prescription drug account) You may also contact UMP Customer Service for an annual accounting of all payments made by the plan that have been counted against medical payment limits, day limits, visit limits, or other limits on your coverage. The plan will provide a written summary of payments within 30 calendar days of your request. Some of this information is also available through your Regence account. You may contact WSRxS Customer Service with questions about coverage of and limitations on prescription drugs. The plan does not prevent or discourage providers from telling you about the care you require, including various treatment options and whether the provider thinks that care is consistent with the plan’s coverage criteria. You may, at any time, get health care outside of plan coverage for any reason. However, you must pay for those services and supplies. In addition, the plan does not prevent or discourage you from talking about other health plans with your provider. Confidentiality of your health information The plan follows the UMP Notice of Privacy Practices, available online on the HCA website at hca.wa.gov/ump-privacy or by contacting UMP Customer Service. The plan will release member health information only as described in that notice or as required or permitted by law or court order. How to designate an authorized representative TIP: Because of privacy laws, the plan usually cannot share information on appeals or complaints with family or other persons unless the member is a minor, or the plan has received written authorization to release personal health information to the other person. In most cases, the plan must have written authorization to communicate with anyone but the member. However, a parent or legal guardian may act as a representative for a member under age 13 without written authorization, except for issues involving contraceptive use. For members ages 13 to 17, a parent or legal guardian may usually act as a representative, except for certain specially protected types of information, for which the plan must receive written authorization as described below. You may choose to authorize a representative to: • Communicate with the plan on your behalf regarding an appeal in process. • Share your protected health information. 136 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage