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Necessary contact lenses Necessary contact lenses are contact lenses that are prescribed by your provider for other than elective or cosmetic purposes. Necessary contact lenses are used to treat specific conditions for which contact lenses provide better visual correction. Network Network is the facilities, providers, and suppliers your health plan contracts with to provide health care services. For more network definitions, see “Core network provider” and “Support network provider”. Network pharmacy A network pharmacy contracts with WSRxS to provide prescription drug coverage to UMP members at the contracted rate (allowed amount). See the “Where to buy your prescription drugs” section for details about the advantages of using network pharmacies. Network provider A network provider is a contracted: • Primary care provider (see page 19). • Specialty provider (see page 20). • Network facility (see page 21). See the “Finding a health care provider” section to learn how the plan covers services by these providers. Network rate The network rate means the plan pays 100 percent of the allowed amount for office visits from your PCP and 85 percent of the allowed amount after you meet your medical deductible for all other services from providers in the core or support network. Network status Network status refers to whether a provider is a network provider or is out-of-network with the plan. You may find out the network status of your provider by visiting the UMP Provider search or by contacting UMP Customer Service (see Directory for link and contact information). Network vaccination pharmacy A network vaccination pharmacy is a pharmacy that contracts with WSRxS to give covered immunizations to plan members at the preventive rate. You may find out which pharmacies are contracted on the UMP Prescription drug coverage webpage or by contacting WSRxS Customer Service (see Directory for link and contact information). Noncovered prescription drugs Noncovered prescription drugs refer to any drug that is only covered if the member receives an exception from the plan. Some drugs may be medically necessary, yet still are not covered. See the "Prescription drugs and products UMP does not cover" section. 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 181

UMP Plus–Puget Sound High Value Network (PSHVN) COC (2024) - Page 182 UMP Plus–Puget Sound High Value Network (PSHVN) COC (2024) Page 181 Page 183