As a UMP Plus member, you may see a provider from one of the networks listed below. The amount you pay for services will depend on the network status of the provider. To find your provider’s network status, visit the UMP Provider search or contact UMP Customer Service (see Directory for links and contact information). Core network — contains primary care providers (PCP) and specialty providers contracted with UMP Plus–PSHVN. • You pay $0 for most covered services when you see your PCP, and the plan pays 100 percent of the allowed amount. Note: When you see a PCP in your network for primary care services, you pay $0 for office visits. However, related services, like x-rays or labs that you may receive during a primary care visit, may be subject to your medical deductible and coinsurance. • You pay 15 percent of the allowed amount for most covered services by all providers other than your PCP, after you meet your medical deductible. • You pay nothing for covered preventive care services and covered immunizations as described in the “Preventive care” benefit. • These providers cannot bill you for more than the plan’s allowed amount. • 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. Health plans are required to have enough providers in their network to ensure that members have access to network providers. To ensure there are enough provider types in UMP Plus–PSHVN network, PSHVN uses certain, but not all, providers contracted with Regence BlueShield. This is called the support network. Support network — the support network includes certain providers contracted with Regence to supplement the core network and ensure network adequacy. Most of the providers in this network are specialty providers (see the “Support network providers” section for examples of support network providers). Naturopaths are considered PCPs. • You pay 15 percent for most covered services. • These providers cannot bill you for charges above the allowed amount. • If you select a naturopath as your PCP, you pay $0 for most covered services. The plan pays 100 percent of the allowed amount. • 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. 16 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage