Covered and noncovered provider types Covered provider types The plan pays the allowed amount for covered services only when performed by covered provider types within the scope of their license(s). When a facility charges facility fees, the plan pays the allowed amount if the services are covered services and are within the scope of the facility’s license. All providers in the core and support networks are covered provider types. See the list of covered provider types at the UMP website at ump.regence.com/pebb/benefits/providers/covered-providers See page 21 for more information on other services covered at the network rate. Noncovered provider types If you see a provider who is not a covered provider type, such as a Licensed Athletic Trainer, the plan will not pay for any of the services received, and you will pay for all charges. As with all noncovered services, any payments you make to a noncovered provider type will not apply to your medical deductible or medical out-of-pocket limit. If you have questions about noncovered providers contact UMP Customer Service. Core network primary care providers To receive full coverage for primary care office visits, you must see a primary care provider (PCP) in the core network (or a naturopath from the support network). A PCP provides, coordinates, and helps you access a range of health care services, such as covered immunizations. When you see a PCP for primary care services, office visits are paid at 100 percent. 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 are not required to choose a PCP. However, a PCP may help prevent and treat health care conditions early, promoting your health and well-being. A core network PCP can refer you to specialty providers and help request a network consent when needed (see the “Network consent for out-of-network services” section). Patients who have a PCP have better health outcomes and a better care experience. To be designated as a PCP, a provider must be one of the provider types and practice under one of the specialties listed below. Provider type: • Doctor of Osteopathic Medicine (D.O.) • Nurse Practitioner (A.R.N.P.) • Medical Doctor (M.D.) • Physician Assistant (P.A.) • Naturopathic Physician (N.D.) PCP Specialties: • Adult Medicine • Internal Medicine • Family Practice • Obstetrics and gynecology (OB/GYN) • General Practice • Pediatrics (for members under age 18) • Geriatrics • Preventive Medicine When you see a PCP for primary care services, office visits are paid at 100 percent. 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. 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 19