Services covered by other insurance The plan does not cover services that are covered by other insurance, including, but not limited to, no fault automobile medical payments (Med-Pay), no fault automobile personal injury protection (PIP), homeowner’s no-fault coverage, commercial premises no fault medical coverage, or sports policies, including excess, underinsured or uninsured motorist coverage or similar contract or insurance. You are responsible for any cost-sharing required under the other coverage as allowed by state law. Once you have exhausted benefits (e.g., reached the maximum medical expenses amount of the other insurance policy (-ies), or services are no longer injury-related), the plan will cover services according to this COC. Motor vehicle coverage If you are involved in a motor vehicle accident, whether as a driver, passenger, pedestrian, or other capacity, you may have rights under multiple motor vehicle insurance no fault coverages and also against a third party who may be responsible for the accident. In that case, this right of reimbursement and subrogation provision still applies. Future medical expenses Benefits for otherwise covered services may be excluded as follows: • When you have received a recovery from another source relating to an illness or injury for services for which we normally would provide benefits. The amount of any exclusions under this provision, however, will not exceed the amount of your recovery. • Until the total amount excluded equals the third-party recovery. General provisions UMP is administered by Regence BlueShield and Washington State Rx Services under contract with the Washington State HCA. What you need to know: your rights and responsibilities To make sure UMP offers access to the best possible medical care, we must work together with you and your providers as partners. To achieve this goal, you must know your rights and responsibilities. As a plan member, you have the right to: • Ask your provider to submit secondary claims to Medicare, if applicable. • Be informed by your providers about all appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. • Be treated with respect. • Complain about or appeal plan services or decisions, or the care you receive. • Get a second opinion about your provider’s care recommendations. • Have a translator’s assistance, if required, when contacting the plan. • Keep your medical records and personal information confidential as described in the UMP Notice of Privacy Practices, available online on the HCA website at hca.wa.gov/ump-privacy. • Make decisions with your providers about your health care. • Make recommendations about member rights and responsibilities. 2024 UMP Plus–UW Medicine ACN (PEBB) Certificate of Coverage 133