Obstetric and newborn care ............................................................................................................................................... 61 Office visits ................................................................................................................................................................................. 63 Orthognathic and Telegnathic surgery ......................................................................................................................... 64 Pain and joint management, interventional ............................................................................................................... 64 Prescription drugs................................................................................................................................................................... 64 Preventive care ......................................................................................................................................................................... 64 Radiology .................................................................................................................................................................................... 66 Second opinions ...................................................................................................................................................................... 67 Skilled nursing facility ........................................................................................................................................................... 67 Sleep therapy ............................................................................................................................................................................ 68 Spinal and extremity manipulations............................................................................................................................... 68 Spinal injections ....................................................................................................................................................................... 68 Spinal surgery ........................................................................................................................................................................... 69 Spine care in the Centers of Excellence (COE) Program ........................................................................................ 69 Substance use disorder ........................................................................................................................................................ 72 Surgery ......................................................................................................................................................................................... 72 Temporomandibular joint (TMJ) disorder treatment ............................................................................................. 72 Therapy: Habilitative and Rehabilitative ...................................................................................................................... 72 Tobacco cessation services ................................................................................................................................................. 74 Transplants ................................................................................................................................................................................. 75 Urgent care ................................................................................................................................................................................ 75 Virtual care ................................................................................................................................................................................. 76 Vision care (diseases and disorders of the eye) ........................................................................................................ 78 Your routine vision benefits ........................................................................................................................................................ 78 Finding a routine vision provider ......................................................................................................................................... 78 Adults (age 19 or older) ............................................................................................................................................................ 79 Children (under age 19) ............................................................................................................................................................. 82 Vision claims administration .................................................................................................................................................. 84 Vision complaints and appeals .............................................................................................................................................. 85 Your prescription drug benefit .................................................................................................................................................. 85 The UMP Preferred Drug List ................................................................................................................................................. 86 How UMP decides which prescription drugs are preferred ..................................................................................... 88 Guidelines for prescription drugs UMP covers .............................................................................................................. 88 What you pay for prescription drugs ................................................................................................................................. 90 How the prescription drug cost-limit works ................................................................................................................... 94 Your prescription drug out-of-pocket limit..................................................................................................................... 95 Where to buy your prescription drugs .............................................................................................................................. 96 10 2024 UMP Select (PEBB) Certificate of Coverage