• List of covered expenses (see the “List of benefits” section) • Policies regarding prescription drug coverage and how the plan adds and removes drugs from the UMP Preferred Drug List (see “The UMP Preferred Drug List” and the “Guidelines for prescription drugs UMP covers” sections) • Preventive health care benefits that are covered (see the “Preventive care” benefit and page 90) • Process for preauthorization, notice, or review (see the “Limits on plan coverage” section and page 100) You may find the following on the UMP website or by contacting UMP Customer Service: • Accreditation information, including measures used to report the plan’s performance, such as consumer satisfaction survey results or Healthcare Effectiveness Data and Information Set (HEDIS) measures • Clinical coverage criteria applicable to health care services and supplies that require preauthorization • Description and justification for provider compensation programs, including any incentives or penalties intended to encourage providers to withhold services • General reimbursement or payment arrangements between the plan and preferred providers • Information on the plan’s care management programs • Notice of privacy practices (includes plan policy for protecting the confidentiality of health information; see “Confidentiality of your health information” on page 139) • Online directory of preferred providers, including both primary care providers and specialists • Procedures to follow for consulting with providers • The Summary of Benefits and Coverage (SBC) • When the plan may retroactively deny coverage for preauthorized medical services The following are available through your Regence account or by contacting UMP Customer Service: • Medical claims history and medical deductible status • Online directory of preferred providers, including both primary care providers and specialists The following are available on the UMP Prescription drug coverage webpage or by contacting WSRxS Customer Service: • The UMP Preferred Drug List • Clinical coverage criteria applicable to prescription drugs that require preauthorization (through your online prescription drug account) • Prescription drug claims history and prescription drug deductible status (through your online prescription drug account) You may also contact UMP Customer Service for an annual accounting of all payments made by the plan that have been counted against medical payment limits, day limits, visit limits, or other limits on your coverage. The plan will provide a written summary of payments within 30 calendar days of your request. Some of this information is also available through your Regence account. You may contact WSRxS Customer Service with questions about coverage of and limitations on prescription drugs. The plan does not prevent or discourage providers from telling you about the care you require, including various treatment options and whether the provider thinks that care is consistent with the plan’s coverage criteria. You may, at any time, get health care outside of plan coverage for any reason. However, you must 138 2024 UMP Select (PEBB) Certificate of Coverage