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Board fast-tracks resolution to eliminate cost‑share for diagnostic breast exams for UMP members, effective Jan. 1, 2025
Summary
To avoid re‑adjudicating claims, the PEBB voted the same day to amend policy so diagnostic and supplemental breast exams are covered with no member cost‑share for Uniform Medical Plan members effective Jan. 1, 2025.
Staff asked the board to take same‑day action to amend the board’s 2024 resolution on diagnostic and supplemental breast exams so that Uniform Medical Plan (UMP) members receive the service without member cost‑share, effective Jan. 1, 2025. Ryan Ramsdell explained that IRS and OIC guidance issued after the board’s 2024 action allowed staff to remove a prior caveat requiring high‑deductible members to meet their deductible first. "Beginning 01/01/2025, diagnostic and supplemental breast exams will be covered without member cost share to Uniform Medical Plan members," Ryan said.
To avoid double adjudication of claims, staff asked regions to hold claims until the board’s vote. The board voted by roll call and passed Resolution PEP‑2025‑04; staff thanked members for accommodating the expedited schedule so claims could be adjudicated under the updated policy.
