Uniform Medical Plan
Uniform Medical Plan (UMP) offers you four different health plans through Washington state’s Public Employees Benefits Board (PEBB). While you pay for coverage through UW, the state designs the plans and contracts with Regence BlueShield and Washington State Rx Services to administer the plan.
You have four UMP plan options:
- UMP Classic
- UMP Plus – UW Medicine Accountable Care Network
- UMP Plus – Puget Sound High Value Network
- UMP CDHP
You’re eligible to enroll in a UMP plan if you’re eligible for PEBB benefits. The two UMP Plus plans, however, are only available to employees who live in King, Pierce, Snohomish, or Thurston county.
If you already know which UMP plan you want, see enroll in a health plan to enroll. Use the information on this page for help choosing the plan that’s best for you and your family.
A plan’s network consists of doctors, clinics, hospitals, specialists, and other health care providers. By using providers within your network, your health care costs will be significantly lower than if you use providers outside your network.
The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. The Plus plan networks are smaller, as each consists of regional providers spread throughout western Washington.
To browse each plan’s network or to find a specific provider, either call the plan directly or use the plan’s web search tool.
|Plan||Network||Find a provider online|
|UMP Classic||Uniform Medical Plan||Regence BlueShield search|
|UMP Plus||UW Medicine Accountable Care Network||UW Medicine network search|
|UMP Plus||Puget Sound High Value Network||Puget Sound HVN search|
|UMP CDHP||Uniform Medical Plan||Regence BlueShield search|
The four UMP plans offer you a range of cost options. As is always the case with health insurance, it’s best to consider not only the premium but also the costs for using services, such as the deductible.
With the Classic plan, both the premium and the deductible are higher than the two Plus plans. The Classic plan’s main appeal is its large network and traditional benefit structure.
The two Plus plans have much smaller networks than the Classic plan, but they also have cheaper premium and deductible costs. Additionally primary care office visits are fully covered and cost you nothing when you use a network provider.
The CDHP plan is a high-deductible style plan, which means that in return for taking on the financial risk of a high deductible, you pay a significantly lower premium. You also get a Health Savings Account to help pay for medical costs. Learn more about how CDHPs and HSAs work.
The table shows a sample of costs to help you quickly compare plans. For a full list of costs, refer to the Certificate of Coverage.
|Plan||Employee premium (per month)||Deductible (per year)||Primary care visit (your cost)|
|UMP Classic||$84||$250||15% coinsurance|
|UMP Plus: UW Medicine Accountable Care Network||$59||$125||$0|
|UMP Plus: Puget Sound High Value Network||$59||$125||$0|
|UMP CDHP||$21||$1400||15% coinsurance|
While all plans cover the same basic health care services, you may want to know whether or not a certain service is covered by the plan. The most direct way to find out is to call the plan and ask. Alternatively, you can read the plan’s Certificate of Coverage (also called the benefits booklet), which describes the plan in detail. These booklets are long, but they can be helpful if you need to know something specific.
If you simply want an overview of a plan’s coverage and costs, take a look at the plan Summary of Benefits and Coverage, an easy-to-read summary that lets you quickly review health plans. You can compare options based on price, benefits, and other features that may be important to you.
To view plan details side by side and directly compare coverage and costs, use the PEBB medical benefit comparison tool.
|Plan||Certificate of Coverage (2016)||Summary of Benefits and Coverage (2016)|
|UMP Classic||View (PDF)||View (PDF)|
|UMP Plus: UW Medicine Accountable Care Network||View (PDF)||View (PDF)|
|UMP Plus: Puget Sound High Value Network||View (PDF)||View (PDF)|
|UMP CDHP||View (PDF)||View (PDF)|
Prescription drug coverage
UMP Classic is the only plan that has a separate prescription drug deductible. However, it only applies to drugs in the higher, more expensive tiers (tier 2 and 3), so you don’t have to pay the deductible if you only use prescription drugs from lower tiers, which include most generic and low-cost drugs.
For all the plans, you pay coinsurance for prescriptions. The amount you pay increases as you move up the tiers from the least expensive, generic drugs to the more expensive, specialty drugs. The one exception is the CDHP plan, which charges the same coinsurance for all tiers of drugs.
You can find complete details about prescription drug coverage by reviewing the plan’s Certificate of Coverage.
Generally, vision benefits are part of your medical plan. Providers can be found in the provider directory, or by contacting the medical plan.
File a claim
You don’t have to submit a claim when you visit a provider who is part of your plan’s network. You may have to submit a claim if you receive services for a provider that is outside your network or if you have other insurance and your UMP coverage is secondary. If you do need to submit a claim, contact UMP.