Uniform Medical Plan
Table of Contents
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. However you should check plan availability where you live, because not all plans are available in all counties. In most cases, you must live in a medical plan’s service area to join the plan. Please visit the HCA page listing medical plans available by county to find plans that serve your area.
You can find step-by-step instructions for enrolling in benefits on the Integrated Service Center’s website.
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)||Employee
Deductible (per year)
|Primary care visit (your cost)|
|UMP Classic||$104||$250||15% coinsurance|
|UMP Plus: UW Medicine Accountable Care Network||$69||$125||$0|
|UMP Plus: Puget Sound High Value Network||$69||$125||$0|
|UMP CDHP||$25||$1400||15% coinsurance|
Complete table of Employee monthly medical premiums 2020
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.
2020 plan summaries
|Plan||Certificate of Coverage (2020)||Summary of Benefits and Coverage (2020)|
|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
For all UMP plans, Tier 3 prescription drugs are being removed from the Preferred Drug List as of January 1, 2020. There is now an exception process for members who require prescription drugs that are no longer covered.
UMP Classic is the only plan that has a separate prescription drug deductible. However, it only applies to Tier 2 prescription drugs, so you don’t have to pay the deductible if you use prescription drugs from any other tier, which includes 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.
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 where your UMP coverage is secondary. If you need to submit a claim, contact UMP.
Plan ID Cards
After you enroll, your health plan(s) will send you an identification (ID) card to show to providers when you receive care. If you have questions about your ID card, contact your plan directly.