Forms & publications

UMP Select (PEBB) Certificate of Coverage (COC) 2024

This book describes what is covered under UMP Select (PEBB), including medical services and prescription drugs. It describes how to find providers and how much you'll pay to see them (including your deductible, coinsurance, and out-of-pocket limit). Your COC also describes how to request an appeal and how to submit a claim. UMP is administered by Regence BlueShield and Washington State Rx Services (WSRxS) under contract with the Washington State Health Care Authority.

UMP Select (PEBB) Certificate of Coverage (COC) 2025

This book describes what is covered under UMP Select (PEBB), including medical services and prescription drugs. It describes how to find providers and how much you'll pay to see them (including your deductible, coinsurance, and out-of-pocket limit). Your COC also describes how to request an appeal and how to submit a claim. UMP is administered by Regence BlueShield and ArrayRx under contract with the Washington State Health Care Authority.

Uniform Dental Plan (PEBB) Certificate of Coverage (COC) 2025

This benefits book describes what is covered under Uniform Dental Plan, including dental services as well as specific services not covered by the plan, finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal and how to submit a claim.

Uniform Dental Plan (SEBB) Certificate of Coverage (COC) 2025

This benefits book describes what is covered under Uniform Dental Plan, including dental services as well as specific services not covered by the plan, finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal and how to submit a claim.

UnitedHealthcare PEBB Balance Evidence of Coverage (EOC) 2025

This booklet gives you the details about your Medicare health care coverage from your UnitedHealthcare PEBB Balance. It explains how to get coverage for the health care services you need. This is an important legal document.

UnitedHealthcare PEBB Complete Evidence of Coverage (EOC) 2025

This booklet gives you the details about your Medicare health care coverage from your UnitedHealthcare PEBB Complete. It explains how to get coverage for the health care services you need. This is an important legal document.

Vision Benefits At-a-Glance (PEBB) 2025

The figures listed in the comparison show what you pay for in-network services, with the amount up to which you would be reimbursed for out-of-network services in parentheses. If anything in these charts conflicts with the vision plan’s Certificate of Coverage (COC), the COC takes precedence and prevails. For information on specific benefits and exclusions, refer to the plan’s COC or contact the plan.

Vision Benefits At-a-Glance (SEBB) 2025

The figures listed in the comparison show what you pay for in-network services, with the amount up to which you would be reimbursed for out-of-network services in parentheses. If anything in these charts conflicts with the vision plan’s Certificate of Coverage (COC), the COC takes precedence and prevails. For information on specific benefits and exclusions, refer to the plan’s COC or contact the plan.

Willamette Dental (PEBB) Certificate of Coverage (COC) 2025

This benefits book describes what is covered under Willamette Dental, including dental services, as well as specific services not covered by the plan finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal and how to submit a claim.