In crisis?
Forms & publications
Can't find what you need? Visit UMP Forms and publications for more documents.
2017-2018 comparison of UMP monthly premiums
This document lists the 2017 and 2018 monthly premiums for UMP members who are employees and retirees.
Publication2018-2019 comparison of UMP monthly premiums
This document lists the 2018 and 2019 monthly premiums for UMP members who are employees and retirees.
PublicationBehavioral health comparison (SEBB) 2020
20-0179Starting in 2020, all carriers must provide information on their websites for mental health and substance abuse treatment providers’ ability to ensure timely access to care. This document includes behavioral health benefits for SEBB medical plans. When you need information about what mental health and substance use disorders are covered, you can read the SEBB medical plans’ Certificates of Coverage.
PublicationCensus data spreadsheet
Spreadsheet for employers to share demographic data
FormCertification of a child with disability (PEBB) 2020
50-142After turning 26, your dependent may be eligible for enrollment under your PEBB coverage. Use this form to certify your dependent's disability and enroll them on your PEBB coverage.
FormCOBRA transition insert for SEBB Continuation Coverage
20-0164This insert explains how you and your dependents, if eligible, can continue your coverage under the SEBB Program in 2020. It covers information related to your situation that may differ from what is provided in the SEBB Continuation Coverage Election Notice booklet.
PublicationDavis Vision (SEBB) Certificate of Coverage (COC) 2020
This benefits book describes what is covered as a SEBB member under Davis vision, including vision services and specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays.
PublicationDavis Vision (SEBB) preauthorization requirements
Preauthorization requirements for Davis Vision plan. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
PublicationDeclaration of tax status (PEBB) 2019
50-704-2019Employees and retirees must complete and submit this form with their enrollment form when enrolling an individual on their PEBB Program coverage who does not qualify as their dependent for federal tax purposes.
FormDeclaration of tax status (PEBB) 2020
50-704Employees and retirees must complete and submit this form with their enrollment form when enrolling an individual on their PEBB Program coverage who does not qualify as their dependent for federal tax purposes.
Form