Forms & publications

UMP Classic (Non-Medicare) (PEBB) (Regence) Summary of Benefits and Coverage (SBC) 2023

This document puts your health plan benefits for UMP Classic (Non-Medicare) in a standardized format to help you compare different plans. It includes common services, deductibles, and normal cost shares such as coinsurance and out-of-pocket limits. It also tells you about limits to specific benefits, like a visit or dollar limit for certain services. UMP medical benefits are administered by Regence BlueShield and prescription drug benefits are administered by Washington State Rx Services.

Certification of a Child with a Disability (PEBB)

After 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.

Certification of a Child with a Disability (SEBB)

After turning 26, your dependent may be eligible for enrollment under your SEBB coverage. Use this form to certify your dependent's disability and enroll them on your SEBB coverage.

Davis 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.

Davis Vision by MetLife (SEBB) Certificate of Coverage (COC) 2024

This benefits book describes what is covered as a SEBB member under Davis Vision by MetLife, 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.