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.

Publication

2018-2019 comparison of UMP monthly premiums

This document lists the 2018 and 2019 monthly premiums for UMP members who are employees and retirees.

Publication

2019-2020 comparison of UMP monthly premiums

This document lists the 2019 and 2020 monthly premiums for UMP members who are employees and retirees.

Publication

ABA Services Authorization Form

This form is for requesting preauthorization of Applied Behavior Analysis (ABA) Therapy services.

Form

Ardon Health Specialty Drug Release Form

This is a form that members must complete and send with initial order for specialty drugs from the UMP network specialty pharmacy, Ardon Health.

Form

Ardon patient request for non-safety caps on prescription containers

Members can use this form when purchasing specialty drugs through Ardon Health to request that Ardon Health not use child-resistant caps ("safety caps") to package a member's medication.

Form

ardon-phi-disclosure-authorization-form.pdf

Ardon Health Protected health information disclosure authorization form

Form

Census data spreadsheet

Spreadsheet for employers to share demographic data

Form

COE Program brochure

This flyer gives an overview of the Centers of Excellence Program in 2019 for knee and hip replacement and spine care.

Publication

Coverage of Applied Behavior Analysis Therapy (ABA Therapy Printable Summary)

This document summarizes the information on Applied Behavior Analysis (ABA) Therapy coverage available on the UMP website.

Publication

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