Forms & publications

This document lists the 2024 and 2025 monthly premiums for Uniform Medical Plan (UMP) PEBB members who are employees and retirees. UMP is administered by Regence BlueShield and ArrayRx under contract with the Washington State Health Care Authority.

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Guidelines, inpatient admissions, radiology, sleep, physical medicine, lab, maternity medicine, and genetic testing. 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.

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Substance use disorder, mental health, DME, surgery and transplants. 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.

Preauthorization requirements for UMP plans (administered by Regence). 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.

Preauthorization for UMP plans pharmacy benefits (administered by ArrayRx). 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.

Preauthorization for UMP plans pharmacy benefits (administered by ArrayRx). 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.

This is the Vision Service Plan's (VSP reimbursement form for UMP (PEBB) members. UMP (PEBB) stands for Uniform Medical Plan (Public Employees Benefits Board)

This is a summary of how vision benefits work for UMP Classic Medicare with Part D (PDP) (PEBB) for benefit year 2025, including what you'll pay for services and supplies and how to find providers. UMP vision benefits are administered by Vision Service Plan (VSP).

This form is to order prescription drugs from the UMP network mail-order pharmacy, Postal Prescription Services (PPS), which is a member of Washington State Rx Services (WSRxS).

This form directs the Uniform Medical Plan's (UMP) administrator, Regence, to communicate with you about your personal health information (PHI).