Forms & publications

UMP Select (PEBB) (Regence) Summary of Benefits and Coverage (SBC) 2022

This document puts your health plan benefits for UMP Select in a standardized format to help you compare different plans. It includes common services, deductibles, normal cost shares such as copays, 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 is administered by Regence BlueShield and Washington State Rx Services under contract with the Washington State Health Care Authority.

UMP Select (PEBB) (Regence) Summary of Benefits and Coverage (SBC) 2023

This document puts your health plan benefits for UMP Select 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.

UMP Select (PEBB) Certificate of Coverage (COC) 2022

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) 2023

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) 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.

Uniform Dental Plan (PEBB) Certificate of Coverage (COC) 2024

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) 2024

This booklet gives you the details about your Medicare health care coverage from your UnitedHealthcare PEBB Balance (MAPD). 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) 2024

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

Washington State Rx Services (Moda) preauthorization (UMP [PEBB] Plans) preauthorization requirements (Part 1)

Preauthorization for UMP plans pharmacy benefits (administered by Washington State Rx Services). 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.

Washington State Rx Services (Moda) preauthorization (UMP [PEBB] Plans) preauthorization requirements (Part 2)

Preauthorization for UMP plans pharmacy benefits (administered by Washington State Rx Services). 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.