Forms & publications

Can't find what you need? Visit UMP Forms and publications for more documents.

MetLife retiree Certificate of Coverage (COC) non-Washington residents 2019

This is the MetLife retiree life insurance certificate of coverage (COC) for retirees who do not live in Washington.

Publication

MetLife retiree Certificate of Coverage (COC) Washington residents 2019

This is the MetLife retiree life insurance certificate of coverage (COC) for retirees who live in Washington.

Publication

MetLife retiree enrollment/change form

Use this form to enroll in or change enrollment in retiree term life insurance through MetLife.

Form

Premera Medicare supplement plan F enrollment form (Form B)

Use this form to enroll in Medicare Supplemental insurance administered by Premera.

Form

Premium Payment Plan Election/Change Form

50-185

Complete this form if you do not want to pay your medical premiums with pretax earnings.

Form

Premium surcharge attestation change form 2019

50-563-2019

This is the 2019 Premium Surcharge Change form. Use this form to report a change that affects your surcharge for tobacco use and/or spouse or state-registered domestic partner coverage.

Form

Premium surcharge help sheet 2019

50-226-2019

This is the 2019 Premium Surcharge Help Sheet. Use the information on this help sheet to attest on your enrollment form or the Premium Surcharge form whether the premium surcharges for tobacco use or spouse/state-registered domestic partner apply.

Form

Regence (UMP plans) preauthorization guidelines

Preauthorization guidelines 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.

Publication

Regence (UMP plans) preauthorization requirements (Chemical Dependency and Mental Health)

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.

Publication

Regence (UMP plans) preauthorization requirements (Genetic Testing)

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.

Publication

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