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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.
PublicationMetLife 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.
PublicationMetLife retiree enrollment/change form
Use this form to enroll in or change enrollment in retiree term life insurance through MetLife.
FormPremera Medicare supplement plan F enrollment form (Form B)
Use this form to enroll in Medicare Supplemental insurance administered by Premera.
FormPremium Payment Plan Election/Change Form
50-185Complete this form if you do not want to pay your medical premiums with pretax earnings.
FormPremium surcharge attestation change form 2019
50-563-2019This 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.
FormPremium surcharge help sheet 2019
50-226-2019This 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.
FormRegence (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.
PublicationRegence (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.
PublicationRegence (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.
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