Forms & publications

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

Regence (UMP [PEBB] plans) preauthorization requirements (Radiology)

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 [PEBB] plans) preauthorization requirements (Surgery)

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 [PEBB] plans) preauthorization requirements (Transplants, Ventricular Assist Devices, and Utilization Management)

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

Retiree coverage change form (form E) 2019

51-0007-2019

Use Form E to make changes to your PEBB retiree insurance coverage.

Form

Retiree coverage election form (form A) 2019

51-403F-2019

This is the 2019 Retiree Coverage Election Form (form A). Use this form to elect Retiree insurance coverage. To make changes to your retiree insurance coverage, use the 2019 Retiree Coverage Change Form (form E).

Form

Retiree enrollment guide 2019

51-205

This retiree guide contains information you need about enrollment, eligibility, benefits, monthly premiums, and the plans available to retirees.

Publication

Retiree/COBRA/PEBB Continuation Coverage Notice of Appeal

51-122

This form is used by Retirees and PEBB Continuation Coverage subscribers to request an appeal.

Form

Spousal plan calculator form 2019

50-027-2019

This is the 2019 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions in the 2019 Premium Surcharge Help Sheet and are wanting to enroll a spouse or state-registered domestic partner.

Form

Spousal plan calculator tool 2019 (xls)

This is the 2019 spousal plan calculator. Use this interactive calculator tool to determine if the spousal premium surcharge applies to you if you answered 'YES' to all the questions in the Premium Surcharge Help Sheet and are wanting to enroll a spouse or state-registered domestic partner on your PEBB medical.

Form

Thinking about retirement (2019)

51-535

Retirement questions for individuals thinking about retirement.

Publication

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