Forms & publications

UMP (SEBB) Newsletter 2024

This newsletter contains important information for Uniform Medical Plan (UMP) School Employees Benefits Board (SEBB) program members about benefit changes and new resources for 2024.

UMP (WSRxS) Authorization for release of information

This form directs Washington State Rx Services (WSRxS) to communicate with you about your personal health information at the address you select. This form does not apply to your health care provider. You must give your provider separate, specific instruction about what health information they may share and with whom.

UMP (WSRxS) Opioid Attestation form

This Uniform Medical Plan (UMP) form is for provider use. This form is required when patients are using opioids chronically or when daily opioid doses reach 120 MME or greater. This form may authorize use for a maximum of 12-months. Washington State Rx Services (WSRxS) created this form.

UMP (WSRxS) Preferred Drug List (PDL) 2024

This document is the 2024 Preferred Drug List (PDL) for the Uniform Medical Plan (UMP). This 2024 PDL will apply to all UMP plans for PEBB and SEBB members. It lists prescription drugs covered by UMP. The prescription drug benefit is administered by Washington State Rx Services (WSRxS).