UMP Achieve 1 (SEBB) Quick start guide 2020

This guide gives a brief overview of the UMP Achieve 1 medical and prescription drug benefits for 2020.

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UMP Achieve 1 (SEBB) Certificate of Coverage (COC) 2020

This book describes what is covered under UMP Achieve 1, 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.

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UMP Achieve 1 (SEBB) (Regence) Summary of Benefits and Coverage (SBC) 2020

This is a summary of popular benefits covered under UMP Achieve 1. It tells you how much you'll pay for these services, as well as specific related limits and exclusions. A Regence document.

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UMP (WSRxS) Value Tier Drugs

This is a list of drugs covered under the Value Tier cost-share for some UMP plans. Washington State Rx Services (WSRxS) created this list.

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UMP (WSRxS) Prescription drug complaints and appeals form

This Washington State Rx Services (WSRxS) form may be included in an appeal or complaint regarding prescription drug coverage, but it is not required. It helps the member include all the necessary information for an appeal or complaint, and it includes the address and fax number where documents should be submitted.

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UMP (WSRxS) Prescription drug claim form

This is a Washington State Rx Services (WSRxS) claim form for reimbursement for prescription drugs for Uniform Medical Plan (UMP) members. Members might use this form if they purchased drugs at nonnetwork pharmacies or have other prescription coverage that pays first and UMP is secondary. Members might also use this form if they fail to show their ID at a network pharmacy or get a prescription from a mail-order or internet pharmacy other than Postal Prescription Services.

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UMP (WSRxS) Non-disclosure directive form

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.

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UMP (WSRxS) Multiple prescription drug coverage inquiry form (coordination of benefits [COB])

This form is for notifying Washington State Rx Services (WSRxS) that you have prescription drug coverage in addition to Uniform Medical Plan (UMP).

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UMP (WSRxS) Chronic opioid attestation form

This Uniform Medical Plan (UMP) form is for provider use. Use of opioids for more than 42 days may be authorized in 12 month intervals when the prescriber signs this attestation form. If a prescriber wants an attestation to be authorized for less than 12 months, the prescriber can include a specific end date on the form. Washington State Rx Services (WSRxS) created this form.

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UMP (SEBB): Preferred Drug List Changes (2020-4)

This Washington State Rx Services (WSRxS) document lists all anticipated changes to the UMP Preferred Drug List (PDL) effective April 1, 2020.

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