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UMP (Regence) Authorization to Disclose Protected Health Information form
This form directs the Uniform Medical Plan's (UMP) administrator, Regence, to communicate with you about your personal health information (PHI).
FormUMP (Regence) International medical claim form
This form is for sending in a claim for medical services received internationally for all Uniform Medical Plans (UMP) (Regence).
FormUMP (Regence) Medical appeals and grievance form
This form may be included in an appeal or complaint, but 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 they should be submitted.
FormUMP (Regence) Medical Claim Form
This medical claim form to send in a claim for medical services for all Uniform Medical Plans (UMP) (Regence).
FormUMP (Regence) Medical incident report
This form is to report to Regence if an injury or illness may be covered under a third party. You may need to use this form even if the incident is not subject to third party coverage.
FormUMP (Regence) Medical Preferred Drug List
This document is the Medical Preferred Drug List (PDL) for the Uniform Medical Plan (UMP). It lists prescription drugs covered by UMP under the medical benefit administered by Regence. This list applies to both PEBB and SEBB.
PublicationUMP (Regence) multiple coverage inquiry form
This form is to notify Regence that you have additional coverage under another medical plan.
FormUMP (Regence) Programs to keep you healthy 2022
This document lists wellness programs offered by the Uniform Medical Plan (UMP) (Regence).
PublicationUMP (Regence) provider fee schedule January 2022
This is the Regence BlueShield fee schedule for providers.
Fee scheduleUMP (Regence) Quartet brochure
This brochure describes Quartet, a benefit that connects Uniform Medical Plan (UMP) members to behavioral health care.
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