UMP (SEBB) monthly premiums comparison 2020-2021

20-0510

This document lists the 2020 and 2021 monthly premiums for the Uniform Medical Plan (UMP) for School Employees Benefits Board (SEBB) Program members. UMP is administered by Regence BlueShield and Washington State Rx Services under contract with the Washington State Health Care Authority.

Publication

UMP (SEBB) monthly premiums comparison 2021-2022

20-0510

This document lists the 2021 and 2022 monthly premiums for Uniform Medical Plan (UMP) for School Employees Benefits Board (SEBB) Program members. UMP is administered by Regence BlueShield and Washington State Rx Services under contract with the Washington State Health Care Authority.

Publication

UMP (SEBB) newsletter 2021

54-0030

This newsletter contains important information for Uniform Medical Plan (UMP) members (SEBB) about benefit changes and new resources for 2021.

Newsletter

UMP (SEBB) newsletter 2022

54-0030

This newsletter contains important information for Uniform Medical Plan (UMP) members (SEBB) about benefit changes and new resources for 2022.

Newsletter

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.

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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 (WSRxS) 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.

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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).

Form

UMP (WSRxS) Preferred Drug List (PDL) 2021

This document is the 2021 Preferred Drug List (PDL) for the Uniform Medical Plan (UMP). This 2021 PDL will apply to all UMP plans for PEBB and SEBB members. It lists prescription drugs covered by UMP, administered by Washington State Rx Services (WSRxS).

Publication

UMP (WSRxS) Prescription drug claim form 2021

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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