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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).
FormUMP (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.
FormUMP (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.
FormUMP (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.
FormUMP (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.
PublicationUMP 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.
PublicationUMP 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.
PublicationUMP 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.
PublicationUMP Achieve 1 (SEBB) Welcome letter
This letter, sent by Uniform Medical Plan (UMP) administrator, Regence, with welcome packets, outlines tips for getting started with UMP.
PublicationUMP Achieve 1, UMP Achieve 2 and UMP High Deductible (SEBB) (Regence) Medical benefits comparison 2020
This handout compares benefits for UMP Achieve 1, UMP Achieve 2, and UMP High Deductible (Regence).
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