Forms & publications

Regence (UMP [PEBB] plans) preauthorization requirements (Document 1)

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Guidelines, inpatient admissions, radiology, sleep, physical medicine, lab, maternity medicine, and genetic testing. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Regence (UMP [PEBB] plans) preauthorization requirements (Medications covered under medical)

Preauthorization requirements for UMP plans (administered by Regence). Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Regence (UMP [SEBB] plans) preauthorization requirements (Document 1)

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Guidelines, inpatient admissions, radiology, sleep, physical medicine, lab, maternity medicine, and genetic testing. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Regence (UMP [SEBB] plans) preauthorization requirements (Document 2)

Preauthorization requirements for UMP plans (administered by Regence). This document includes: Substance use disorder, mental health, DME, surgery and transplants. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Regence (UMP [SEBB] plans) preauthorization requirements (Medications covered under medical)

Preauthorization requirements for UMP plans (administered by Regence). Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

UMP (Ardon Health) Non-safety caps on prescription containers request form

Members can use this form when purchasing specialty drugs through Ardon Health to request that Ardon Health not use child-resistant caps ("safety caps") to package a member's medication. Ardon Health is a member of Washington State Rx Services (WSRxS)
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UMP (Ardon Health) Specialty prescription drug release form

This is a form that members must complete and send with initial order for specialty drugs from the Uniform Medical Plan (UMP) network specialty pharmacy, Ardon Health. Ardon Health is a member of Washington State Rx Services (WSRxS).

UMP (PEBB) (Regence) What’s new for 2022

This is an overview of new Uniform Medical Plan (UMP) benefits and changes to benefits for plan year 2022 for Public Employees Benefits Board (PEBB) members. UMP medical benefits are administered by Regence BlueShield and prescription drug benefits are administered by Washington State Rx Services.