Forms & publications

UMP Select (PEBB) (Regence) Summary of Benefits and Coverage (SBC) 2022

This document puts your health plan benefits for UMP Select in a standardized format to help you compare different plans. It includes common services, deductibles, normal cost shares such as copays, coinsurance, and out-of-pocket limits. It also tells you about limits to specific benefits, like a visit or dollar limit for certain services. UMP is administered by Regence BlueShield and Washington State Rx Services under contract with the Washington State Health Care Authority.

UMP Select (PEBB) (Regence) Summary of Benefits and Coverage (SBC) 2023

This document puts your health plan benefits for UMP Select in a standardized format to help you compare different plans. It includes common services, deductibles, and normal cost shares such as coinsurance and out-of-pocket limits. It also tells you about limits to specific benefits, like a visit or dollar limit for certain services. UMP medical benefits are administered by Regence BlueShield and prescription drug benefits are administered by Washington State Rx Services.

UMP Select (PEBB) (Regence) Summary of Benefits and Coverage (SBC) 2024

This document puts your health plan benefits for UMP Select in a standardized format to help you compare different plans. It includes common services, deductibles, and normal cost shares such as coinsurance and out-of-pocket limits. It also tells you about limits to specific benefits, like a visit or dollar limit for certain services. UMP medical benefits are administered by Regence BlueShield and prescription drug benefits are administered by Washington State Rx Services.

UMP Select (PEBB) Certificate of Coverage (COC) 2022

This book describes what is covered under UMP Select (PEBB), 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.

UMP Select (PEBB) Certificate of Coverage (COC) 2023

This book describes what is covered under UMP Select (PEBB), 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.

UMP Select (PEBB) Certificate of Coverage (COC) 2024

This book describes what is covered under UMP Select (PEBB), 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.

Washington State Rx Services (Moda) preauthorization (UMP [PEBB] Plans) preauthorization requirements (Part 1)

Preauthorization for UMP plans pharmacy benefits (administered by Washington State Rx Services). 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.

Washington State Rx Services (Moda) preauthorization (UMP [PEBB] Plans) preauthorization requirements (Part 2)

Preauthorization for UMP plans pharmacy benefits (administered by Washington State Rx Services). 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.

Washington State Rx Services (Moda) preauthorization (UMP [SEBB] Plans) preauthorization requirements (Part 1)

Preauthorization for UMP plans pharmacy benefits (administered by Washington State Rx Services). 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.