Forms & publications

Can't find what you need? Visit UMP Forms and publications for more documents.

Summary of Benefits and Coverage 2018 UMP Plus UW Medicine Accountable Care Network

This is a summary of popular benefits covered under UMP Plus UW Medicine Accountable Care Network. It tells you how much you'll pay for these services, as well as specific related limits and exclusions.

Publication

Summary of Benefits and Coverage 2019 UMP Classic (Medicare)

This document puts your health plan benefits for UMP Classic (Medicare) 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.

Publication

Summary of Benefits and Coverage 2019 UMP Classic (Non-Medicare)

This document puts your health plan benefits for UMP Classic (Non-Medicare) 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.

Publication

Summary of Benefits and Coverage 2019 UMP Consumer-Directed Health Plan (UMP CDHP)

This document puts your health plan benefits for UMP CDHP in a standardized format to help you compare different plans. It includes common services, deductibles, 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.

Publication

Summary of Benefits and Coverage 2019 UMP Plus Puget Sound High Value Network

This is a summary of popular benefits covered under UMP Plus Puget Sound High Value Network. It tells you how much you'll pay for these services, as well as specific related limits and exclusions.

Publication

Summary of Benefits and Coverage 2019 UMP Plus UW Medicine Accountable Care Network

This is a summary of popular benefits covered under UMP Plus UW Medicine Accountable Care Network. It tells you how much you'll pay for these services, as well as specific related limits and exclusions.

Publication

UMP (SEBB) Preferred Drug List 2020

This document is the Preferred Drug List (PDL) for the Uniform Medical Plan (UMP). It lists prescription drugs covered by UMP.

Publication

UMP Achieve 2 (SEBB) 2020 Certificate of Coverage (COC)

This book describes what is covered under UMP Achieve 2 (SEBB), 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.

Publication

UMP 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.

Form

UMP Classic 2017 Certificate of Coverage (COC)

This benefits book describes what is covered under UMP Classic, including medical services and prescription drugs, as well as specific services not covered by the plan. Finding preferred providers and how much you'll pay, including deductibles, coinsurance, and copays. It also includes how to request an appeal, submit a claim, and how Medicare works with UMP Classic.

Publication

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