UMP (PPS) Prescription drug mail-order form

This form is to order prescription drugs from the UMP network mail-order pharmacy, Postal Prescription Services (PPS), which is a member of Washington State Rx Services (WSRxS).


UMP (Regence) International medical claim form

This form is for sending in a claim for medical services received internationally for all Uniform Medical Plans (UMP) (Regence).


UMP (Regence) Medical 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.


UMP (Regence) Medical Claim Form

This medical claim form to send in a claim for medical services for all Uniform Medical Plans (UMP) (Regence).


UMP (Regence) Medical incident report

This form is to report to Regence if an injury or illness may be covered under a third party. You may need to use this form even if the incident is not subject to third party coverage.


UMP (Regence) medical multiple coverage inquiry form (coordination of benefits (COB))

This form is to notify Regence that you have additional coverage under another medical plan.


UMP (Regence) Medical Preferred Drug List

This document is the Medical Preferred Drug List (PDL) for the Uniform Medical Plan (UMP). It lists prescription drugs covered by UMP under the medical benefit administered by Regence. This list applies to both PEBB and SEBB.


UMP (Regence) provider fee schedule January 2019

This is the Regence BlueShield fee schedule for providers.

Fee schedule

UMP (Regence) Vision Claim Form

Use this Uniform Medical Plan (UMP) form to submit claims for vision hardware, such as eyeglasses and contact lens, to Regence.


UMP (SEBB) (Regence) Important information for 2020

This document provides information to help School Employees Benefits Board (SEBB) members decide if UMP is right for them. Some examples of topics covered include explaining your choices if you and your spouse or state-registered domestic partner are enrolling in a UMP plan, what happens if you have an active preauthorization for medical care, and what happens if you are covered by two health insurance plans.