Forms & publications

This is the 2025 Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are wanting to enroll a spouse or state-registered domestic partner.

This is the 2025 SEBB Spousal plan calculator form. Use this form if you answered 'YES' to all the questions on your enrollment form and are wanting to enroll a spouse or state-registered domestic partner.

Retirement questions for individuals thinking about retirement.

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)

Ardon Health Protected health information (PHI) disclosure authorization form. Ardon Health is a member of Washington State Rx Services (WSRxS).

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).

This document contains information about prescription drugs covered under the UMP Classic Medicare with Part D (PDP) plan.

This form directs ArrayRx 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.

ArrayRx Protected health information (PHI) disclosure authorization form for UMP Classic Medicare with Part D (PDP) members.

This documents provides a list of UMP Classic Medicare with Part D (PDP) network pharmacies. This directory is for network pharmacies in Washington State and Oregon. ArrayRx does cover a service larger area and more network pharmacies may be available to members upon request.