Forms & publications

This guide gives a brief overview of the UMP Classic (PEBB) medical and prescription drug benefits for 2025.

This form is used for UMP Classic Medicare with Part D (PDP) members to authorize automatic monthly bank deductions for late enrollment penalties. Funds will be automatically deducted when the member signs up for Electronic Funds Transfer deductions.

This is an ArrayRx Medicare claim form for reimbursement for prescription drugs for Uniform Medical Plan (UMP) Classic Medicare with Part D (PDP) members.

This handout describes benefits under UMP Classic Medicare with Part D (PDP). UMP medical benefits are administered by Regence BlueShield and Part D prescription drug benefits are administered by ArrayRx.

This handout describes benefits under UMP Classic Medicare with Part D (PDP). UMP medical benefits are administered by Regence BlueShield and Part D prescription drug benefits are administered by ArrayRx.

This document puts your health plan benefits for UMP Classic Medicare with Part D (PDP) 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.

This document puts your health plan benefits for UMP Classic Medicare with Part D (PDP) 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.

This book describes what is covered under UMP Classic Medicare with Part D (PDP) (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 ArrayRx under contract with the Washington State Health Care Authority.

This book describes what is covered under UMP Classic Medicare with Part D (PDP) (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 ArrayRx under contract with the Washington State Health Care Authority.

This guide gives a brief overview of the UMP Classic Medicare with Part D (PDP) (PEBB) medical and prescription drug benefits for 2025.