Forms & publications

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

Indian Nation Intergovernmental Agreement

Form

Introduction to PEBB Coverage for Employer Groups 2019

Explains the PEBB Program for interested employer groups.

Publication

Introduction to PEBB Coverage for Employer Groups 2019 (surcharges)

Explains the PEBB Program for interested employer groups.

Publication

Introduction to PEBB Coverage for K-12, ESDs, and Charter Schools 2019

Explains the PEBB Program for interested K-12, ESDs, and Charter Schools.

Publication

k12-monthly-cost-tool-2019.xlsx

Monthly cost tool for K-12 employer groups in PEBB.

Form

Kaiser Permanente NW Classic Certificate of Coverage (COC) 2019

This benefits book describes what is covered under Kaiser Permanente NW 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 your plan.

Publication

Kaiser Permanente NW Classic Summary of Benefits and Coverage (SBC) 2019

A summary of what the Kaiser Permanente NW Classic plan covers and what it costs.

Publication

Kaiser Permanente NW Consumer-Directed Health Plan (CDHP) Certificate of Coverage (COC) 2019

This benefits book describes what is covered under Kaiser Permanente NW CDHP, 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 your plan.

Publication

Kaiser Permanente NW Consumer-Directed Health Plan Summary of Benefits and Coverage (SBC) 2019

A summary of what the Kaiser Permanente NW Consumer-Directed Health Plan (CDHP) covers and what it costs.

Publication

Kaiser Permanente NW preauthorization requirements

Preauthorization requirements for Kaiser Permanente NW plans. 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.

Publication

Pages