Uniform Medical Plan (UMP)

Compare medical plans

Uniform Medical Plan Classic (UMP Classic), UMP Consumer-Directed Health Plan (UMP CDHP), and UMP Plus are self-insured by the state of Washington. The plans are offered to Public Employees Benefits Board (PEBB) members and their eligible dependents.

Medical coverage

Regence BlueShield administers UMP medical services. Members have the flexibility to choose from a broad network of medical providers. All the plans provide no-cost preventive care when you see a preferred provider (for UMP Classic and UMP CDHP) or network provider affiliated with your UMP Plus network. You don’t pay a deductible for preventive care. Also, there are no office visit charges for UMP Plus members seeing their Primary Care Network provider.

You pay 15% coinsurance for most services from preferred providers (for UMP Classic and UMP CDHP) or network providers (for UMP Plus). You pay more for services outside the network.

Prescription drug coverage

Washington State Rx Services administers prescription drug coverage.

  • UMP Classic has a $100 prescription drug deductible, separate from the medical deductible.
  • UMP CDHP has one deductible that applies to prescription drugs and medical services.
  • UMP Plus does not have a deductible for prescription drugs.

UMP Classic and UMP Plus prescription drugs are covered under a tiered system, with generic drugs being less expensive and nonpreferred brand-name drugs costing more. For UMP CDHP, once you meet your deductible, you pay 15% for all covered drugs.

Retirees and Medicare enrollees

UMP Classic is available to Medicare retirees. Non-Medicare retirees can enroll in a UMP Plus plan if you meet other eligibility requirements. Compare your medical plan options on the PEBB website.

Contact PEBB customer service at 1-800-200-1004 to learn more about your health plan options, including how your Medicare-entitled dependents may affect your coverage.

Medical FSA vs. HSA

PEBB benefits-eligible employees who work at state and higher-education institutions may be eligible to enroll in a Medical Flexible Spending Arrangement (FSA). The Medical FSA allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. Learn more about Medical FSAs on the PEBB website.

UMP CDHP members are not eligible to enroll in a Medical FSA. Instead, UMP CDHP members are automatically enrolled in a health savings account (HSA). Your HSA allows you to set aside money tax-free for qualified medical expenses. Learn more about HSAs on the PEBB website. You cannot have a Medical FSA and an HSA at the same time.

While you must spend all the money in your Medical FSA account by the end of each plan year, there is no time limit to spend your HSA funds. You must maintain enrollment in a qualifying health plan to deposit funds to your HSA. However, you do not have to be enrolled in a qualifying health plan to spend existing HSA funds.

While UMP CDHP has a higher up-front deductible, it also has the lowest premiums of the UMP plans offered. Also, your employer or the PEBB Program contributes up to $700.08 for a subscriber or $1,400.04 for a family to your HSA through monthly installments each year.

Compare the plans chart

 

UMP Classic

UMP CDHP

UMP Plus

Medical deductible

$250 per person/$750 family (3 or more)

$1,400 per person/$2,800 family (2 or more)

$125 per person/$375 family (3 or more)

Prescription drug deductible

Note: See “Prescription drugs” below.

$100 per person/$300 family (3 or more) for Tier 2 and Tier 3 drugs.

No deductible for Value Tier and Tier 1 drugs.

None

None

Medical out-of-pocket limit

Note: When one family member meets the out-of-pocket limit, no one else in the family needs to meet their medical deductible to be covered.

Non-Medicare: $2,000 per person/$4,000 family (2 or more)

Medicare: $2,500 per person/$5,000 family (3 or more)

$4,200 per person/$8,400 family (2 or more)

$2,000 per member/$4,000 family (2 or more)

Prescription drug out-of-pocket limit

$2,000 per person/no family limit

No separate prescription drug limit

$2,000 per person/no family limit

Preventive

Note: Preventive care visits are not subject to the deductible.

100% covered when seeing preferred providers

100% covered when seeing preferred providers

100% covered when seeing UMP Plus network providers

Primary care

Unless preventive, covered at standard rate

Unless preventive, covered at standard rate

Office visit charges covered in full when using a primary care network provider in your UMP Plus network; related services may be covered as standard.

Note: Primary care visits are not subject to the deductible.

Standard

Preferred providers: You pay 15% coinsurance

Participating providers: You pay 40%

Out-of-network providers: You pay 40%, and provider may balance bill

Preferred providers: You pay 15% coinsurance

Participating providers: You pay 40%

Out-of-network providers: You pay 40%, and provider may balance bill

Network providers: You pay 15% coinsurance (includes primary care and specialty network providers in your UMP Plus network AND Regence ancillary providers inside the UMP Plus Service Area)

Non-network providers: You pay 50%

Out-of-network providers: You pay 50%, and provider may balance bill

Note: See “Primary care” above.

Inpatient services (hospital, facility)

Non-Medicare: $200 per day copay/$600 max. per year per patient

Medicare: $200 per day copay/$600 max. per admission per patient

Professional charges are billed separately from facility charges; you pay the Standard rate based on the network status of the provider, in addition to the inpatient copay.

No copay, paid at Standard rate

$200 per day copay/$600 max. per year per patient

Professional charges are billed separately from facility charges; you pay the Standard rate based on the network status of the provider, in addition to the inpatient copay.

Emergency Room services

Note: If your emergency room visit is determined to be a medical emergency, it will be paid at the preferred/network level for both preferred/network and out-of-network facilities.

$75 copay plus standard rate (depending on network status)

Professional charges are billed separately from facility charges; you pay the Standard rate based on the network status of the provider, in addition to the ER copay.

No copay, paid at Standard rate

$75 copay plus standard rate (depending on network status)

Professional charges are billed separately from facility charges; you pay the Standard rate based on the network status of the provider, in addition to the ER copay.

Prescription drugs

Deductible: $100 per person/$300 family (3 or more); applies to Tier 2 and Tier 3 only.

Tiers:

  • Value: You pay 5%
  • Tier 1: 10%
  • Tier 2: 30%
  • Tier 3: 50%*

Individual prescription cost-limit applies to Value, Tier 1, and Tier 2 drugs when purchased from a network pharmacy.

*Tier 3 drugs: $150 per-prescription limit for specialty drugs only.

No separate prescription drug deductible; see “Medical deductible” above.

All covered drugs: You pay 15% of allowed amount after combined deductible is met.

No deductible for covered prescription drugs.

Tiers:

  • Value: You pay 5%
  • Tier 1: 10%
  • Tier 2: 30%
  • Tier 3: 50%*

Individual prescription cost-limit applies to Value, Tier 1, and Tier 2 drugs when purchased from a network pharmacy.

*Tier 3 drugs: $150 per-prescription limit for specialty drugs only.