Uniform Medical Plan (UMP)

Compare medical plans

Medical coverage

Regence BlueShield administers medical services for all UMP plans.

Here's how the UMP plans are the same:

  • Preventive care is covered in full when you see a preferred provider (network provider for UMP Plus), even if you haven't met your deductible.
  • You pay 15% coinsurance for most services from a preferred provider (network provider for UMP Plus).
  • You pay more for services outside the network.

Here are some differences:

  • UMP Plus members get free primary care network provider office visits. Services related to the visit, such as labs or x-rays, are paid at the standard rate (see table below).
  • UMP CDHP has a lower monthly premium, but a higher deductible, than UMP Classic or UMP Plus. UMP CDHP members also have access to a health savings account (HSA). See "Medical FSA vs. HSA" below for details.

Prescription drug coverage

Washington State Rx Services administers prescription drug coverage for all UMP plans.

Here's how the prescription drug deductible works for each plan:

UMP Classic and UMP Plus prescription drugs are covered under a tiered system: generic drugs are less expensive than nonpreferred brand-name drugs.

For UMP CDHP, you pay 15% for all covered drugs after you meet your deductible.

Retirees and Medicare enrollees

Medicare retirees can enroll in UMP Classic. Non-Medicare retirees can enroll in UMP Classic or a UMP Plus plan if they meet other eligibility requirements.

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.

HSA and Medical FSA

Alert! You cannot have an HSA and a Medical FSA at the same time.

HSA

You are automatically enrolled in a Health Savings Account (HSA) through HealthEquity when you enroll in UMP CDHP. Your HSA allows you to set aside money tax-free for qualified medical expenses. 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. Visit the Health Savings Account webpage for details.

Medical FSA

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 lets you set aside money tax-free 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 because they are automatically enrolled in an HSA.

FSA versus HSA

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.

Medical FSAs are offered through Navia Benefit Solutions. Compare Medical FSAs and HSAs on the Navia website.

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

$100 per person, and
$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*

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

These 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.

Standard

The standard rate depends on the network status of the provider:
Preferred providers: You pay 15% coinsurance
Participating providers: You pay 40%
Out-of-network providers: You pay 40%, and provider may balance bill

The standard rate depends on the network status of the provider:
Preferred providers: You pay 15% coinsurance
Participating providers: You pay 40%
Out-of-network providers: You pay 40%, and provider may balance bill

The standard rate depends on the network status of the provider:
Network providers: You pay 15% coinsurance
Non-network providers: You pay 50%
Out-of-network providers: You pay 50%, and provider may balance bill

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 plus 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 plus the inpatient copay.

Emergency room services**

$75 copay plus standard rate

Professional charges are billed separately from facility charges.

No copay, paid at standard rate

$75 copay plus standard rate

Professional charges are billed separately from facility charges.

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% (see more about specialty drugs)

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

No separate prescription drug deductible.

You pay 15% of allowed amount after deductible is met.

No deductible for covered prescription drugs.

Tiers:

  • Value: You pay 5%
  • Tier 1: 10%
  • Tier 2: 30%
  • Tier 3: 50% (see more about specialty drugs)

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

*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.

**For a medical emergency, you can see any provider, regardless of network status, and receive the network rate. However, if you see an out-of-network provider, they may balance bill you.

Contact

UMP Customer Service
Phone: 
1-888-849-3681
TRS: 711

Washington State Rx Services
Phone: 1-888-361-1611
TDD: 1-800-433-6313