Uniform Medical Plan (UMP)

The UMP website is moving. This website contains 2019 UMP information for PEBB members only (through the end of 2019). If you are a PEBB member and/or you will be a new School Employees Benefits Board (SEBB) member and you need 2020 UMP benefits information, visit our new UMP website.

Compare medical plans

Medical coverage

Regence BlueShield administers medical services for all UMP plans. That means they perform UMP's administrative work, such as processing claims, providing customer service, and contracting with providers.

Here's how the UMP plans are the same:

  • You pay 15 percent coinsurance for most services from a preferred provider (network provider for UMP Plus).
  • 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 more for services outside the network.

Here are some differences:

  • UMP Plus members get free office visits with network primary care providers. 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 percent 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 Division Customer Service at 1-800-200-1004 (TRS: 711) 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 is a tax-advantaged spending and savings account that can be used to pay for qualified medical expenses. Your HSA is funded by pre-tax contributions from you, your employer, or both.

The State of Washington will contribute $700.08 for one person, and $1,400.04 for more than one person on an HSA account. The amount is deposited in equal amounts over the calendar year. Visit the Health Savings Account webpage for details.

Medical FSA

PEBB benefits-eligible employees who work at state agencies, higher-education institutions and community and technical colleges may be eligible to enroll in a Medical Flexible Spending Arrangement (FSA). The Medical FSA is an employer-sponsored benefit that allows you to set aside money from your paycheck on a pretax basis to pay for out-of-pocket health care costs. Learn more about Medical FSAs on the PEBB Program web pages.

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 (2 or more)

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

Note: No single member pays more than $6,850 for covered services from preferred providers.

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

Prescription drug out-of-pocket limit

$2,000 per person
No family maximum

No separate prescription drug limit

$2,000 per person
No family maximum

Preventive

(These visits are not subject to the deductible.)

100% covered with preferred providers

100% covered with preferred providers

100% covered with 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 network primary care provider. Related services may be covered as standard.

Standard

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

The standard rate depends on the network status of the provider:

Preferred providers: You pay
15% allowed amount
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% allowed amount
Out-of-network providers: You pay 50%, and provider may balance bill

Inpatient services (hospital, facility)

Non-Medicare: $200 per day copayment at preferred facilities, $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.

The standard rate depends on the network status of the provider:

Preferred providers: You pay
15% allowed amount
Participating providers: You pay 40%
Out-of-network providers: You pay 40%, and provider may balance bill

$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

You are usually billed separately for facility charges, professional services, and lab tests, x-rays, and other imaging tests.

Standard rate

$75 copay plus standard rate

You are usually billed separately for facility charges, professional services, and lab tests, x-rays, and other imaging tests.

Prescription drugs

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

Tiers:

  • Preventive: You pay nothing
  • Value: You pay 5%
  • Tier 1: 10%
  • Tier 2: 30%
  • Tier 3: 50% (see more about specialty drugs)

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

No separate prescription drug deductible.

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

No deductible for covered prescription drugs.

Tiers:

  • Preventive: You pay nothing
  • 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.

 

Contact

UMP Customer Service
Online:
Your Regence account
Phone: 1-888-849-3681
TRS: 711
Business hours: Monday through Friday 5 a.m. to 8 p.m.; Saturday 8 a.m. to 4:30 p.m. (Pacific)

Washington State Rx Services
Online: Your pharmacy account
Phone: 1-888-361-1611
TRS: 711
Business hours: 24 hours a day, 7 days a week