Forms & publications

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

2017-2018 comparison of UMP monthly premiums

54-510

This document lists the 2017 and 2018 monthly premiums for UMP members who are employees and retirees.

Publication

2018-2019 comparison of UMP monthly premiums

54-510

This document lists the 2018 and 2019 monthly premiums for UMP members who are employees and retirees.

Publication

2019-2020 comparison of UMP monthly premiums

54-510

This document lists the 2019 and 2020 monthly premiums for UMP members who are employees and retirees.

Publication

2020 UMP Achieve 1 (SEBB) Certificate of Coverage

This book describes what is covered under UMP Achieve 1, 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.

Publication

2020 UMP Achieve 2 (SEBB) Certificate of Coverage

This book describes what is covered under UMP Achieve 2 (SEBB), 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.

Publication

2020 UMP High Deductible (SEBB) Certificate of Coverage

This book describes what is covered under UMP High Deductible, 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.

Publication

2020 UMP Plus–Puget Sound High Value Network (SEBB) Certificate of Coverage

This book describes what is covered under UMP Plus–PSHVN (SEBB), 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.

Publication

2020 UMP Plus–UW Medicine Accountable Care Network (SEBB) Certificate of Coverage

This book describes what is covered under UMP Plus–UW Medicine ACN (SEBB), 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.

Publication

ABA Services Authorization Form

This form is for requesting preauthorization of Applied Behavior Analysis (ABA) Therapy services.

Form

Ardon Health Protected Information Disclosure Authorization Form

15350288

Ardon Health Protected health information disclosure authorization form

Form

Pages