Forms & publications

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UMP (SEBB) Preferred Drug List 2020

This document is the Preferred Drug List (PDL) for the Uniform Medical Plan (UMP). It lists prescription drugs covered by UMP.

Publication

UMP Appeals and Grievance Form

This form may be included in an appeal or complaint, but is not required. It helps the member include all the necessary information for an appeal or complaint, and it includes the address and fax number where they should be submitted.

Form

UMP Classic 2017 Certificate of Coverage (COC)

54-550 10-16

This benefits book describes what is covered under UMP 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 UMP Classic.

Publication

UMP Classic 2018 Certificate of Coverage (COC)

54-550

This book describes what is covered under UMP Classic, including medical services and prescription drugs. It describes how to find providers and how much you'll pay to see them (including your deductible and coinsurance, and out-of-pocket limit). Your COC also describes how to request an appeal and how to submit a claim.

Publication

UMP Classic 2019 Certificate of Coverage (COC)

54-550 10-18

This book describes what is covered under UMP Classic, 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

UMP Classic and UMP Plus: 2019 High-cost generic drugs

This is a 2019 list of generic prescription drugs covered at Tier 2 under UMP Classic and UMP Plus. The list is subject to change throughout the year, so check back regularly for updates.

Publication

UMP Classic and UMP Plus: Value Tier Drugs

This is a list of drugs covered under the Value Tier cost-share for UMP Classic and UMP Plus.

Publication

UMP Consumer-Directed Health Plan (UMP CDHP) 2017 Certificate of Coverage (COC)

54-549 10-16

This benefits book describes what is covered under UMP 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 your deductible and coinsurance, and out-of-pocket limit. It also includes your Health Savings Account, how to request an appeal, and submit a claim.

Publication

UMP Consumer-Directed Health Plan (UMP CDHP) 2018 Certificate of Coverage (COC)

54-549 5-18

This book describes your benefits under UMP CDHP, including medical services and prescription drugs. It describes how to find preferred providers and how much you'll pay to see them (including your deductible and coinsurance, and out-of-pocket limit). It also explains how your Health Savings Account works, how to request an appeal, and how to submit a claim.

Publication

UMP Consumer-Directed Health Plan (UMP CDHP) 2019 Certificate of Coverage (COC)

54-549 10-18

This book describes your benefits under UMP CDHP, including medical services and prescription drugs. It describes how to find preferred providers and how much you'll pay to see them (including your deductible, coinsurance, and out-of-pocket limit). It also explains how your Health Savings Account (HSA) works, how to request an appeal, and how to submit a claim.

Publication

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