Forms & publications

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Medical Claim Form

This form is for sending in a claim for medical services for all Uniform Medical Plans.

Form

Medical Incident Report

This form is to report to Regence if an injury or illness may be covered under a third party. You may need to use this form even if the incident is not subject to third party coverage.

Form

Medical Multiple Coverage Inquiry Form (Medical Coordination of Benefits)

This form is to notify Regence that you have additional coverage under another medical plan.

Form

MODA-002_0.pdf

This form is to order prescription drugs from the UMP network mail-order pharmacy.

Form

Open Enrollment Benefits Handout 2017 for UMP Classic and Medicare

REG-006

This 3-page benefits fair handout describes benefits under UMP Classic and Medicare.

Publication

Open Enrollment Benefits Handout 2017 UMP Classic and UMP CDHP

REG-005

This 3-page handout compares benefits for UMP Classic and UMP CDHP.

Publication

Open Enrollment Benefits Handout 2017 UMP Classic and UMP Plus

REG-100

This benefits fair handout compares benefits of UMP Classic and UMP Plus.

Publication

Open Enrollment Benefits Handout 2018 for UMP Classic and Medicare

REG-006

This 3-page benefits fair handout describes benefits under UMP Classic and Medicare.

Publication

Open Enrollment Benefits Handout 2018 UMP Classic and UMP CDHP

REG-005

This 3-page handout compares benefits for UMP Classic and UMP CDHP.

Publication

Open Enrollment Benefits Handout 2018 UMP Classic and UMP Plus

REG-100

This benefits fair handout compares benefits for UMP Classic and UMP Plus.

Publication

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