Glossary

UMP Classic

Allowed amount, medical services
Allowed amount, prescription drugs
Ambulatory surgery center (ASC)
Annual open enrollment
Appeal
Authorized representative
Balance billing
Brand-name drug
Business day
Calendar day
Calendar year
Chronic migraine
Clinical review
Coinsurance
Coordination of benefits (COB)
Copay
Cost-share
Custodial care
Dependent
Developmental delay
Durable medical equipment (DME)
Efficacy
Emergency
Emergency fill
Enrollee
Experimental or investigational
Explanation of Benefits (EOB)
Family
Fee schedule
Formulary
Generic drug
Generic equivalent
Grievance
Health Care Authority
Health intervention
High-cost generic drugs
Home
Home health agency
Hospice
Hospital
Inpatient copay
Inpatient stay
IRO
Limited benefit
Maintenance care
Medical
Medical benefit
Medical deductible
Medical emergency
Medical out-of-pocket limit
Medically necessary or medical necessity
Member
Network
Network pharmacy
Network rate
Network status
Network vaccination pharmacy
Non-network pharmacy
Noncovered services
Nonduplication of benefits
Nonpreferred drug
Nonprescription alternative
Nonprescription drug
Normal benefit
Occupational injury or illness
Orthognathic surgery
Out-of-network provider(s)
Out-of-pocket limit, medical
Out-of-pocket limit, prescription drugs
Over-the-counter alternative
Over-the-counter drugs
Over-the-counter equivalent
Participating provider
Peer-reviewed medical literature
Pharmacy & therapeutics (P&T) committee
Physician services
Plan
Preauthorization
Preferred drug
Preferred Drug List
Preferred provider
Preferred Provider Organization (PPO)
Prenatal
Prescription cost-limit
Prescription drug deductible
Preventive care
Primary care provider
Primary payer
Professional services
Provider
Provider network(s)
Public Employees Benefits Board (PEBB)
Public Employees Benefits Board (PEBB) plan
Public Employees Benefits Board (PEBB) Program
Quantity limit
Reconstructive surgery
Regence service area
Residential treatment facility
Respite care
Routine
Scientific evidence
Scope of practice
Screening
Secondary coverage
Skilled nursing care
Skilled nursing facility
SmartHealth
Specialty drugs
Standard reference compendium
State-registered domestic partner
Subscriber
Substance use disorder
Substance use disorder treatment facility
Therapeutic alternative
Therapeutic equivalent
Therapeutic interchange
Tier
Tobacco cessation services
UMP Classic
Value Tier

UMP CDHP

Allowed amount, medical services
Allowed amount, prescription drugs
Ambulatory surgery center (ASC)
Annual open enrollment
Appeal
Authorized representative
Balance billing
Brand-name drug
Business day
Calendar day
Calendar year
Chronic migraine
Clinical review
Coinsurance
Coordination of benefits (COB)
Copay
Cost-share
Custodial care
Deductible
Dependent
Developmental delay
Durable medical equipment (DME)
Efficacy
Emergency
Emergency fill
Enrollee
Experimental or investigational
Explanation of Benefits (EOB)
Family
Fee schedule
Formulary
Generic drug
Generic equivalent
Grievance
Health Care Authority
Health intervention
Health Savings Account (HSA)
High-deductible health plan (HDHP)
Home
Home health agency
Hospice
Hospital
Inpatient stay
IRO
Limited benefit
Maintenance care
Medical
Medical benefit
Medical emergency
Medically necessary or medical necessity
Member
Network
Network pharmacy
Network rate
Network status
Network vaccination pharmacy
Non-network pharmacy
Noncovered services
Nonduplication of benefits
Nonpreferred drug
Nonprescription alternative
Nonprescription drug
Normal benefit
Occupational injury or illness
Orthognathic surgery
Out-of-network provider(s)
Out-of-pocket limit
Over-the-counter alternative
Over-the-counter drugs
Over-the-counter equivalent
Participating provider
Peer-reviewed medical literature
Pharmacy & therapeutics (P&T) committee
Physician services
Plan
Preauthorization
Preferred drug
Preferred Drug List
Preferred provider
Preferred Provider Organization (PPO)
Prenatal
Preventive care
Primary care provider
Primary payer
Professional services
Provider
Provider network(s)
Public Employees Benefits Board (PEBB)
Public Employees Benefits Board (PEBB) plan
Public Employees Benefits Board (PEBB) Program
Qualified medical expense
Quantity limit
Reconstructive surgery
Regence service area
Residential treatment facility
Respite care
Routine
Scientific evidence
Scope of practice
Screening
Secondary coverage
Skilled nursing care
Skilled nursing facility
SmartHealth
Specialty drugs
Standard reference compendium
State-registered domestic partner
Subscriber
Substance use disorder
Substance use disorder treatment facility
Therapeutic alternative
Therapeutic equivalent
Therapeutic interchange
Tobacco cessation services
UMP Consumer-Directed Health Plan (UMP CDHP)

UMP Plus

Allowed amount, medical services
Ancillary providers and services
Appeal
Core network providers
Enrollee
Experimental or investigational
Formulary
High-cost generic drugs
IRO
Medical benefit
Medical deductible
Network
Network pharmacy
Network provider(s)
Network status
Network vaccination pharmacy
Non-network pharmacy
Nonduplication of benefits
Nonpreferred drug
Out-of-network provider(s)
Out-of-pocket limit, medical
Out-of-pocket limit, prescription drugs
Participating provider
Pharmacy & therapeutics (P&T) committee
Physician services
Plan
Preauthorization
Preferred drug
Preferred Drug List
Prescription cost-limit
Primary care provider
Primary payer
Professional services
Quantity limit
Reconstructive surgery
Regence service area
Residential treatment facility
Respite care
Routine
Scientific evidence
Scope of practice
Screening
Secondary coverage
Skilled nursing care
Skilled nursing facility
SmartHealth
Specialty drugs
Specialty provider(s)
Standard reference compendium
State-registered domestic partner
Substance use disorder
Substance use disorder treatment facility
Support network provider(s)
Therapeutic alternative
Therapeutic equivalent
Therapeutic interchange
Tier
Tobacco cessation services
UMP Plus
UMP Plus–Puget Sound High Value Network (PSHVN)
UMP Plus–Puget Sound High Value Network (PSHVN) service area
UMP Plus–UW Medicine Accountable Care Network (UW Medicine ACN)
UMP Plus–UW Medicine ACN service area
Value Tier

UMP Achieve 1

Allowed amount, prescription drugs
Ambulatory surgery center (ASC)
Annual open enrollment
Authorized representative
Balance billing
Brand-name drug
Business day
Calendar day
Calendar year
Chronic migraine
Clinical review
Coinsurance
Coordination of benefits (COB)
Copay
Cost-share
Custodial care
Dependent
Developmental delay
Durable medical equipment (DME)
Efficacy
Emergency
Emergency fill
Explanation of Benefits (EOB)
Family
Fee schedule
Generic drug
Generic equivalent
Grievance
Health Care Authority
Health intervention
Home
Home health agency
Hospice
Hospital
Inpatient stay
Limited benefit
Maintenance care
Medical
Medical emergency
Medical out-of-pocket limit
Medically necessary or medical necessity
Member
Network rate
Noncovered services
Nonprescription alternative
Nonprescription drug
Normal benefit
Occupational injury or illness
Orthognathic surgery
Over-the-counter alternative
Over-the-counter drugs
Over-the-counter equivalent
Peer-reviewed medical literature
Preferred provider
Preferred Provider Organization (PPO)
Prenatal
Preventive care
Provider
Subscriber

UMP Achieve 2

Allowed amount, prescription drugs
Ambulatory surgery center (ASC)
Annual open enrollment
Authorized representative
Balance billing
Brand-name drug
Business day
Calendar day
Calendar year
Chronic migraine
Clinical review
Coinsurance
Coordination of benefits (COB)
Copay
Cost-share
Custodial care
Dependent
Developmental delay
Durable medical equipment (DME)
Efficacy
Emergency
Emergency fill
Explanation of Benefits (EOB)
Family
Fee schedule
Generic drug
Generic equivalent
Grievance
Health Care Authority
Health intervention
Home
Home health agency
Hospice
Hospital
Inpatient stay
Limited benefit
Maintenance care
Medical
Medical emergency
Medical out-of-pocket limit
Medically necessary or medical necessity
Member
Network rate
Noncovered services
Nonprescription alternative
Nonprescription drug
Normal benefit
Occupational injury or illness
Orthognathic surgery
Over-the-counter alternative
Over-the-counter drugs
Over-the-counter equivalent
Preferred provider
Preferred Provider Organization (PPO)
Prenatal
Preventive care
Provider
Subscriber

UMP High Deductible

Allowed amount, prescription drugs
Ambulatory surgery center (ASC)
Annual open enrollment
Authorized representative
Balance billing
Brand-name drug
Business day
Calendar day
Calendar year
Chronic migraine
Clinical review
Coinsurance
Coordination of benefits (COB)
Copay
Cost-share
Custodial care
Dependent
Developmental delay
Durable medical equipment (DME)
Efficacy
Emergency
Emergency fill
Explanation of Benefits (EOB)
Family
Fee schedule
Generic drug
Generic equivalent
Grievance
Health Care Authority
Health intervention
Health Savings Account (HSA)
High-deductible health plan (HDHP)
Home
Home health agency
Hospice
Hospital
Inpatient stay
Limited benefit
Maintenance care
Medical
Medical emergency
Medically necessary or medical necessity
Member
Network rate
Noncovered services
Nonprescription alternative
Nonprescription drug
Normal benefit
Occupational injury or illness
Orthognathic surgery
Over-the-counter alternative
Over-the-counter drugs
Over-the-counter equivalent
Peer-reviewed medical literature
Preferred provider
Preferred Provider Organization (PPO)
Prenatal
Preventive care
Provider
Subscriber

UMP Plus (PEBB)

Allowed amount, prescription drugs
Ambulatory surgery center (ASC)
Annual open enrollment
Authorized representative
Balance billing
Brand-name drug
Business day
Calendar day
Calendar year
Chronic migraine
Clinical review
Coinsurance
Coordination of benefits (COB)
Copay
Cost-share
Custodial care
Dependent
Developmental delay
Durable medical equipment (DME)
Efficacy
Emergency
Emergency fill
Explanation of Benefits (EOB)
Family
Fee schedule
Generic drug
Generic equivalent
Grievance
Health Care Authority
Health intervention
Home
Home health agency
Hospice
Hospital
Inpatient copay
Inpatient stay
Limited benefit
Maintenance care
Medical
Medical emergency
Medical out-of-pocket limit
Medically necessary or medical necessity
Member
Network rate
Noncovered services
Nonprescription alternative
Nonprescription drug
Normal benefit
Occupational injury or illness
Orthognathic surgery
Over-the-counter alternative
Over-the-counter drugs
Over-the-counter equivalent
Peer-reviewed medical literature
Preferred provider
Preferred Provider Organization (PPO)
Prenatal
Preventive care
Provider
Public Employees Benefits Board (PEBB)
Public Employees Benefits Board (PEBB) plan
Public Employees Benefits Board (PEBB) Program
Subscriber

UMP Plus (SEBB)

Allowed amount, prescription drugs
Ambulatory surgery center (ASC)
Annual open enrollment
Authorized representative
Balance billing
Brand-name drug
Business day
Calendar day
Calendar year
Chronic migraine
Clinical review
Coinsurance
Coordination of benefits (COB)
Copay
Cost-share
Custodial care
Dependent
Developmental delay
Durable medical equipment (DME)
Efficacy
Emergency
Emergency fill
Explanation of Benefits (EOB)
Family
Fee schedule
Generic drug
Generic equivalent
Grievance
Health Care Authority
Health intervention
Home
Home health agency
Hospice
Hospital
Inpatient copay
Inpatient stay
Limited benefit
Maintenance care
Medical
Medical emergency
Medical out-of-pocket limit
Medically necessary or medical necessity
Member
Network rate
Noncovered services
Nonprescription alternative
Nonprescription drug
Normal benefit
Occupational injury or illness
Orthognathic surgery
Over-the-counter alternative
Over-the-counter drugs
Over-the-counter equivalent
Peer-reviewed medical literature
Preferred provider
Preferred Provider Organization (PPO)
Prenatal
Preventive care
Provider
Subscriber

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.

Over-the-counter alternative

An over-the-counter alternative drug is a drug that you may buy without a prescription that has similar safety, efficacy, and ingredients as a prescription drug.

Uniform Medical Plan (UMP)

Glossary

Over-the-counter alternative

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Uniform Medical Plan (UMP)

Glossary

Over-the-counter alternative

Related links

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