Uniform Medical Plan (UMP)

Glossary

The UMP Glossary is currently being updated to include new and revised terms for plan year 2020.

Term Plan
Allowed amount, medical services UMP CDHP, UMP Classic, UMP Plus
Allowed amount, prescription drugs UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Ambulatory surgery center (ASC) UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Ancillary providers and services UMP Plus
Annual open enrollment UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Appeal UMP CDHP, UMP Classic, UMP Plus
Authorized representative UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Balance billing UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Brand-name drug UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Business day UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Calendar day UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Calendar year UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Chronic migraine UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Clinical review UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Coinsurance UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Coordination of benefits (COB) UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Copay UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Core network providers UMP Plus
Cost-share UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Custodial care UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Deductible UMP CDHP
Dependent UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Developmental delay UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Durable medical equipment (DME) UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Efficacy UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Emergency UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Emergency fill UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Enrollee UMP CDHP, UMP Classic, UMP Plus
Experimental or investigational UMP CDHP, UMP Classic, UMP Plus
Explanation of Benefits (EOB) UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Family UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Fee schedule UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Formulary UMP CDHP, UMP Classic, UMP Plus
Generic drug UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Generic equivalent UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Grievance UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Health Care Authority UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Health intervention UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Health Savings Account (HSA) UMP CDHP, UMP High Deductible
High-cost generic drugs UMP Classic, UMP Plus
High-deductible health plan (HDHP) UMP CDHP, UMP High Deductible
Home UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Home health agency UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Hospice UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Hospital UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Inpatient copay UMP Classic
Inpatient copay UMP Plus (PEBB), UMP Plus (SEBB)
Inpatient stay UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
IRO UMP CDHP, UMP Classic, UMP Plus
Limited benefit UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Maintenance care UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Medical UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Medical benefit UMP Classic, UMP Plus
Medical benefit UMP CDHP
Medical deductible UMP Classic
Medical deductible UMP Plus
Medical emergency UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Medical out-of-pocket limit UMP Achieve 1, UMP Achieve 2, UMP Classic, UMP Plus (PEBB), UMP Plus (SEBB)
Medically necessary or medical necessity UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Member UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Network UMP CDHP, UMP Classic, UMP Plus
Network pharmacy UMP CDHP, UMP Classic, UMP Plus
Network provider(s) UMP Plus
Network rate UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Network status UMP CDHP, UMP Classic
Network status UMP Plus
Network vaccination pharmacy UMP CDHP, UMP Classic, UMP Plus
Non-network pharmacy UMP CDHP, UMP Classic, UMP Plus
Noncovered services UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Nonduplication of benefits UMP Classic, UMP Plus
Nonduplication of benefits UMP CDHP
Nonpreferred drug UMP CDHP, UMP Classic, UMP Plus
Nonprescription alternative UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Nonprescription drug UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Normal benefit UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Occupational injury or illness UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Orthognathic surgery UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Out-of-network provider(s) UMP CDHP, UMP Classic, UMP Plus
Out-of-pocket limit UMP CDHP
Out-of-pocket limit, medical UMP Classic, UMP Plus
Out-of-pocket limit, prescription drugs UMP Classic, UMP Plus
Over-the-counter alternative UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Over-the-counter drugs UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Over-the-counter equivalent UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Participating provider UMP CDHP, UMP Classic, UMP Plus
Peer-reviewed medical literature UMP Achieve 1, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Pharmacy & therapeutics (P&T) committee UMP CDHP, UMP Classic, UMP Plus
Physician services UMP CDHP, UMP Classic, UMP Plus
Plan UMP CDHP, UMP Classic, UMP Plus
Preauthorization UMP CDHP, UMP Classic, UMP Plus
Preferred drug UMP Classic, UMP Plus
Preferred drug UMP CDHP
Preferred Drug List UMP CDHP
Preferred Drug List UMP Plus
Preferred Drug List UMP Classic
Preferred provider UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Preferred Provider Organization (PPO) UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Prenatal UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Prescription cost-limit UMP Classic, UMP Plus
Prescription drug deductible UMP Classic
Preventive care UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Primary care provider UMP CDHP, UMP Classic, UMP Plus
Primary payer UMP CDHP, UMP Classic, UMP Plus
Professional services UMP CDHP, UMP Classic, UMP Plus
Provider UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Provider network(s) UMP CDHP, UMP Classic
Public Employees Benefits Board (PEBB) UMP CDHP, UMP Classic, UMP Plus (PEBB)
Public Employees Benefits Board (PEBB) plan UMP CDHP, UMP Classic, UMP Plus (PEBB)
Public Employees Benefits Board (PEBB) Program UMP CDHP, UMP Classic, UMP Plus (PEBB)
Qualified medical expense UMP CDHP
Quantity limit UMP CDHP, UMP Classic, UMP Plus
Reconstructive surgery UMP CDHP, UMP Classic, UMP Plus
Regence service area UMP CDHP, UMP Classic, UMP Plus
Residential treatment facility UMP CDHP, UMP Classic, UMP Plus
Respite care UMP CDHP, UMP Classic, UMP Plus
Routine UMP CDHP, UMP Classic, UMP Plus
Scientific evidence UMP CDHP, UMP Classic, UMP Plus
Scope of practice UMP CDHP, UMP Classic, UMP Plus
Screening UMP CDHP, UMP Classic, UMP Plus
Secondary coverage UMP CDHP, UMP Classic, UMP Plus
Skilled nursing care UMP CDHP, UMP Classic, UMP Plus
Skilled nursing facility UMP CDHP, UMP Classic, UMP Plus
SmartHealth UMP CDHP, UMP Classic, UMP Plus
Specialty drugs UMP CDHP, UMP Classic, UMP Plus
Specialty provider(s) UMP Plus
Standard reference compendium UMP CDHP, UMP Classic, UMP Plus
State-registered domestic partner UMP CDHP, UMP Classic, UMP Plus
Subscriber UMP Achieve 1, UMP Achieve 2, UMP CDHP, UMP Classic, UMP High Deductible, UMP Plus (PEBB), UMP Plus (SEBB)
Substance use disorder UMP CDHP, UMP Classic, UMP Plus
Substance use disorder treatment facility UMP CDHP, UMP Classic, UMP Plus
Support network provider(s) UMP Plus
Therapeutic alternative UMP CDHP, UMP Classic, UMP Plus
Therapeutic equivalent UMP CDHP, UMP Classic, UMP Plus
Therapeutic interchange UMP CDHP, UMP Classic, UMP Plus
Tier UMP Classic, UMP Plus
Tobacco cessation services UMP CDHP, UMP Classic, UMP Plus
UMP Classic UMP Classic
UMP Consumer-Directed Health Plan (UMP CDHP) UMP CDHP
UMP Plus UMP Plus
UMP Plus–Puget Sound High Value Network (PSHVN) UMP Plus
UMP Plus–Puget Sound High Value Network (PSHVN) service area UMP Plus
UMP Plus–UW Medicine Accountable Care Network (UW Medicine ACN) UMP Plus
UMP Plus–UW Medicine ACN service area UMP Plus
Value Tier UMP Classic, UMP Plus