Uniform Medical Plan (UMP)

Glossary

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

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