Forms available online

Note: Due to requirements regarding secure transmission of confidential information, we cannot post forms that may be filled and submitted online. However, you may print and complete the forms below and send via mail. Some may be filled in onscreen, then printed and mailed.

Medical forms

To find a Release of Information form, call UMP Customer Service at 1-888-849-3681 (TRS: 711), or log in to your Regence account.

Prescription drug forms

Health Savings Account (HSA) form

Eligibility and enrollment forms

All of the forms related to eligibility, enrollment, dependent certification, payroll deduction, and more are available on the Employee and Retiree Benefits Forms and publications page:

Contact

UMP Customer Service
Phone: 1-888--849-3681
TRS: 711
Business hours: Monday-Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific time (PT)

Washington State Rx Services
Phone: 1-888-361-1611
TRS: 711
Business hours: 24 hours a day, 7 days a week

Postal Prescription Services (PPS)
Online: www.ppsrx.com
Phone: 1-800-552-6694

Ardon Health
Phone: 1-855-425-4085
Business hours: Monday-Friday 8 a.m. to 7 p.m. and Saturday 8 a.m. to 12 p.m. PT

PEBB Program
Phone: 1-800-200-1004
TRS: 711
Business hours: Monday-Friday 8 a.m. to 5 p.m. PT