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.

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:


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

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

Postal Prescription Services (PPS)
Online: Your PPS account
Phone: 1-800-552-6694

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

PEBB Program
Online: PEBB Program home page
Phone: 1-800-200-1004
TRS: 711
Business hours: Monday through Friday 8 a.m. to 5 p.m. (Pacific)