If you have other coverage

If you or your dependents have other insurance, you must let Regence BlueShield and Washington State Rx Services know so claims are paid correctly: 

Contact information for Regence and Washington State Rx Services is available at the bottom of this page.

Note: If your coverage under other plans changes, please call UMP Customer Service at 1-888-849-3681 right away.

For complete information, see "If you have other medical coverage" in your plan's certificate of coverage (COC).

Read your COC

How coordination of benefits works

Coordination of benefits happens when you have health coverage through two or more groups (such as your employer and your spouse’s employer), and these two group health plans both pay a portion of your health care claims. 

The "If you have other medical coverage" section in your UMP certificate of coverage explains the rules that determine which plan pays first ("primary payer") and which pays second ("secondary payer"). UMP processes claims differently when it pays first or second.

Tip: If you have other health coverage, it is important that you let all of your providers know, including the pharmacies where you get your prescription drugs.

How UMP works when it pays first

If UMP is your primary payer (pays first), UMP  pays the normal benefit as described in your certificate of coverage.

If you are enrolled in another health plan and have questions about how that plan coordinates benefits, you should contact that plan. You may need to send UMP's Explanation of Benefits and a copy of your provider’s bill to your secondary payer to receive payment. Check with that plan for more information.

If you are unsure about which plan is primary, contact UMP Customer Service at 1-888-849-3681 (TRS: 711).

Note: If you or your dependents are enrolled in UMP CDHP and want to enroll in another health plan, you and your dependents can only enroll in other high-deductible health plans. The second high-deductible health plan cannot include an HSA. See your UMP CDHP certificate of coverage for more information on secondary health plans and limitations. 

Because of this limitation, whenever we refer to "another health plan,"  "another group plan," or  “another plan,” on this webpage, this means a high-deductible health plan for UMP CDHP members.

How UMP works when it pays second

Tip: Different rules apply to members who have Medicare as their primary plan. See For Medicare retirees for more information.

UMP uses a type of coordination of benefits called nonduplication of benefits (see definition for UMP Classic and UMP Plus or UMP CDHP), except for Medicare retirees.

When UMP pays second to another group plan that covers you, UMP will pay only an amount needed to bring the total benefit up to the amount UMP would have paid if you did not have another plan. Read the "How UMP  coordinates benefits when it pays second" in your certificate of coverage for examples of how this works.

The intent of this type of coordination of benefits is to maintain the level of benefits available through the UMP plans. It is not designed to pay your covered expenses in full.

When UMP pays second, you must still pay your medical deductible (deductible for CDHP) before UMP pays benefits. Remember, your costs will usually be higher if you see out-of-network providers.

Please contact UMP Customer Service at 1-888-849-3681 (TRS: 711) for help with any questions when you or a family member is covered by more than one plan. 

How prescription drug coverage works

Note: UMP covers diabetes care supplies under the prescription drug benefit. How the claim is processed when UMP pays second may depend on where you get your supplies. See "If you have other medical coverage" in your plan's certificate of coverage for more information.

For Medicare retirees coverage may be different depending on whether Medicare pays the claim under the Part B medical benefit. Read "Diabetes care supplies when Medicare pays first" for more information.

Some of the limits and restrictions to prescription drug coverage will apply when UMP pays second to another plan. Read the "Guidelines for drugs UMP covers" section of your certificate of coverage for details.

To learn how to submit a prescription drug claim, read Submitting a claim.

Note: If UMP pays second to a plan other than Medicare, nonduplication of benefits applies. This means that UMP may pay nothing after your primary plan pays.

Here's how to get the most out of your drug coverage:

  • At network pharmacies: If you have primary coverage through another plan that covers prescription drugs, show both plan cards to the pharmacy and make sure they know which plan pays first. It is important that the pharmacy bills the plans in the correct order, or claims may be denied or paid incorrectly.
  • At the mail-order pharmacy: If your primary plan, except for Medicare, uses Postal Prescription Services (PPS) as the plan's network mail-order pharmacy, PPS can process payments for both plans and charge only what’s left. Make sure PPS has the information for both plans and knows which plan is primary. However, if your primary plan uses a different mail-order pharmacy, you will have to use your primary plan’s mail order, then submit a paper claim for payment by UMP.

For UMP Classic members only: If UMP Classic pays second, you must still pay your prescription drug deductible before UMP Classic covers Tier 2 and Tier 3 drugs.

Submit secondary claims promptly

Note: When UMP pays second to Medicare you will not have to submit a claim for medical services because your providers bill Medicare. However, you may still need to submit a claim for prescription drugs. For more information, read "How UMP Classic prescription drug coverage works with Medicare" in your certificate of coverage.

All health plans have deadlines for filing a claim, called a “timely filing” requirement. The timely filing deadline for UMP is 12 months from the date of service. If a claim is not submitted within 12 months from the date of service, UMP will deny it.

If your primary plan delays payment on a claim, the claim should be submitted to UMP (for medical services) or Washington State Rx Services (for prescription drugs) within 12 months of the date of service or purchase to prevent denial of the claim.

UMP will try to contact your primary plan for their benefit payment information or may estimate it in order to provide you with timely processing of your secondary benefit. Adjustments may be made when the primary plan finally pays their portion of your claim.

Promptly notifying your providers of any change to your coverage will help avoid errors and delays in processing of claims.

See Submitting a claim for more information. 

Occupational injury or illness (worker's compensation) claims

UMP does not coordinate with worker's compensation claims. When a claim for workers’ compensation is accepted as being caused by a work-related injury or illness, all services related to that injury or illness are not covered, even if some services are denied by workers’ compensation.

You must file a workers’ compensation claim with your workers’ compensation carrier. If your claim for workers’ compensation is denied because it is determined the injury or condition is not related to an occupational injury or illness, UMP will pay for covered services under the terms of  your plan's certificate of coverage.

For more information read "Does UMP coordinate with occupational injury or illness (worker's compensation) claims?" in your plan's certificate of coverage.

Contact

UMP Customer Service (Regence BlueShield)
Fax: 1-877-357-3418
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)
Mailing Address:
Regence BlueShield
Attn: UMP Claims
PO Box 91015
MS BU 386
Seattle, WA 98111-9115

Washington State Rx Services
Fax: 503-412-4058
Phone: 1-888-361-1611 (TRS: 711)
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. PT
Mailing Address:
Washington State Rx Services
PO Box 40168
Portland, OR 97240-0168

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