Knee and hip replacement

The Center of Excellence (COE) Program covers knee and hip replacement surgery at little to no cost for qualifying UMP Classic and UMP CDHP members.

Watch this video to learn what a UMP member experiences while participating in the COE Program.

Learn more about this benefit.

Visit Premera's COE page

Why create the COE Program?

The Health Care Authority (HCA) works to provide high-quality health care at lower costs to our members. That is why HCA has created the Center of Excellence (COE) Program for eligible UMP Classic and UMP CDHP members.

Through this program, HCA contracts with providers who specialize in treating certain medical conditions. These providers are named Centers of Excellence because they have proven their ability to provide excellent service with successful results for patients with those conditions.

HCA has chosen Virginia Mason as the Center of Excellence for knee and hip replacement surgery. The COE Program, administered by Premera Blue Cross, is only available at Virginia Mason.

Eligibility for the program

This program is open to UMP Classic and UMP CDHP members who:

  • Are age 18 or older.
  • Are not enrolled in Medicare as their primary coverage.

Virginia Mason must determine if joint replacement is appropriate for you based on established medical guidelines.

Note: This program is not available to members enrolled in Medicare as their primary coverage or UMP Plus members. Medicare members still have access to covered services related to joint replacement outside of this program. These services are paid at the standard rate.

Your cost for this benefit

To learn about your cost-share for this benefit, read the "Joint replacement surgery" section in your UMP Classic or UMP CDHP certificate of coverage. 

Members having surgery under the COE Program may qualify for assistance with travel and lodging expenses. All travel arrangements must be made through Premera to be covered.

If you choose to drive, mileage reimbursements are determined by the IRS rates for medical mileage. If you choose to fly, you must travel to and from one of the airports listed on Premera's travel benefit page.

Getting started

If you are interested in participating in the COE Program:

  • You may self-refer by calling Premera at 1-855-784-4563.
  • Your regular provider may refer you.

You may receive information in the mail about the COE Program, which will explain how the program works and whom to contact for more information.

After you apply, Premera will determine if you are eligible to be considered for the COE Program. If you are, Premera will refer you to Virginia Mason for further assessment. Next, Virginia Mason will review your medical records to determine if you are eligible for surgery. Note: You may be required to follow a plan Virginia Mason gives you as a condition of approval for surgery.

Visit Premera's COE page for more information about Virginia Mason's clinical review requirements.

Contact

Premera Customer Service
Phone: 1-855-784-4563
Business hours: 7 a.m. to 5 p.m. Monday - Friday