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.

Out-of-pocket limit

How your out-of-pocket limit works

The out-of-pocket limit is the most you pay during a calendar year for covered services from preferred and participating providers. Once you meet this limit for the year, the plan pays for covered services by preferred and participating providers at 100 percent of the allowed amount.

Expenses are counted from January 1, 2019, or your first day of enrollment (whichever is later); through December 31, 2019, or your last day of enrollment (whichever is first).

Your out-of-pocket limit depends on the number of persons covered on the account.

  • One person covered: $4,200. 
  • Two or more persons covered: $8,400. Once an individual meets $6,850 in covered out-of-pocket expenses annually, the plan will pay for covered services at 100 percent for that individual.

What counts toward this limit?

What doesn’t count toward this limit?

  1. Amounts paid by the plan, including services covered in full.
  2. Your monthly premium.
  3. Non-network pharmacy charges that exceed the allowed amount.
  4. Balance billed amounts. 
  5. Your coinsurance paid to out-of-network providers (note that out-of-network coinsurance does count toward your deductible).
  6. Services not covered by the plan.
  7. Amounts that are more than a maximum dollar amount paid by the plan. For example, the plan pays a maximum of $150 for adult vision hardware once every two calendar years. Any amount you pay over $150 does not count toward the out-of-pocket limit.
  8. Amounts paid for services exceeding a benefit limit. For example, the benefit limit for acupuncture is 16 visits. If you have more than 16 acupuncture visits in one year, you will pay in full for those visits and what you pay will not count toward this limit.

Note: You will still be responsible for paying numbers 2–8 above after you meet your out-of-pocket limit.

You still pay for out-of-network provider services

Services by out-of-network providers are paid by the plan at 60 percent of the allowed amount (see below for exceptions). Even after you meet your out-of-pocket limit, you will pay 40 percent coinsurance for out-of-network provider services and the provider may still balance bill you. 


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