Summary of benefits

Some benefits are affected by Health Technology Clinical Committee (HTCC) decisions.

How does this work?

Below is a list of select services covered by UMP CDHP, including general payment information.

Call UMP Customer Service at 1-888-849-3681 (TTY: 711) with any questions or if you have trouble opening the links below.

Please note that not all covered services are listed here. Also see the list of certain services not covered by the plan; it is not a complete list of all services not covered.

If you would like more information about the benefits listed below, you can read your UMP CDHP Certificate of Coverage, the Summary of Benefits and Coverage, or the Regence medical policies

Benefit
Select link for benefit details
How much I'll pay
(See descriptions of service types listed below)
Acupuncture Standard
Limited benefit: Select benefit link for limits.
Ambulance Special: Select link on left for benefit details.

Applied Behavior Analysis (ABA) Therapy

HTCC decision on ABA Therapy​

Standard
See link at left for limits and requirements.
Autism treatment Standard

Bariatric surgery

HTCC decision on bariatric surgery​

Standard, Inpatient

Breast health screening tests

HTCC decision on breast MRI​

Standard, Preventive
Chemical dependency treatment Standard, Inpatient, Outpatient
Dental services Special: Select link on left for benefit details.
Diabetes care supplies Prescription drugs
Diabetes education Standard
Diabetes prevention program Preventive

Diagnostic tests, laboratory, and X-rays

See list of all HTCC decision to find specific tests

Standard
Dialysis Standard

Durable medical equipment, supplies, and prostheses

HTCC decision on microprocessor-controlled lower limb prosthetics​

Standard
Emergency room
Must be a medical emergency
Standard
End-of-life counseling Standard
Family planning services Preventive, Standard, Prescription drugs
See benefit link at left for details
Foot care, maintenance Standard
Genetic services Standard
Hearing care (related to diseases and disorders of the ear) Standard
Hearing exams and hearing aids (Routine) Preventive, Special
Limited benefit: Select benefit link for limits.
Home health care Standard
Hospice care (inpatient, outpatient, and respite care) Standard, Inpatient, Outpatient, Prescription drugs 
See benefit link at left for details
Hospital services Standard, Inpatient, Outpatient
Immunizations Preventive
Joint replacement, knees and hips–Center of Excellence (COE) Program Special: Select link on left for benefit details.

Knee arthroplasty

HTCC decision on knee arthroplasty​

Standard
Mammograms Preventive, Standard
See benefit link at left for details
Massage therapy Standard
Limited benefit: Select benefit link for limits.
Mastectomy and breast reconstruction Standard, Inpatient
Mental health treatment Standard, Inpatient, Outpatient
Naturopathic physician services Standard
See benefit link at left for details
Nutrition counseling and therapy Standard

Obstetric and newborn care

HTCC decision on routine ultrasound for pregnancy​

Standard, Inpatient
Office visits Standard
Orthognathic surgery Standard, Inpatient, Outpatient
Physical, occupational, speech, and neurodevelopmental therapy Standard
Limited benefit: Select benefit link for limits.
Prescription drugs See What you pay for drugs
Preventive care Preventive
Second opinions Special: Select link on left for benefit details.
Skilled nursing facility Standard, Inpatient
Spinal and extremity manipulations Standard
Limited benefit: Select benefit link for limits.

Spinal injections

HTCC decision on spinal injections​

Standard

Surgery

See list of all HTCC decisions for specific procedures

Standard, Inpatient
Telemedicine services Standard
See benefit link at left for details
Temporomandibular Joint (TMJ) treatment Standard
Tobacco cessation services Special: Select link on left for benefit details.
Transgender health Standard
Transplants Standard, Inpatient
Urgent care Standard
Vision care (related to diseases and disorders of the eye) Standard
Vision exams (routine) Preventive
Vision hardware (eyeglasses and contact lenses) Special: Select link on left for benefit details.

Contact

UMP Customer Service (medical benefits)
Phone: 1-888-849-3681
TTY: 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 (prescription drugs)
Phone: 1-888-361-1611
TDD: 1-800-433-6313
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. PT