Summary of benefits

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

How does this work?

Only certain services are listed in the table below. For those not listed, see the alphabetical list of covered benefits in your certificate of coverage.

Not all details, such as benefit limitations or exclusions, are included in the table. Also review:

If you have questions about your benefits, services that require preauthorization or plan notification, or services not covered by the plan, call UMP Customer Service at 1-888-849-3681 (TRS: 711).

If you would like more information about the benefits listed below, you can read your UMP CDHP 2019 Certificate of Coverage, the Summaries of Benefits and Coverage, or the medical policies

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

Applied Behavior Analysis (ABA) Therapy

Standard

Breast health screening tests

See "Mammograms" below.
Chiropractic physician services See "Spinal and extremity manipulations" below.
Contraceptive services Preventive or special
Special: Select link on left for benefit details.
Dental services Special: Select link on left for benefit details.
Diabetes care supplies Special: Select link on left for benefit details.
Diabetes Control Program Preventive
Diabetes Prevention Program Preventive

Diagnostic tests, laboratory, and x-rays

Standard

Durable medical equipment, supplies, and prostheses

Standard
Emergency room (ER)

Standard
Select link on left for benefit details, including coverage of emergency services at out-of-network facilities. See also Medical emergency.

End-of-life counseling
  • If received as part of hospice services: Paid at 100% after meeting your deductible.
  • If received outside of hospice services: standard.
Family planning services

Standard
Some contraceptive services are covered as preventive. Deductible applies to male condoms and male spermicides.

Headaches, chronic migraines or tension Standard: Covered Botox injections for migraines
All other specified treatments not covered
Hearing aids  Special: Select link on left for benefit details.
Hearing exams (routine) Standard
Home health care Standard
Hospice care (inpatient, outpatient, and respite care) Special: Select link on left for benefit details.
Hospital services (Inpatient services) Inpatient
Hospital services (Outpatient services) Standard
Immunizations (Vaccines) Preventive (usually)
Joint replacement, knees and hips–Centers of Excellence (COE) Program Special: Select link on left for benefit details.
Mammograms (Diagnostic) Standard
Mammograms (Screening) Preventive
Massage therapy Standard
Mastectomy and breast reconstruction Standard
Mental health treatment (Inpatient services) Inpatient
Mental health treatment (Outpatient services) Standard
Naturopathic physician services Standard

Obstetric and newborn care

Inpatient (standard for related outpatient visits)
Some breast pumps are covered as preventive.
Office visits Standard
Physical, occupational, speech, and neurodevelopmental therapy Standard
Inpatient services are usually charged separately from facility charges.
Prescription drugs  15% after deductible is met. Also see What you pay for drugs.
Preventive care (Includes vaccines, routine exams, some screening tests) Preventive
Skilled nursing facility Inpatient
Some services may be billed separately (such as physical therapy).
Spinal and extremity manipulations Standard
Spine care–Centers of Excellence (COE) Program Special: Select link on left for benefit details.
Substance use disorder treatment (Inpatient services) Inpatient
Substance use disorder treatment (Outpatient services) Standard

Surgery (Inpatient services)

Inpatient
Surgery (Outpatient services) Standard
Telemedicine services Standard
Tobacco cessation services Preventive
Transgender health Standard
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.
Well-child visits Preventive

Contact

UMP Customer Service (medical benefits)
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 (prescription drugs)
Online: Your pharmacy account
Phone: 1-888-361-1611
TRS: 711
Business hours: 24 hours a day, 7 days a week