Summary of benefits
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:
- Services that require preauthorization.
- Services for which your provider must notify the plan.
- Services that are not covered (exclusions).
- List of HTCC decisions.
- Summary of benefits table in your certificate of coverage.
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).
|Benefit||How much I'll pay
(See descriptions of types of services listed below)
|Ambulance||Special: Select link on left for benefit details.|
|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|
|Emergency room (ER)||
|Family planning services||
|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.|
|Mastectomy and breast reconstruction||Standard|
|Mental health treatment (Inpatient services)||Inpatient|
|Mental health treatment (Outpatient services)||Standard|
|Naturopathic physician services||Standard|
|Inpatient (standard for related outpatient visits)
Some breast pumps are covered as preventive.
|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)
|Surgery (Outpatient services)||Standard|
|Tobacco cessation services||Preventive|
|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.|
UMP Customer Service (medical benefits)
Online: Your Regence account
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
Business hours: 24 hours a day, 7 days a week