UMP Classic and UMP CDHP cover the full cost of the services listed below, under the conditions described.
It might be hard to remember to go to the doctor when you’re not sick, but getting an annual check-up and other preventive care is one of the easiest ways to protect your health. Plus, when you see a preferred provider for these services, you pay nothing.
You may call UMP Customer Service at 1-888-849-3681 (TRS: 711) to ask if a medical service is covered as preventive. Call Washington State Rx services Customer Service at 1-888-361-1611 (TRS: 711) for questions about preventive prescription drugs.
Diabetes Control Program
For non-Medicare members ages 18 and older with a diagnosis of diabetes, the plan covers 100 percent for Diabetes Control Program administered by the Case Management Program at Regence. This program is exempt from the medical deductible.
Case managers are trained to help you reduce the risk of complications of diabetes by tracking and controlling blood sugar, cholesterol levels, blood pressure, and weight in a series of quarterly consultations.
You can find out if you qualify for the program at screening events scheduled at your employer worksite, or you can visit your primary care provider for a blood sugar laboratory test. If you see a screening vendor, they will tell you if you meet criteria to participate in the program at the time of the screening. If you see your primary care provider, they will tell you if you meet criteria once the laboratory results are available.
If you qualify for the Diabetes Control Program, you can self-refer by calling 866-543-5765.
Diabetes Prevention Program (DPP)
Alert: These programs are not available to Medicare retirees enrolled in UMP.
For non-Medicare members ages 18 and older, the plan covers 100 percent for the Diabetes Prevention Program (DPP).
If you have prediabetes or are at high risk of developing prediabetes you have access to a virtual (online) DPP through Omada Health. You can take an online screening questionnaire to see if you meet the program’s criteria by visiting Omada Health and creating an account.
If you meet the criteria, you can participate in the program at no cost to you. The virtual program includes a professional health coach, a wireless scale, and weekly online classes with a small group of participants who provide real-time support.
Instead of the online questionnaire, you can qualify for the program:
- If your provider ordered a blood sugar test in the last 12 months; and
- The test showed you are in the prediabetes range.
Contact UMP Customer Service at 1-888-849-3681 (TRS: 711) for more information.
Members already enrolled in the YMCA’s DPP classes who have additional classes remaining, may continue to participate in the in-person classes.
Nicotine replacement therapy
UMP Classic and UMP cover only certain nicotine replacement therapy products as preventive (at no cost to you), designated on the UMP Preferred Drug List with “PV” in the Tier column.
Over-the-counter drugs are normally not covered by UMP, but nicotine replacement products are covered when they are purchased at a pharmacy using your UMP ID card. You may get nicotine replacement therapy directly from the Quit for Life program, or by following these steps:
- Get a prescription from your provider.
- Take the prescription to a network pharmacy.
- Make your purchase at the pharmacy counter of the network pharmacy. Give your prescription and your UMP ID card to the pharmacist. The purchase must be submitted through the prescription drug system to be covered. CDHP
If you get a nicotine replacement therapy product not designated as preventive, you will pay as follows:
- UMP Classic: any remaining prescription drug deductible and Tier 3 coinsurance.
- UMP CDHP: any remaining deductible and 15 percent coinsurance.
The plan does not cover e-cigarettes or vaporizers (“vapes”).
The plan also covers in-person counseling related to tobacco cessation at no cost to you when you see a preferred or participating provider. Phone or online counseling is covered only through the Quit for Life program. UMP members age 17 and under may use the Smokefree Teen program.
UMP Classic and UMP CDHP members age 18 and older may participate in the Quit for Life tobacco cessation program. This program offers phone counseling in addition to the services described above at no cost to you. Read your UMP Classic or UMP CDHP certificate of coverage to learn more.
UMP Classic or UMP CDHP members age 17 and under may use the Smokefree Teen program in addition to nicotine replacement therapy and counseling.