Preventive care

For complete information, read the "Preventive Care" section in your Certificate of Coverage.

Find your Certificate of Coverage

Preventive care for UMP Classic and UMP CDHP

You don't have to meet your deductible (or medical deductible for UMP Classic) before the plan pays for services covered under the preventive care benefit. When you see a preferred provider for these services, you pay nothing. If you see an out-of-network provider, you pay 40% of the allowed amount, and the provider may balance bill you. However, if you do not have access to a preferred provider for preventive services, the plan may pay 100% of billed charges.

For a list of services covered as preventive, visit HealthCare.gov. This site also features links to specific preventive services covered for women and children. Note that recommendations added during the calendar year may not be covered as preventive until later years.

Examples of services covered as preventive care

  • Preventive visits such as well-baby care and annual physical exams.
  • Preventive vision acuity screening from birth through 18 years of age.
  • Intensive behavioral counseling for adults who are overweight or obese and have additional cardiovascular disease risk factors.
  • Screening for hepatitis B for non-pregnant adolescents and adults at high risk.
  • Routine screenings for women (see list below for examples).
  • Certain radiology and lab tests such as screening mammograms.
  • Screening procedures such as colonoscopy; see "Coverage of diagnostic tests, laboratory, and x-rays" for coverage of colonoscopy performed to diagnose or treat disease or illness.
  • One-time screening by ultrasound for abdominal aortic aneurysm, for men ages 65-75 who have ever smoked.
  • Immunizations as explained below.
  • Hearing tests as part of a newborn screening.
  • Fluoride for prevention of caries (dental decay); prescribed by primary care provider to children age 6 months and older, when water is fluoride deficient.
  • Certain screening tests performed during pregnancy.

You may call Customer Service at 1-888-849-3681 to ask if a service is covered as preventive.

Preventive services specifically for women

  • Human Papillomavirus (HPV) testing for women ages 30 and over, once every three years.
  • Chlamydia and gonorrhea testing in sexually active women age 24 years and younger, and for women age 25 and older who are at increased risk for infection.
  • Education and counseling regarding contraception.
  • Counseling and screening for HIV; counseling and screening for interpersonal and domestic violence; and counseling for sexually transmitted infections.

For more services covered as preventive for women, read the following sections in your plan's Certificate of Coverage:

Note: Prostate cancer screening (prostate-specific antigen [PSA] testing) is not covered under the preventive care benefit, but is covered as a medical benefit (subject to the deductible and coinsurance).

ALERT! Follow-up visits or tests, or other services received during preventive care visits, are not covered under the preventive care benefit.

Covered immunizations

The plan covers immunizations as included on the applicable immunization schedule (children, adolescents, adults) for U.S. residents by the Centers for Disease Control and Prevention (CDC). See the lists of covered immunizations, or call Customer Service at 1-888-849-3681.

Immunizations covered under the preventive care benefit are not subject to either the medical or the prescription drug deductibles. Immunizations given by the providers listed below are paid under the preventive care benefit. If you see an out-of-network provider for covered immunizations, you pay 40% of the allowed amount and the provider may balance bill you.

Where can I get immunizations?

Immunizations covered under the preventive care benefit are free when received from a:

  • Preferred provider.
  • Network vaccination pharmacy. To find one, visit the Find drugs page or call Washington State Rx Services at 1-888-361-1611.
  • Public health department.

The plan does not cover immunizations for travel or employment, even when recommended by the CDC or required by travel regulations.

Tip: Flu shots are covered as included on the applicable CDC immunization schedule.

 

Contact

UMP Customer Service
Phone: 1-888-849-3681 (TYY: 711)
Business hours: Monday–Friday 7 a.m. to 5 p.m. Pacific Time