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 Classic, 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 Classic Certificate of Coverage, the Summaries of Benefits and Coverage, or the Regence medical policies

Benefit

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 top link at left for limits and requirements. See the HTCC link for more information.

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 decisions 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, plus $75 copay

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
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
Phone: 1-888-361-1611
TDD: 1-800-433-6313
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. PT