Summary of benefits

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

How does this work?

UMP Classic Summary of Benefits

Below is an alphabetical list of select services covered by UMP Classic, including general payment information. Select a service for more information.

Please note that not all covered services are listed here. Call UMP Customer Service at 1-888-849-3681 (TTY users: 711) with any questions.

Also see the list of certain services not covered by the plan. This list does not include all services not covered.

Benefit
Select link for benefit details

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

Standard
See link at left for limits and requirements.

Autism treatment

Standard

Bariatric surgery

Standard, Inpatient

Breast health screening tests

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

Standard

Dialysis

Standard

Durable medical equipment, supplies, and prostheses

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

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

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

Standard

Surgery

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.

*This is a limited benefit; see the benefit description in the link for details.

 

Contact

UMP customer service
Phone: 1-888-849-3681
TTY: 711
Business hours: Monday–Friday 7 a.m. to 5 p.m. Pacific Time (PT)

UMP prescription drugs
Phone: 1-888-361-1611
TDD: 1-800-433-6313
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. Pacific Time (PT)