Cost for providers by type

How much you pay to see providers

The table describes how much you'll pay for services with UMP Plus.

Unless otherwise noted:

  • All payment is based on the allowed amount, which is the fee accepted by network and non-network providers.
  • Services are subject to the medical deductible.

Note: Ancillary providers or naturopaths (primary care) contracted with Regence but not affiliated with your UMP Plus network are paid at the network rate only for services provided within the UMP Plus service area.

If you receive services from an ancillary provider or naturopath as described above at a location outside the UMP Plus service area, covered services are paid at the non-network rate (50%)— even if the provider is network within your UMP Plus network's service area.

UMP Plus costs for services

Type of service How much I pay
Primary care services, office visits

Naturopaths contracted with Regence but not affiliated with your UMP Plus network must be within the UMP Plus service area to be covered as network.

Primary Care Network providers: You pay $0; the plan pays in full. Services performed during a primary care office visit that aren't considered preventive (such as x-rays or labs) may be covered under the Standard benefit described below.

If you receive primary care office visits from the following providers, services are subject to the medical deductible and the following coinsurance:

Standard

Subject to the medical deductible: You must pay the first $125 in covered services before the plan begins to pay.

Most ancillary providers and services are paid at the standard rate.

How much you pay (your coinsurance) depends on the provider’s network status:

Ancillary providers contracted with Regence but not affiliated with your UMP Plus network must be within the UMP Plus service area to be covered as network.

Preventive

Preventive services are not subject to the medical deductible (you don’t have to pay your deductible before the plan pays).

How much you pay (your coinsurance) depends on the provider’s network status:
Outpatient

Subject to the medical deductible.

If you receive services at a facility that offers inpatient services but you are not admitted as an inpatient, the services are covered as outpatient. See the specific benefit—for example, diagnostic tests—for how much you will pay.
Inpatient

Subject to the medical deductible.

You pay the inpatient copay and separate charges for professional services, such as doctor consultations and lab tests. See the specific benefit—for example, diagnostic tests—for how the plan covers these related services.

  • Professional providers may contract separately from a facility. Even if a facility is network, a professional provider may not be.
  • Most inpatient services require both:

The inpatient copay is $200 per day at network facilities, $600 maximum per calendar year.

Note: The inpatient copay counts toward your medical out-of-pocket limit.

When you are admitted to a network facility as an inpatient, you will pay:

  • Any remaining medical deductible;
  • The inpatient copay; AND
  • Your coinsurance for professional services; depends on the provider’s network status as described under the Standard type of service, listed above.

If you receive non-emergency inpatient care at an out-of-network facility, you will pay according to the Standard benefit above. See the table for details of coverage of out-of-network facility charges.

Services are considered inpatient only when you are admitted as an inpatient to a facility.

Facility Fees

Facility fees associated with primary care office visits will be paid at 100 percent. Facility fees associated with non-primary care office visits will be paid at the coinsurance level shown on the right.

Your coinsurance for facility fees not related to a primary care office visit depends on the provider’s* network status:

  • Network providers‑You pay 15% of the allowed amount.
  • Non-network providers‑You pay 50% of the allowed amount; the provider may not balance bill you.
  • Out-of-network providers‑You pay 50% of the allowed amount, and the provider may balance bill you.

*A facility, such as a hospital, may be referred to as a “provider.”

Special

Subject to the medical deductible.

These services have unique payment rules. See your Certificate of Coverage (benefits book) for details.

Contact

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