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UMP Plus covers the following services at no cost to you, under the conditions described. For example, to receive preventive care services at no cost, you must see a network provider.
Preventive care services include many vaccines, routine physical exams, and certain tests. If you see a network provider, you can receive preventive services without paying your deductible or coinsurance.
UMP follows the Centers for Disease Control and Prevention (CDC) recommendations for which services are covered as preventive. See the CDC lists of preventive services (for adults, women, and children) or call UMP Customer Service at 1-888-849-3681.
You pay nothing for office visits when you see a primary care provider (PCP) in the core network (or a naturopath in the support network). Other services provided at a primary care visit, like x-rays or labs, may be subject to the medical deductible and coinsurance.
Why choose a PCP? By managing all of your care, your PCP gets to know you and all your health care needs. This helps your PCP choose appropriate tests and treatment plans, including when you should be referred to a specialty provider.
Diabetes Prevention Program
Alert! These programs are not available to Medicare retirees enrolled in UMP. Workplace testing events are the main way members connect with the program, so it is only offered to employees and their dependents.
For non-Medicare members ages 18 and older, the plan covers 100 percent for the Diabetes Prevention Program. The program offers screening to determine if you meet criteria that show you may be at high risk for or have prediabetes. Diabetes screening is covered at 100 percent.
Screening events are scheduled at your employer worksite, or you can visit your primary care provider for a blood sugar test. If you see a screening vendor, they will tell you whether or not 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 test results are available. If you meet the program’s screening criteria, you will be encouraged to participate in the program at no cost to you.
The PEBB Program may schedule screening events at sites around the state. You may also qualify for classes if a blood sugar test ordered by your provider in the previous 12 months is in the prediabetes range. Call UMP Customer Service at 1-888-849-3681 for more information.
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. 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.
UMP Plus covers certain nicotine replacement therapies and prescription drugs for tobacco cessation at no cost to you.
Nicotine replacement therapy
UMP Plus covers certain nicotine replacement therapies and prescription drugs for tobacco cessation at the preventive rate (covered at 100 percent).
To get these therapies and drugs at no cost, you must:
- Get a prescription from your provider.
- Buy them at the pharmacy counter of a network pharmacy. Show your prescription and your UMP ID card when making the purchase.
Alert! You may not receive full reimbursement from the plan if you get nicotine replacement therapy or prescription drugs at a non-network pharmacy, or buy them at the front counter of a network pharmacy and submit a claim.
Nicotine replacement therapy and prescription drugs for tobacco cessation that are designated as preventive on the UMP Preferred Drug List are not subject to coinsurance. If you get therapy or drugs that are not preventive, you will pay Tier 3 coinsurance.
The plan does not cover e-cigarettes or vaporizers (“vapes”).
UMP Plus 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.
Quit for Life
UMP Plus 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 listed above at no cost to you. Visit the Quit for Life website to learn more.
Tip: You do not have to enroll in the Quit for Life program to get coverage of nicotine replacement therapy or prescription drugs for tobacco cessation. Call UMP Customer Service at 1-888-849-3681 with any questions.
UMP members under age 18 may use the Smokefree Teen program in addition to the services described above.
UMP Customer Service
Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific Time