The UMP website is moving. This website contains 2019 UMP information for PEBB members only (through the end of 2019). If you are a PEBB member and/or you will be a new School Employees Benefits Board (SEBB) member and you need 2020 UMP benefits information, visit our new UMP website.
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UMP Plus covers the following services at no cost to you, under the conditions described.
Preventive care services include many covered immunizations, annual physical exams, and certain tests. If you see a network provider, you can receive preventive services without paying your deductible or coinsurance.
You may call UMP Customer Service at 1-888-849-3681 (TRS: 711) to ask if a medical service is covered as preventive. Call Washington State Rx services Customer Service at 1-888-361-1611 (TRS: 711) for questions about preventive prescription drugs.
You pay nothing for primary care 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 (DPP)
Alert: These programs are not available to Medicare retirees enrolled in UMP.
For non-Medicare members ages 18 and older, the plan covers 100 percent for the Diabetes Prevention Program (DPP).
If you have prediabetes or are at high risk of developing prediabetes you have access to a virtual (online) DPP through Omada Health.
You can take an online screening questionnaire to see if you meet the program’s criteria by visiting Omada Health and creating an account. If you meet the criteria, you can participate in the program at no cost to you. The virtual program includes a professional health coach, a wireless scale, and weekly online classes with a small group of participants who provide real-time support.
Instead of the online questionnaire, you can qualify for the program:
- If your provider ordered a blood sugar test in the last 12 months; and
- The test showed you are in the prediabetes range.
Contact UMP Customer Service at 1-888-849-3681 (TRS: 711) for more information.
Members already enrolled in the YMCA's DPP classes who have additional classes remaining, may continue to participate in the in-person classes.
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. The purchase must be submitted through the prescription drug system to be covered.
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 the preventive rate when you see a network provider. Phone or online counseling is covered only through the Quit for Life program described below. UMP members age 17 and under may use the Smokefree Teen program explained below.
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 described 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 (TRS: 711) with any questions.
UMP members age 17 and under may access similar support services through the Smokefree Teen program in addition to the services listed above.