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 Plus, including general payment information. This summary applies to both UMP Plus networks: Puget Sound High Value Network (PSHVN) and UW Medicine Accountable Care Network (UW Medicine ACN).  

Call UMP Customer Service at 1-888-849-3681 (TRS: 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. 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: PSHVN and UW Medicine ACN

Standard
Limited benefit: Select benefit link for limits.
Ambulance: PSHVN and UW Medicine ACN Special: Select link on left for benefit details.
Applied Behavior Analysis (ABA) Therapy: PSHVN and UW Medicine ACN Standard
See link at left for limits and requirements.
Autism treatment: PSHVN and UW Medicine ACN Standard
Bariatric surgery: PSHVN and UW Medicine ACN Standard, Inpatient
Breast health screening tests: PSHVN and UW Medicine ACN Standard, Preventive
Chemical dependency treatment: PSHVN and UW Medicine ACN Standard, Inpatient, Outpatient
Dental services: PSHVN and UW Medicine ACN Special: Select link on left for benefit details.
Diabetes care supplies: PSHVN and UW Medicine ACN Prescription drugs
Diabetes Control Program: PSHVN and UW Medicine ACN Preventive
Diabetes education: PSHVN and UW Medicine ACN Standard
Diabetes Prevention Program: PSHVN and UW Medicine ACN Preventive
Diagnostic tests, laboratory, and X-rays: PSHVN and UW Medicine ACN Standard
Dialysis: PSHVN and UW Medicine ACN Standard
Durable medical equipment, supplies, and prostheses: PSHVN and UW Medicine ACN Standard
Emergency room: PSHVN and UW Medicine ACN
Must be a medical emergency
Standard, plus $75 copay
End-of-life counseling: PSHVN and UW Medicine ACN Standard
Family planning services: PSHVN and UW Medicine ACN Preventive, Standard, Prescription drugs 
See benefit link at left for details
Foot care, maintenance: PSHVN and UW Medicine ACN Standard
Genetic services: PSHVN and UW Medicine ACN Standard
Headaches: PSHVN and UW Medicine ACN Standard
Hearing care (diseases and disorders of the ear): PSHVN and UW Medicine ACN Standard
Hearing exams and hearing aids: PSHVN and UW Medicine ACN Preventive, Special
Limited benefit: Select benefit link for limits.
Home health care: PSHVN and UW Medicine ACN Standard
Hospice care (inpatient, outpatient, and respite care): PSHVN and UW Medicine ACN

Standard, Inpatient, Outpatient, Prescription drugs
See benefit link at left for details

Hospital services: PSHVN and UW Medicine ACN Standard, Inpatient, Outpatient
Immunizations: PSHVN and UW Medicine ACN Preventive
Knee arthroplasty: PSHVN and UW Medicine ACN Standard
Mammograms: PSHVN and UW Medicine ACN Preventive, Standard
See benefit link at left for details
Massage therapy: PSHVN and UW Medicine ACN Standard
Limited benefit: Select benefit link for limits.
Mastectomy and breast reconstruction: PSHVN and UW Medicine ACN Standard, Inpatient
Mental health treatment: PSHVN and UW Medicine ACN Standard, Inpatient, Outpatient
Naturopathic physician services: PSHVN and UW Medicine ACN Standard
See benefit link at left for details
Nutrition counseling and therapy: PSHVN and UW Medicine ACN Standard
Obstetric and newborn care: PSHVN and UW Medicine ACN Standard, Inpatient
Office visits: PSHVN and UW Medicine ACN Standard, Primary care 
See benefit link at left for details
Orthognathic surgery: PSHVN and UW Medicine ACN Standard, Inpatient, Outpatient
Physical, occupational, speech, and neurodevelopmental therapy: PSHVN and UW Medicine ACN Standard
Limited benefit: Select benefit link for limits.
Prescription drugs See What you pay for drugs
Preventive care: PSHVN and UW Medicine ACN Preventive
Second opinions: PSHVN and UW Medicine ACN Special: Select link on left for benefit details.
Skilled nursing facility: PSHVN and UW Medicine ACN Standard, Inpatient
Spinal and extremity manipulations: PSHVN and UW Medicine ACN Standard
Limited benefit: Select benefit link for limits.
Spinal injections: PSHVN and UW Medicine ACN Standard
Surgery: PSHVN and UW Medicine ACN Standard, Inpatient
Telemedicine services: PSHVN and UW Medicine ACN Standard
See benefit link at left for details
Temporomandibular Joint (TMJ) treatment: PSHVN and UW Medicine ACN Standard
Tobacco cessation services: PSHVN and UW Medicine ACN Special: Select link on left for benefit details.
Transgender health: PSHVN and UW Medicine ACN Standard
Transplants: PSHVN and UW Medicine ACN Standard, Inpatient
Urgent care: PSHVN and UW Medicine ACN Standard
Vision care (diseases and disorders of the eye): PSHVN and UW Medicine ACN Standard
Vision exams (routine): PSHVN and UW Medicine ACN Preventive
Vision hardware (eyeglasses and contact lenses): PSHVN and UW Medicine ACN Special: Select link on left for benefit details.

Contact

UMP Customer Service
Phone: 1-888-849-3681
TRS: 711

Washington State Rx Services
Phone: 1-888-361-1611
TRS: 711