Summary of benefits

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

How does this work?

UMP Plus Summary of Benefits

Below is an alphabetical list of select services covered by UMP Plus, including general payment information. This summary applies to both UMP Plus networks: UMP Plus—Puget Sound High Value Network (PSHVN) and UMP Plus—UW Medicine Accountable Care Network (UW Medicine ACN).  Select a service for more information.

Please note that not all covered services are listed here. Call Uniform Medical Plan 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
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, non-primary care Standard
Office visits, primary care Primary care (There is no cost for office visits when you see a Primary Care Network Provider; other services provided at a primary care visit may be subject to the medical deductible and coinsurance.) 
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

Uniform Medical Plan
Phone: 1-888-849-3681
TTY: 711
Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific Time (PT)

Washington State Rx Services
Phone: 1-888-361-1611
TDD: 1-800-433-6313
Business hours: Monday-Friday 7:30 a.m. to 5:30 p.m. PT