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 a 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).  

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

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

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

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