UMP Plus FAQs

Below you'll find answers to some frequently asked questions (FAQs) about UMP Plus.

UMP Plus is a plan offered by the Public Employees Benefits Board (PEBB) Program that contains two networks: UMP Plus–Puget Sound High Value Network (PSHVN) and UMP Plus–UW Medicine Accountable Care Network (UW Medicine ACN).

UMP Plus provides lower costs and a local network of doctors and specialists who coordinate to improve patient care. UMP Plus providers are rewarded for giving members quality care. Better patient care helps you stay healthy and save money. That’s why office visits with primary care providers, including pediatricians, are covered at no cost to you.

No. You choose either PSHVN or UW Medicine ACN when you enroll in UMP Plus. They are separate provider networks. When you enroll in one, the providers in the other network are considered non-network providers and will be paid at the non-network rate (50 percent of the allowed). However, you will find that some providers are in both UMP Plus networks.

To enroll in UMP Plus, you must live in a county covered by a UMP Plus network. (You cannot enroll if you only work in one of the counties.)

Network Covered Counties
UMP Plus—Puget Sound High Value Network Grays Harbor, King, Kitsap, Pierce, Snohomish, Spokane, Thurston, or Yakima
UMP Plus—UW Medicine Accountable Care Network Grays Harbor, King, Kitsap, Pierce, Skagit, Snohomish, or Thurston

You must also be one of the following:

  • Employee.*
  • Continuation coverage (formerly Leave Without Pay) member.
  • Retiree and a covered spouse or state-registered domestic partner not enrolled in Medicare.
  • COBRA member and a covered spouse or state-registered domestic partner not enrolled in Medicare.

*Employees who are enrolled in Medicare Part A and Part B are eligible for UMP Plus. Employees’ spouses are also eligible, even if the spouse is also enrolled in Medicare. Due to federal Medicare regulations, employees’ state-registered domestic partners who are enrolled in Medicare are not eligible for UMP Plus.

If you move out of the UMP Plus network area during the plan year, you must notify the Public Employees Benefits Board (PEBB) Program of your change in residence and choose a new medical plan.

It offers high-quality service at a good price, including:

  • Lower premiums.
  • Lower medical deductible.
  • No prescription drug deductible.
  • Lower out-of-pocket costs when using network providers. 
  • Office visits with primary care providers at no charge.
  • Fast access to primary and specialty care.
  • Focus on wellness such as screenings and preventive care.
  • Coordinated care between your physicians and multiple specialists for chronic conditions such as diabetes.
  • Providers with extended office hours.

Yes. When you travel, covered medical emergencies at any Regence-network emergency room and urgent care facility are paid at 85 percent for covered services. If you receive primary or ancillary specialty care outside of the UMP Plus network, you’ll pay 50 percent for covered services, and may be balance billed.

UMP Plus members have access to the BlueCard and BlueCard Worldwide programs, which are extensive networks of emergency and urgent care facilities around the world. For additional information, call BlueCard Worldwide at 1-800-810-2583 or search for a provider outside the United States.

Learn more about coverage outside the United States.

Visit a primary care network provider in your UMP Plus network or a Regence-network naturopathic physician. Office visits, preventive care services, and immunizations given by these providers or physicians are covered in full; you pay nothing. There is no limit to the number of appointments you and your family can have under this benefit.

However, services related to an office visit may be subject to the deductible and coinsurance. For example, at a visit with your primary care network provider, tests are ordered. The office visit will be covered at no cost to you; tests not considered preventive are subject to the medical deductible and coinsurance. Learn more about how much you pay to see providers.

Check your network’s provider lists to make sure that your doctor is in your UMP Plus network. Even if your doctor is located in a clinic or hospital that is in one of the UMP Plus networks, be sure to confirm that he or she is in-network before scheduling an appointment. Please confirm the full name, "UMP Plus," when asking if your provider is in-network.

Puget Sound High Value Network
Phone: 1-855-776-9503
TTY: 711

UW Medicine Accountable Care Network
Phone: 1-855-520-9500
TTY: 711

Regence
Phone: 1-888-344-6347
TTY: 711

Network providers are in the UMP Plus service area, which includes Grays Harbor, King, Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, and Yakima counties. (Counties in bold have been added for coverage beginning January 1, 2017.) Start your search for UMP Plus providers.

For most services, no, you do not need a referral. Please be sure to save money by seeing primary care and specialty providers within the network.

If your network provider thinks you should see a non-network provider, they can request a network waiver before services are performed. When your waiver is approved, you will pay the 15 percent coinsurance rate for the approved non-network provider. Like UMP Classic, UMP Plus subscribers can see any network provider they choose, including specialists, and pay 15 percent coinsurance.

Yes, and UMP Plus members can also expect:

  • Lower annual deductibles.
  • No prescription deductibles.
  • Lower out-of-pocket costs when using network providers.
  • No out-of-pocket costs when receiving care from primary care network providers.

Members can choose the provider they want to see, but the most savings are available only when using providers in your UMP Plus network. Visit the UMP Plus website for more information about your cost for benefits.

The UMP Plus annual medical deductible is $125 per person, with a maximum of $375 for a family of three or more. Services that do not count towards your deductible include:

  • Out-of-pocket prescription costs.
  • Preventive care.
  • Immunizations.
  • Routine vision and hearing care.
  • Select contraceptive supplies and services.
  • Tobacco cessation services.
  • Diabetes prevention and control programs.

Other services may also be exempt from the deductible. You can reduce your deductible by earning a SmartHealth wellness incentive.

The coverage is the same, but the cost is different. You do not pay a separate deductible for prescription drugs with UMP Plus (UMP Classic has a separate deductible for Tier 2 and Tier 3 drugs).

Coinsurance ranging from 5 to 50 percent depending on the drug tier is identical to UMP Classic. Also, just like UMP Classic, your out-of-pocket maximum is $2,000 per person. Learn more about UMP Plus drug coverage.

Active employees can enroll in UMP Plus while on Medicare Part A and Part B. Employees' spouses are also eligible for UMP Plus, even if the spouse is also enrolled in Medicare. Due to federal Medicare regulations, employees' state-registered domestic partners who are enrolled in Medicare are not eligible for UMP Plus.
 

Retirees enrolled in Medicare Part A and Part B are not eligible for UMP Plus. They may enroll in other PEBB plans that are not consumer-directed health plans.

Yes. However, you must choose a new medical plan once you enroll in Medicare.

If you are an active employee, you may enroll in Medicare Part and Part B while on UMP Plus. An active employee's spouse may also enroll in Medicare while on UMP Plus. Due to federal Medicare regulations, employees’ state-registered domestic partners who are enrolled in Medicare are not eligible for UMP Plus.
 

If you are a retiree, you must choose a new medical plan for yourself and all covered family members when you become eligible for Medicare. If a covered family member becomes eligible for Medicare, you may either choose a new medical plan or remove that family member from your account. Your family member will not qualify for COBRA or other continuation coverage through the PEBB Program.

Yes, you can enroll in UMP Plus if you are an active employee over age 65 and enrolled in Medicare Part A and Part B.

Yes. Remember that you must enroll each year in the Medical FSA and DCAP and choose your new deductions.

No. HSAs are only available to enrollees who select a consumer-directed health care plan (CDHP).

You keep your HSA and can still use your funds for qualified medical expenses. However, you will not be able to contribute to your HSA in 2017, and you may be charged a monthly service fee if your account drops below $2,500. Learn more about your HSA options on the PEBB home page or by contacting Health Equity.

UMP Plus offers many types of providers to give members access to a wide variety of services. The major differences between these providers are the services they provide and the cost of visiting them.

Members can choose the provider they want to see, and visits to primary care providers are offered at no-charge. However, coinsurance savings and additional services apply only when seeing a provider within the UMP Plus network. Learn more about how much you pay to see providers.

Possibly not. UMP Plus covers your dependents who live outside the Puget Sound area for covered medical emergencies at any emergency room. Urgent care facilities contracted with Regence are also covered at the network rate. However, if your dependents live outside the UMP Plus network area, they live away from the providers available to them and must return to the network area for in-network services.

Compare the UMP plans to ensure all family members can receive the service they need when they need it. Both UMP Plus networks also have websites and customer service representatives to help answer your questions.

Puget Sound High Value Network
Phone: 1-855-776-9503
TTY: 711

UW Medicine Accountable Care Network
Phone: 1-855-520-9500
TTY: 711

We are here to help you choose a medical plan for you and your family. During open enrollment November 1-30, you can attend a PEBB benefits fair for in-person answers to your questions. You can check out our Member Tool Kit or talk to your employer’s personnel/payroll office to learn more. Many resources are also available on the PEBB home page and the UMP home page.

Contact

For questions about PEBB benefits
Your employer's personnel, payroll, or benefits office

If you are a retiree or self-pay PEBB member
Phone: 1-800-200-1004
Online: PEBB home page

For questions about the UMP Plus networks (for example, providers or facilities)
Online: UMP home page

For more information about the networks
Puget Sound High Value Network
Phone: 1-855-776-9503
TTY: 711

UW Medicine Accountable Care Network
Phone: 1-855-520-9500
TTY: 711