UMP Plus FAQs

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

Alert! Starting January 1, 2019, the UMP Plus networks will no longer provide coverage in Grays Harbor County. Other health care coverage options are available for the 2019 plan year, including UMP Classic and UMP CDHP. To compare medical plans, use the Medical Benefit Comparison tool or visit PEBB’s website.

UMP Plus is a plan offered by the Public Employees Benefits Board (PEBB) Program that contains two networks: Puget Sound High Value Network (PSHVN) and 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 Puget Sound High Value Network or UW Medicine Accountable Care Network when you enroll in UMP Plus. They are separate provider networks.

When you enroll in one, the providers in the other network are considered out of network. Most covered services you receive from out-of-network providers are paid at 50 percent of the allowed amount, and you may be balance billed.

However, some providers are in both UMP Plus networks.

To enroll in UMP Plus, you must be a PEBB benefits-eligible member who lives 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:

  • Employees and their covered dependents.*
  • Continuation coverage members and their dependents.
  • Retirees and their covered dependents not enrolled in Medicare Part A or Part B.
  • COBRA members and their covered dependents not enrolled in Medicare Part A or Part B.

*Employees and their covered spouses who are enrolled in Medicare Part A and Part B are eligible for UMP Plus, even if the spouse is 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 your UMP Plus network service area (Puget Sound High Value Network or UW Medicine Accountable Care Network), you have 60 days from the date you move to change plans. You can change plans by contacting the following:

  • Employees: Your employer.
  • Retirees: The Public Employee Benefits Board (PEBB) Program at 1-800-200-1004 (TRS: 711).

If you do not change plans within 60 days of moving, you may change plans during the next annual open enrollment period, which happens each year from November 1-30.

For most services, you should see network providers in your network’s service area. If you see out-of-network providers, you may pay significantly more.

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

  • Lower premiums than many other PEBB Program health plans.
  • Lower medical deductible than many other PEBB Program health plans.
  • No prescription drug deductible.
  • Lower out-of-pocket costs when using network providers. 
  • Office visits with primary care providers at no charge.
  • Quick access to primary and specialty care.
  • Focus on wellness, such as screenings and preventive care.
  • Coordinated care between your providers for chronic conditions such as diabetes.
  • Providers with extended office hours.

Yes. When you travel, you can see any provider for a medical emergency, regardless of network status, and receive the network rate. However, if you see an out-of-network provider, they may balance bill you.

If you receive primary, ancillary, or 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 details, 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 provider in the core network or a naturopathic physician in the support network. Office visits, preventive care services, and immunizations given by these providers 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 you receive during an office visit, like x-rays or labs, may be subject to the 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 your UMP Plus network, confirm that he or she is also network before scheduling an appointment. If you call to ask if a provider is network, please use the full name, "UMP Plus," and mention your network's name.

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

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

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

Network providers are in the UMP Plus service area, which includes Grays Harbor, King, Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, and Yakima counties. Start your search for UMP Plus providers.

For most services, no, you do not need a referral. Like UMP Classic, UMP Plus subscribers can see any network provider they choose, including specialists, and pay 15 percent coinsurance. Please be sure to save money by seeing primary care and specialty providers within the network.

If your network provider thinks you should see an out-of-network provider, they can request a network waiver before services are performed. If your waiver is approved, you will pay 15 percent coinsurance for the approved out-of-network provider.

Accountable Care Networks, like UMP Plus, were established to promote high-quality care at a lower cost. The Health Care Authority designed UMP Plus to help providers achieve those goals while allowing members to choose their own providers in the network.

Providers who join UMP Plus agree to be accountable for delivering and evaluating the quality of your care. When you receive preventive care and coordinated treatment, the overall cost of that care is lower. These cost savings help keep your premium and deductible lower without limiting necessary care.

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 zero 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 medical plans that are not consumer-directed health plans (CDHPs).

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 A 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 2018, 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 office visits to primary care providers are free to you. However, you save money when you see a provider in the core or support 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 network services.

Compare the UMP plans to find one under which all family members can get 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
TRS: 711

UW Medicine Accountable Care Network
Phone: 1-855-520-9500
TRS: 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 to learn more. Many resources are also available on the PEBB home page and the UMP home page.

Contact

If you are an employee: Ask your employer about benefit questions

If you are a retiree or self-pay PEBB member
Phone: 1-800-200-1004
TRS: 711

For questions about the UMP Plus networks
Puget Sound High Value Network
Phone: 1-855-776-9503
TRS: 711

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