UMP Plus provider information

Learn more about network providers under UMP Plus coverage.

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Where can I see providers for network services?

For most services, you should see network providers in your UMP Plus network's service area.

You may access emergency care anywhere in the world.

May I see providers in either UMP Plus network?

TIP: A few provider groups are currently affiliated with both UMP Plus networks.

  • To receive network-level reimbursement, you should see providers affiliated with your UMP Plus network (primary care and specialty). The two networks are not interchangeable.
  • Providers affiliated with the other UMP Plus network who are not ancillary providers are covered at the non-network rate.
  • In addition, you may not switch between UMP Plus networks during the plan year, unless you have an event that qualifies you to change plans during the plan year (special open enrollment; see the PEBB website). Note that a provider leaving the network during the plan year does not qualify for a special open enrollment.

What kind of providers can I see for emergency or urgent care services?

Emergency Room Services

In case of a medical emergency, any emergency room will be paid at the network rate (the plan pays 85% of the allowed amount for most covered services). However, for “out-of-network” emergency room providers (not contracted with Regence), the provider may bill you for charges exceeding the plan allowed amount, in addition to your 15% coinsurance.

Urgent care services

When you need immediate care but the situation is not a medical emergency, you should see an urgent care provider if you cannot get in to see your primary care provider. You receive network-level benefits for both UMP Plus and Regence network providers for urgent care services. However, out-of-network urgent care providers are paid at the out-of-network rate (you pay 50% of the plan allowed amount, plus any amount billed by the out-of-network provider that is above the allowed amount).

What is a network provider under UMP Plus coverage?

What is a provider? A provider is an individual medical professional (such as a doctor or nurse), a facility such as a hospital or clinic, or other entity performing health care services (for example, lab testing).

Under UMP Plus, a network provider is one of the following:

  • A Primary Care Network provider affiliated with your UMP Plus network.
  • An ancillary provider contracted with Regence and located in your UMP Plus network's service area.
  • A specialty provider affiliated with your UMP Plus network.
  • A network facility (such as, but not limited to, a clinic or hospital) that is affiliated with your UMP Plus network.

Find descriptions of these provider types on the provider search tool. This tool helps you determine what type of provider you need, and where to go to receive care.

Make sure a provider is in the network before you visit by calling Uniform Medical Plan at 1-888-849-3681. When you see a network provider at a facility (such as a hospital), check that the facility is also in the network.

How much do I pay for network provider services?

Once you meet your medical deductible, you pay 15 percent of the plan allowed amount for most covered services. Some exceptions are the inpatient hospital copay and the emergency room copay (which you pay even after meeting your deductible). When you see primary care providers affiliated with your UMP Plus network, you pay nothing for primary care office visits.

What are “non-network” versus “out-of-network” providers?

Non-network providers

Under UMP Plus coverage, a non-network provider is a provider that is contracted with Regence and is not affiliated with your UMP Plus network, but is not any of the following:

For covered services by non-network providers, you pay 50% of the plan’s allowed amount. Non-network providers may not bill you for charges above the allowed amount.

Out-of-network providers

An out-of-network provider is not contracted with Regence or affiliated with a UMP Plus network. For most covered out-of-network services, you pay 50% of the plan’s allowed amount, plus any amount the provider charges exceeding the allowed amount.