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3 0 obj 2020: 2021: What type of enrollee are you? The following documents—called a Certificate of Coverage—provide in-depth descriptions of the health care benefits for each plan. As of the 1994 coverage year, all HEALTH PLANSoffering coverage in State of Wisconsin Group Health Insurance Program must provide the Uniform Benefits as described in this document. The following changes were made to our Uniform Medical Plan Pre-authorization List effective January 1, 2020: ... 2020 changes. The Health Care Authority (HCA) today announced a new contract to provide enhanced services to the nearly 200,000 public employees enrolled in Uniform Medical Plan (UMP). UMP is the state’s self-funded medical option for eligible members enrolled in the Public Employees Benefits Board (PEBB) Program. Applies to Uniform Medical Plan (UMP) Generally, you must pay all of the costs for medical services and prescription drugs (combined) up to the deductible amount before this plan begins to pay. However, it only applies to Tier 2 prescription drugs, so you don’t have to pay the deductible if you use prescription drugs from any other tier, which includes most generic and low-cost drugs. An employer can permit employees to apply unused health and dependent care FSA amounts remaining as of the end of a grace period ending in 2020 or a plan year ending in 2020 (i.e., an off calendar year plan) to pay or reimburse expenses incurred for the same type of FSA through December 31, 2020. Same-day appointments are often available, you can search for real-time availability of Eye Doctors who accept Uniform Medical Plan insurance and make an appointment online. This limit helps you plan for health care expenses. cover eligible dependents, everyone must enroll in the same medical plan Effective Date: 1/1/2020 Date Generated: 12/18/2019 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. See For general topics, check the table of contents. Choose a plan that opens doors to top doctors and coordinated, cost-saving networks close to home. UMP Classic is the only plan that has a separate prescription drug deductible. As of the 1994 coverage year, all HEALTH PLANSoffering coverage in the State of Wisconsin ... of the Uniform Benefits plan. How to use this certificate of coverage . Guidance 1. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. ���a�~�Wj��s��\/�&� �8�� u.�\�a�s��I�ֿ�_��*��Oݪ�X���6����"MRd4%�0�ѣ�x:���r���05�EC��i��et%O��~���B��S��h{_H��@�M�o�͕�]��m�E���f� %�6���% ��X8�$��!$�- Under the Affordable Care Act, health insurers and group health plans will provide the 180 million Americans who have private insurance with clear, consistent and comparable information about their health plan benefits and coverage. Your options are limited to the plans available in your county. b. 4 0 obj In general, you may choose from the plans listed below. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. 2021: Available in all Oregon and Idaho counties and nationwide. Specifically, the regulations will ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices. Included below are the medical management programs that will apply to UMP members effective January 1, 2020 (except as noted below). Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. Uniform Medical Plan (UMP) plans. Use one of Regence's provider directories. Learn more about the plans. Generated Date: 3/23/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. Online: UMP websitePhone: 1-888-849-3681TRS: 711Business hours: Monday–Friday 7 a.m. to 5 p.m. (Pacific), Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. Use the tables below to make sure you live in the plan's service area. �������V��H���m�5�U�~x�ꗳO�������r��g��Jޯw��l�x[�]mNzv�_9���.���.�k|�^Ë�I��|��ׯ��������sȻsȳ2��y ��K�n�l X���(�G��1�p�.wrT"?V����1�w���,�;����G���{����^�mFEY���ftOs��9DN��=>�/q��b!A�6rV��q"zmR��\��K�\�$��Sɟ\���o Health plans with health savings accounts (HSAs) Contact HCA. �O��_��� W���"�J�ě��$��]�wF'��U"(yNR���6@����as@1�BmO*�-t��8��ӍV����O�Q~�g���y�J�0�_H���%1h�O~=3|?޿��;E%�b���I9$��Bv�?|��~$=�g�!��%����!5e�~�7V����r!�n%S�l巏���_�+���� ����S��� ��*À�� ��n����#����Y�֟c��ѻb���|��Erp��ߟN�۰��~��E��tZګQG�7P� F$�ԅ!x���ѣ�gc���V�s�*MI3�U��*-2��a�KP��� /2FJT ���t���S�z�K��LV���vy���~�'�"� November 4, 2014 Group Health Plans that Fail to Cover In-Patient Services 2. As of September 23, 2012 or soon after, health insurance issuers and group health plans are required to provide you with an easy-to-understand summary about a health plan’s benefits and coverage. 2020 Formulary (Li st of Covered Drug s) PLEASE READ: T HIS DOCUMENT CO NTAINS INF ORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submissi Version Numberon ID 20104 21, This formulary was updated on 11/24/2020… (i.e. 2020 UMP Classic (PEBB) Certificate of Coverage 6. Learn more about your customer service options. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R 71 0 R 72 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> %PDF-1.7 If you move out of your plan's service area, you may need to change plans. This applies to all essential health benefits, including some services not included in the out-of-pocket limit. February 29, 2016 Final: Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 5. Sleep Medicine . %���� In-network uniform preventative and medical benefits are offered in all plans. endobj o�h�K�?ɫ��� r��Q� �s�w�l_���L��K���S4j� Alert: All specialty drugs require preauthorization. All dental benefits are paid according to the terms of the Master Contract between the Health Plan, Dental Plan and Group Insurance Board. Revised 9/8/2020 . 2 0 obj What are my plan options? certain level 3 & 4 prescription drugs and certain hearing aids covered under this plan). For all UMP plans, Tier 3 prescription drugs are being removed from the Preferred Drug List as of January 1, 2020. After a two-year competitive process, HCA selected Regence BlueShield as […] 0iY�. 2020: King, Kitsap, Pierce, Snohomish, Thurston, Yakima, 2021: Chelan, Douglas, King, Kitsap, Pierce, Snohomish, Thurston, Yakima. <> 1 0 obj December 23, 2015 Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 4. With the Uniform Medical Plan, you may choose from the plans listed below. Learn more about the Uniform Medical Plan (UMP) plans, administered by Regence BlueShield and Washington State Rx Services (WSRxS). Effective Date: 5/1/2020 Generated Date: 4/23/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. Plus, have the peace of mind that comes from emergency coverage wherever you’re traveling. UMP Achieve 1 UMP Achieve 2 UMP High Deductible UMP Plus—Puget Sound High Value Network UMP Plus—UW Medicine Accountable Care Network UMP Plus— Puget Sound Employee: Retiree (Medicare) Retiree (non-Medicare) PEBB Continuation Coverage (COBRA Medicare) King, Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, Yakima, Uniform Medical Plan UMP Plus–Puget Sound High Value Network (PSHVN) does not have primary care network providers for adults in Thurston County at this time due to limited access. Page 1 of 7. To help you decide on a plan, it can be helpful to know the network—or the group of doctors, hospitals and pharmacies that are part of the plan. To learn more, please call Washington State Rx Services at 888-361-1611. <>/Metadata 2372 0 R/ViewerPreferences 2373 0 R>> endobj Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2020 – 12/31/2020 Uniform Medical Plan (UMP) Classic (Medicare) (PEBB) Coverage for: Individual/Family | Plan Type: PPO 1 of 10 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.

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