Use one of Regence's provider directories. In-network uniform preventative and medical benefits are offered in all plans. The following changes were made to our Uniform Medical Plan Pre-authorization List effective January 1, 2020: ... 2020 changes. Page 1 of 9 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) Achieve 1 (SEBB) Coverage for: Individual/Family | Plan Type: PPO * For more information about limitations and exceptions, see the plan’s certificate of coverage or policy document at hca.wa.gov/ump -sebb coc. b. Included below are the medical management programs that will apply to UMP members effective January 1, 2020 (except as noted below). How to use this certificate of coverage . <> UMP Plus—UW Medicine Accountable Care Network, UMP Consumer-Directed Health Plan (UMP CDHP) (2021), UMP Plus—Puget Sound High Value Network (PSHVN) (2021), UMP Plus—UW Medicine Accountable Care Network (UW Medicine ACN) (2021), UMP Consumer-Directed Health Plan (UMP CDHP) (2020), UMP Plus—Puget Sound High Value Network (PSHVN) (2020), UMP Plus—UW Medicine Accountable Care Network (UW Medicine ACN) (2020, UMP Plus—Puget Sound High Value Network (2021), UMP Plus—UW Medicine Accountable Care Network (2021), UMP Plus—Puget Sound High Value Network (2020), UMP Plus—UW Medicine Accountable Care Network (2020), Website feedback: Tell us how we’re doing. cover eligible dependents, everyone must enroll in the same medical plan Martin’s Point Health Care US Family Health Plan Serving Maine, New Hampshire, Vermont, Upstate and Western New York, and Northern Pennsylvania. Health plans with health savings accounts (HSAs) Contact HCA. February 29, 2016 Final: Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 5. UMP Classic is the only plan that has a separate prescription drug deductible. The following documents—called a Summary of Benefits and Coverage—provide summaries of what each plan covers and what it costs. Applies to Uniform Medical Plan (UMP) With the Uniform Medical Plan, you may choose from the plans listed below. Is there a quick way to see benefits and costs? 2020 Benefit Year It’s Your Choice Health Plan (Program Option 1) Revised 8/29/2019 UNIFORM BENEFITS . Medical Benefit Comparison. 1 of 9 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) Plus—UW Medicine Accountable Care Network (ACN) (PEBB) Coverage for: Individual/Family | Plan Type: ACP The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 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. Generated Date: 5/22/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. Due to COVID-19, HCA’s lobby is closed. For a summary of benefits and costs, see Is there a quick way to see benefits and costs? %���� For all UMP plans, Tier 3 prescription drugs are being removed from the Preferred Drug List as of January 1, 2020. Learn more about the plans. %PDF-1.7 endobj x��=ko�6�������{1#�R�!��ds��fwf�X$���ݶ���v�۞��~���=HJ�D{�cwS�"Y�wϿ;�6W��)�����N���f}��r�y������?/�7��i�ߝ��r����^^���%�?\$��~������2˓,U�p�'���W�C�{����ׯ�?�D~����+"e I HEALTH PLANSare required to provide PARTICIPANTS with a In most cases, you must live in a medical plan’s service area to join the plan. Plus, have the peace of mind that comes from emergency coverage wherever you’re traveling. Applies to Uniform Medical Plan (UMP) Pediatric primary care as well as adult and pediatric specialty care remains available in the Olympia area. For in-depth descriptions of benefits and coverage, see What are the full benefits of each plan? Specifically, the regulations will ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices. 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. 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. 2020: 2021: What type of enrollee are you? Telehealth services through PSHVN may also be an appropriate option for some primary care needs. WSRxS – Washington State Rx (prescription drug) Services. Do I live in the medical plan's service area? For general topics, check the table of contents. 2 0 obj 2020 Plan Year Uniform Dental Benefits Certificate of Coverage For All Programs with Dental Please read the following information carefully for your procedure frequencies and provisions. 2020 State of Wisconsin Group Health Insurance Program Certificate of Coverage IYC Health Plan 20ET-2107cc ... all health plans offering coverage in the State of Wisconsin Group Health Insurance Program must provide the Uniform Benefits as described in this document. Choose a plan that opens doors to top doctors and coordinated, cost-saving networks close to home. ���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�$��!$�- Resolved that, beginning January 1, 2020, contingent upon approval of a value formulary resolution by both the PEB an SEB Boards, all Uniform Medical Plans plans require the use of a value-based formulary and : For additional information about your prescription On average, patients who use Zocdoc can search for an Eye Doctor who takes Uniform Medical Plan insurance, book an appointment, and see the Eye Doctor within 24 hours. As of September 23, 2012 or soon after, health insurance issuers and group health plans are required to provide you with an easy-to-understand summary about a health plan’s benefits and coverage. The new regulation is designed to help you better understand and evaluate your health … After a two-year competitive process, HCA selected Regence BlueShield as […] An employer can permit employees to apply unused health and dependent care FSA amounts remaining as of the end of a grace period ending in 2020 or a plan year ending in 2020 (i.e., an off calendar year plan) to pay or reimburse expenses incurred for the same type of FSA through December 31, 2020. 4 0 obj 2020 Plan Year Uniform Dental FAQs For the State Employee & Retiree Health Plan 1. Who is eligible for the Uniform Dental Benefit plan? UMP Plus–Puget Sound High Value Network (PSHVN) does not have primary care network providers for adults in Thurston County at this time due to limited access. This applies to all essential health benefits, including some services not included in the out-of-pocket limit. Your options are limited to the plans available in your county. �O��_��� W���"�J�ě��$��]�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���~�'�"� Revised 9/8/2020 . 2021: Available in all Oregon and Idaho counties and nationwide. Page 1 of 7. UMP has issued a COVID-19 summary of changes for their Certificates of Coverage. Learn more about your customer service options. Generated Date: 3/23/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. 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. This means that you and any adult dependents may need to travel to another county served by UMP Plus–PSHVN for primary care services from a network provider. 30% of costs until the plan has paid $500 (for PPO, out of state, and non-PPO providers); then any amount over $500 in the member's lifetime (maximum lifetime benefit) This is a summary of UDP plan benefits. Alert: All specialty drugs require preauthorization. Employee: Retiree (Medicare) Retiree (non-Medicare) PEBB Continuation Coverage (COBRA Medicare) In general, you may choose from the plans listed below. UMP – Uniform Medical Plan . Use the tables below to make sure you live in the plan's service area. 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. Some drugs may show that they are "not covered." November 4, 2014 Group Health Plans that Fail to Cover In-Patient Services 2. The VHA Comprehensive Mental Health Strategic Plan and the requirements included in this Handbook have been developed to implement the goals of the President’s New Freedom Commission on Mental Health, including the principle that mental health care is an essential component of overall heath care. 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. 0iY�. 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. Applies to Uniform Medical Plan (UMP) $1,400/per person, $2,800/family Deductible is what you pay before the plan begins to pay. All state employees and retirees who elect medical coverage through the State of Wisconsin Group Health Insurance Program are eligible. All dental benefits are paid according to the terms of the Master Contract between the Health Plan, Dental Plan and Group Insurance Board. King, Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, Yakima, Uniform Medical Plan Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. What are my plan options? See The federal maximum out-of-pocket is $8,150 individual/$16,300 family. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. stream <>/Metadata 2372 0 R/ViewerPreferences 2373 0 R>> UMP is the state’s self-funded medical option for eligible members enrolled in the Public Employees Benefits Board (PEBB) Program. 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). you must report your new address to your payroll or benefits office no later than 60 days after your move. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. If you move out of your plan's service area, you may need to change plans. <> UNIFORM BENEFITS . 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. Members: 1-888-674-8734 Non-Members: 1-888-241-4556 Providers: 1-888-732-7364 <>/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>> 1 0 obj 2020: King, Kitsap, Pierce, Snohomish, Thurston, Yakima, 2021: Chelan, Douglas, King, Kitsap, Pierce, Snohomish, Thurston, Yakima. 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… 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. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. April 14, 2015 Key Dates in 2015: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance, and Risk Corridors 3. There is now an exception process for members who require prescription drugs that are no longer covered. Sleep Medicine . December 23, 2015 Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 4. (i.e. Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options. ... 2020 UMP Classic (PEBB) Certificate of Coverage 8 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 For all the plans, you pay coi… As of the 1994 coverage year, all HEALTH PLANSoffering coverage in the State of Wisconsin ... of the Uniform Benefits plan. o�h�K�?ɫ��� r��Q� �s�w�l_���L��K���S4j� Uniform Medical Plan (UMP) plans. Uniform Glossary of Coverage and Medical Terms SBC and Uniform Glossary Translations - Chinese, Spanish, Tagalog, and Navajo Summary of Benefits and Coverage (SBC) Templates, Instructions, and Related Materials – for plan years beginning on or after 4/1/17 �������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 Employees can choose a health plan with or without dental (routine and preventative dental), and the It’s Your ... 11/18/2020 It’s Your Choice Health Plan (IYC) Benefit Schedule Benefits You Receive Included endobj Guidance 1. The following documents—called a Certificate of Coverage—provide in-depth descriptions of the health care benefits for each plan. 2021: Available in all Washington counties and nationwide. If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. See the 2020 Preferred Drug List. Which year would you like information on? 3 0 obj To learn more, please call Washington State Rx Services at 888-361-1611. The HEALTH PLAN may not alter the language, benefits or exclusions and limitations of the Uniform Benefits plan. This limit helps you plan for health care expenses. 2020 UMP Classic (PEBB) Certificate of Coverage 6. Available in all Washington counties and nationwide. 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. certain level 3 & 4 prescription drugs and certain hearing aids covered under this plan). endobj