Use the tables below to make sure you live in the plan's service area. certain level 3 & 4 prescription drugs and certain hearing aids covered under this plan). <>/Metadata 2372 0 R/ViewerPreferences 2373 0 R>> Do I live in the medical plan's service area? Some drugs may show that they are "not covered." Specifically, the regulations will ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices. 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. 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. 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 : (i.e. With the Uniform Medical Plan, you may choose from the plans listed below. �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���~�'�"� Page 1 of 7. o�h�K�?ɫ��� r��Q� �s�w�l_���L��K���S4j� Guidance 1. 2020: King, Kitsap, Pierce, Snohomish, Thurston, Yakima, 2021: Chelan, Douglas, King, Kitsap, Pierce, Snohomish, Thurston, Yakima. Applies to Uniform Medical Plan (UMP) WSRxS – Washington State Rx (prescription drug) Services. cover eligible dependents, everyone must enroll in the same medical plan <>/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 %PDF-1.7 For general topics, check the table of contents. The following documents—called a Summary of Benefits and Coverage—provide summaries of what each plan covers and what it costs. 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. endobj What are my plan options? stream See the 2020 Preferred Drug List. If you move out of your plan's service area, you may need to change plans. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. For additional information about your prescription The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Applies to Uniform Medical Plan (UMP) The HEALTH PLAN may not alter the language, benefits or exclusions and limitations of the Uniform Benefits plan. 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. All dental benefits are paid according to the terms of the Master Contract between the Health Plan, Dental Plan and Group Insurance Board. <> UMP is the state’s self-funded medical option for eligible members enrolled in the Public Employees Benefits Board (PEBB) Program. All state employees and retirees who elect medical coverage through the State of Wisconsin Group Health Insurance Program are eligible. This applies to all essential health benefits, including some services not included in the out-of-pocket limit. Employee: Retiree (Medicare) Retiree (non-Medicare) PEBB Continuation Coverage (COBRA Medicare) 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. 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 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. Which year would you like information on? 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. 2020 Benefit Year It’s Your Choice Health Plan (Program Option 1) Revised 8/29/2019 UNIFORM BENEFITS . 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. endobj Choose a plan that opens doors to top doctors and coordinated, cost-saving networks close to home. Your options are limited to the plans available in your county. 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. To learn more, please call Washington State Rx Services at 888-361-1611. For all UMP plans, Tier 3 prescription drugs are being removed from the Preferred Drug List as of January 1, 2020. UNIFORM BENEFITS . 0iY�. 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. ���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�$��!$�- 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 2020: 2021: What type of enrollee are you? In most cases, you must live in a medical plan’s service area to join the plan. For a summary of benefits and costs, see Is there a quick way to see benefits and costs? The following documents—called a Certificate of Coverage—provide in-depth descriptions of the health care benefits for each plan. 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. December 23, 2015 Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 4. The new regulation is designed to help you better understand and evaluate your health … 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. Included below are the medical management programs that will apply to UMP members effective January 1, 2020 (except as noted below). February 29, 2016 Final: Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 5. Sleep Medicine . King, Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, Yakima, Uniform Medical Plan 2020 Plan Year Uniform Dental FAQs For the State Employee & Retiree Health Plan 1. Who is eligible for the Uniform Dental Benefit plan? 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. In-network uniform preventative and medical benefits are offered in all plans. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. Generated Date: 5/22/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. April 14, 2015 Key Dates in 2015: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance, and Risk Corridors 3. 2020 UMP Classic (PEBB) Certificate of Coverage 6. Uniform Medical Plan (UMP) plans. Medical Benefit Comparison. 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. 3 0 obj Telehealth services through PSHVN may also be an appropriate option for some primary care needs. For in-depth descriptions of benefits and coverage, see What are the full benefits of each plan? 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 As of the 1994 coverage year, all HEALTH PLANSoffering coverage in the State of Wisconsin ... of the Uniform Benefits plan. Health plans with health savings accounts (HSAs) Contact HCA. 2021: Available in all Oregon and Idaho counties and nationwide. Use one of Regence's provider directories. For all the plans, you pay coi… 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. See Plus, have the peace of mind that comes from emergency coverage wherever you’re traveling. 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… Applies to Uniform Medical Plan (UMP) you must report your new address to your payroll or benefits office no later than 60 days after your move. Available in all Washington counties and nationwide. This limit helps you plan for health care expenses. 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. Martin’s Point Health Care US Family Health Plan Serving Maine, New Hampshire, Vermont, Upstate and Western New York, and Northern Pennsylvania. If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. Generated Date: 3/23/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract.