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Medical/Dental Insurance
for Faculty, Staff & Librarians—Choose a Medical Plan

UNDERSTAND

It's important to choose a medical plan that's best for you and your family. A carefully selected health plan can potentially reduce medical costs over the long term and give you peace of mind. The Public Employees Benefits Board (PEBB) sponsors the following medical plans for your consideration:

ACT

Follow this step-by-step approach to make an informative decision about your medical plan.

Step 1: See which plans are available in your area​

In most cases, you must live in the medical plan’s service area to join the plan. Be sure to call the plan(s) you are interested in to ask about provider availability in your county.

Step 2: Consider costs

In addition to monthly premiums which are deducted from your pay, other costs should be considered when choosing a medical plan:

*Definitions for these medical terms may be found at Department of Labor's Glossary of Health Coverage & Medical Terms.

Step 3: Search for a doctor or medical facility

If you have a doctor or medical facility that you want to continue to visit, contact them to ask whether they will accept your new plan. If you do not have a current doctor, you can find a provider here.

Step 4: Determine which type of plan is best for your circumstances

Uniform Medical Plan (UMP) CLASSIC, a preferred provider plan, is generally best for people who:

Group Health and Kaiser's CLASSIC (managed care plans) are generally best for people who:

Group Health VALUE, a managed care plan, is generally best for people who:

CDHP-HSA plan is generally best for people who:

Step 5: Compare and confirm your choice

Compare Plan Types

This chart shows a basic comparison between medical plans. For a more detailed comparison, see the PEBB's Summary of Benefits and Coverage.

Note: CDHP with HSA = Consumer Directed Health Plan with Health Savings Account

 

Managed Care Plans

 

Preferred Provider Organization (PPO)

 

Classic Value CDHP with HSA Classic CDHP with HSA

Health Plan

Group Health Classic, Kaiser Permanente Classic Group Health Value Group Health CDHP, Kaiser Permanente CDHP Uniform Medical (UMP) Classic Uniform Medical (UMP) CDHP

Primary Health Care Provider referral required?

 

Must use provider's facilities for care. Not necessary for all family members to use the same physician.

No. Choose any approved provider worldwide for medically necessary services, except massage therapy (must be used within network only).

 

In-Network discounts available?

Not applicable.

Yes.

Yes.

Yes.

Annual Medical Deductible

$250/person, $750/family

$350/person; $1,050/family

$1,400/person; $2,800/family

$250/person,

$750/family

$1,400/person; $2,800/family

Prescription Drug Deductible

Not applicable.

$100/person,

$300/family

(Tier 2 and 3 drugs)

Not applicable

Office Copay

$15-30 per visit depending on specialist.

$20-40 per visit depending on specialist.

None. See co-insurance below.

None. See co-insurance below.

 

Co-Insurance (after deductible)

 

None. See co-pay above.

 

Group Health CDHP members pay 10% for In-Network care; 30% for Extended Network care.

UMP Classic members pay 15% for In-Network care; 40% for Out-of-Network care.

 

UMP CDHP members pay 15% for In-Network care; 40% for Out-of-Network care.

 

Kaiser CDHP members, call
1-800-813-2000.

Out-of-Pocket Maximum

$2,000/person,

$4,000/family of 3+ persons

 

Group Health: $5,100/person; $10,200/family.

$2,000/person, $4,000/family

UMP CDHP: $4,200/person; $8,400 /family

Kaiser CDHP: $4,200/person; $8,400 /family.

Monthly Premiums

See rates.

Highest
Lower
Higher Lowest

Preventive Care

(per Certificate of Coverage)

Enrollee pays $0; not subject to the annual deductible.
In-Network provider: 100% covered and deductible does not apply.

In-Network: 100% covered.

Out-of-Network: 60% covered; not subject to deductible

In-Network provider: 100% covered and deductible does not apply.

Emergency Room

Copay waived if admitted

$150; not subject to annual deductible.
85% Covered at 85% after $75 co-pay per visit. 85%
Flexible Spending Account (FSA) Eligible?
Yes.
No. HSA required. Yes. No. HSA required.
Health Savings Account (HSA) Eligible?
No.
Yes, required. Employer contribution applies. No. Yes, required. Employer contribution applies.
Self-refer for specialized care? No, you must be referred by your primary care provider (PCP) for any specialized care, or care outside of the plan's facilities. Same as managed care plan (left).
Yes.
Massage Therapy & Physical Therapy Must be referred by your primary care provider (PCP) for any specialized care, or care outside of the plan's facilities. Same as managed care plan (left). Covered only when prescribed by an approved provider type. Must be within the UMP provider network for services to be covered. See box to the left.
Managing paperwork & Filing Claims Very few claim forms. Doctors, labs and pharmacies file most necessary claims directly. You must track your HSA account with HealthEquity, qualified trustee. You must keep receipts and track expenses according for IRS review in case of audit.

Preferred Provider: Will file claims with plan administrator on your behalf.

Non-preferred provider: May or may not file claims for you. Check with your provider.
You must track your HSA account with HealthEquity, qualified trustee. You must keep receipts and track expenses according for IRS review in case of audit.

Enroll in (or change) a medical plan

Traditional Classic or Value plans have just a few enrollment steps whereas the CDHP-HSA plans require an additional form, the Employee Authorization for Payroll Deduction to Health Savings Account form.

To begin the enrollment process, go to Enroll in a Medical Plan.

Waiving Coverage

You may elect to waive medical coverage for yourself and your family members. (Note: Dental coverage may not be waived—there is no employee premium for this coverage.) If you waive coverage for yourself, you may not enroll a family member. Even if you waive medical coverage you will not receive any additional compensation because the UW is required to pay the employer portion of your coverage to the Health Care Authority regardless.

EXPLORE

Gather further information about your plan choice

Each health plan’s website contains information about participating doctors and pharmacies, certificates of coverage, plan availability and specific benefits, including preauthorization requirements and exclusions. Also, see the individual plans at the right side bar.

If you have questions about the certificate of coverage, or to receive a copy, contact the plan.


Disclaimer: The information on this page does not substitute for official plan documents. If there is a conflict between the information on this site and an official plan document, the official plan document will govern. Refer to the Benefits Forms & Publications page.

Plan availability and eligibility may change depending on your employment status and/or actions of the Washington State Health Care Authority (HCA), the agency that purchases and coordinates health insurance benefits for public employees, including employees of the University of Washington, through the Public Employees Benefits Board (PEBB) program.

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General Health Assessment
Receive valuable feedback about your health and associated risk factors by taking a Health Assessment through your health plan. It's fast, easy, confidential and free! Learn more.