Choose a Medical Plan

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:

1. Uniform Medical Plan (UMP) Classic - a Preferred Provider Organization (PPO) traditional plan
2. UMP Consumer Driven Health Plan with Health Savings Account (CDHP-HSA)
3. Group Health Classic - a managed care traditional plan
4. Group Health Value - a managed care value plan
5. Group Health CDHP-HSA
6. Kaiser Permanente Classic - a managed care traditional plan covering certain regions
7. Kaiser Permanente CDHP-HSA covering certain regions

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

Step 1: Determine which medical plans are available in your area.

Go to PEBB's Plan Comparison web site to see which plans are available in your area. Compare up to three plans at once, checking the orange box to display only the benefits that are different.

Step 2: Determine what you are willing to pay for health care.

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

• Annual deductibles, Copayments or Copays, Coinsurance, Out-of-pocket maximums*
• Also, if you have a specific medical condition, investigate costs and provider options outlined in the plan's Certificate of Coverage.

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

Step 3: Search for your 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:

• Do not mind paying higher premiums to ensure lower deductibles.
• Want flexibility in choosing any approved provider worldwide for medically necessary services, but are open to using a Preferred Provider to keep their costs down.
• May have covered family member(s) with a chronic condition requiring specialty care.
• Want the option of using a Flexible Spending Account (FSA).

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

• Want lower monthly premiums.
• May have covered family member(s) with a chronic condition requiring ongoing medical management including prescription drugs, regular office visits, and specialty care.
• Want the least hassle with paperwork.
• Are willing to use the health care network.
• Want the option of using a Flexible Spending Account.

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

• Want a low monthly premium.
• Have covered family members in good health who rarely use health care services.
• Want the least hassle with paperwork.
• Are willing to use the health care network for care.
• Want the option of using a Flexible Spending Account.

CDHP-HSA plan is generally best for people who:

• Want the lowest monthly premium.
• Can meet the eligibility requirements to participate in a CDHP-HSA.
• Can pay out-of-pocket for treatments and services needed, if there are not enough dollars accrued in the HSA.
• Are generally very healthy; primarily use preventive care from their health plan; and do not have ongoing major medical needs and/or use specialty drugs (e.g. high-cost injectable, oral, or inhaled drugs).
• Are willing to retain documentation for HSA expenditures in case of IRS audit.
• Are willing to verify if services or supplies, not covered by insurance, are qualified medical expenses for coverage under the HSA.
• Want additional tax-free savings for future medical expenses.
• Want to build a health savings account that remains with them even after UW employment or into retirement.

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 Driven 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.

Step 6: 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.

Step 7: Enroll in (or change) a medical plan.

1. Download the Enrollment/Change Form (PDF).
2. To add family members to your coverage, you must provide valid dependent verification documents that prove their eligibility, along with the Enrollment/Change form.
3. Also, to add a qualified domestic partner to your coverage, you will need to provide a Tax Status form (PDF).
4. Return all forms to the Benefits Office.
5. If you have a CDHP-HSA, learn how to start HSA payroll deductions.

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.

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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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