UNDERSTAND

Uniform Medical is a preferred provider organization (PPO) medical insurance plan administered by Regence BlueShield. Two types of Uniform Medical plans are offered to UW employees and their dependents:

1. Uniform Medical Classic (PPO) Plan
2. Uniform Medical Consumer-Driven Health Plan (CDHP)

Both plans feature the following:

• You are free to choose any approved provider worldwide for medically necessary services, except for massage therapy (see note below).
• Your choice of providers and facilities will determine your benefit level. You receive the highest benefits by visiting a preferred provider.
• The plans include a calendar-year deductible for most services.
• Note: Massage therapists must be within the UMP provider network for services to be covered, i.e. after the deductible is met. In addition, the plan covers massage therapy and physical therapy only when prescribed by an approved provider type. For more details, refer to the plan's Certificate of Coverage.

Terms to Know

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

• Annual deductibles - the amount you must pay out of pocket for health care and prescriptions before the plan begins to pay.
• Co-insurance - the cost that you and the plan share. (Applies to CDHP-HSA plan only.)
• Out-of-pocket maximums - the maximum amount you will generally pay in any year.
• Also, if you have a specific medical condition, investigate costs and provider options outlined in the plan's Certificate of Coverage.

Uniform Medical Plans (UMP)

Classic (PPO) Plan

For UMP Classic, covered services are paid using a combination of deductibles, coinsurance, and copayments (explained below). Total cost for care also depends on whether you see a network or non-network provider. Not all doctors who provide services in network hospitals are necessarily in your plan's network. See hospital-based providers for more information.

Annual Medical Deductible: Before your plan pays for most services, you must pay a medical deductible every calendar year. The following services are covered before you meet your medical deductible:

• Services covered under the preventive care benefit (includes well-baby care and screening mammograms)
• Routine vision care (eye exams, eyeglasses and contact lenses)
• Routine hearing care (hearing exams and hearing aids)
• The Quit For Life tobacco cessation program
• Required second opinions (refer to Certificate of Coverage)

Prescription Drug Deductible: Tier 1 prescription drugs (generic drugs) have no deductible. Tier 2 and Tier 3 prescription drugs (brand-name drugs) require that you pay an annual prescription drug deductible before UMP pays benefits.

Coinsurance: UMP Classic covers most medical services based on a percentage of the allowed amount providers agree to accept as payment in full. Coinsurance is the percentage of the allowed amount you must pay when the plan pays less than 100% of the allowed amount.

Uniform Medical Classic Coinsurance

For network providers:	15% of the allowed amount.
For non-network providers:	40% of the allowed amount, plus any amount billed by the provider that is above the allowed amount.

Copayment: "Copays" are a set dollar amount you pay when you receive specific services, treatments, or supplies, such as inpatient hospitalization, emergency room care, or a prescription filled through a network mail-order pharmacy.

View Benefits Booklet, plan summary, and contact information for the Uniform Medical Classic Plan.

For questions about coverage, call Regence Customer Service at 1-888-849-3681.

• Find a Network Provider
• List of Pharmacies
• Medical Premiums

Consumer-Directed Health Plan with a Health Savings Account (CDHP-HSA)

Uniform Medical's consumer-directed health plan is a high-deductible, low-premium type of plan. The premiums are considerably lower and the annual deductible is considerably higher than the Classic plan. To enroll this plan, you must first open a Health Savings Account (HSA). The HSA is funded by pre-tax contributions from the UW. You have the option of contributing as well.

• See an overview of how the CDHP-HSA works.
• View the Benefits Booklet, plan summary, and contact information for Uniform Medical's CDHP-HSA.

Note: If you plan to enroll in a CDHP-HSA, you and your spouse will not be able to participate in an FSA in the same year. If you already have an FSA for a prior year, you will be required to use all funds by the end of the current year, i.e. there will be no grace period.

ACT

Compare the plans

Compare the per-visit costs of some in-network benefits for PEBB's medical plans.

Note: Some copays and coinsurance do not apply until after you've paid your annual deductible. Call your plan directly for more information on specific benefits, including preauthorization requirements and exclusions.

Find a Provider

See a List of Health Care Provider for Uniform Medical plans.

Enroll in a plan

Following the instructions at Choose Your Medical Plan, step 7, to enroll (or change) your medical plan:

1. As a new hire or newly-eligible employee
2. To change your plan during the Open Enrollment period
3. To change your plan due to a Qualified Life Event

EXPLORE

Uniform Medical Plan Classic Plan - Certificate of Coverage (Benefits Booklet)

Uniform Medical Plan CDHP - Certificate of Coverage (Benefits Booklet)

---

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.

• uwhr@uw.edu |
• HR Contacts

Copyright © 2007 University of Washington