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Medical/Dental Insurance
for Faculty, Staff & Librarians — Uniform Medical Plans

UNDERSTAND

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

  1. Uniform Medical Plan (UMP) Classic
  2. UMP Consumer-Directed Health Plan (CDHP)

Two plans are new for 2016:

  1. UMP Plus - Puget Sound High Value Network (PSHVN)
  2. UMP Plus - UW Medicine Accountable Care Network (ACN)

All plans feature the following:

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:

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 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 preferred (in-network) provider or out-of-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:

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.

UMP Plus Plans

The health care coverage for the two UMP Plus plans is identical; however, the network of health care providers is different. To choose between the two UMP Plus plans, determine which network of health care providers best meets your needs.

Annual Medical Deductible: Each year you must pay for health care services until you have paid your full deductible amount. Once that is paid, you insurance begins paying for services. However, you insurance pays for some services even if you have not yet paid your deductible. These services include:

Prescription Drug Deductible: There is no prescription drug deductible for the Plus plans.

Coinsurance: When you visit an in-network health care provider, you pay nothing for certain services such as primary care, preventative care, immunizations, and eye exams. For other services, you pay a part of the cost and the insurance pays the rest. The part you pay is called coinsurance. The coinsurance for most services is 15 percent when you use in-network providers and 50 percent when you use out-of-network providers. Review the plan information to learn what coinsurance you pay for various health care services.

Copayment: For most health care services, you pay coinsurance rather than a copay. You make copayments for emergency room visits and inpatient treatment.

Compare the two UMP Plus networks:

The UMP Plus plans have separate networks of health care providers. So when choosing between Plus plans, compare the two networks and determine which one is right for you. Once you enroll, the providers in the other network will be non-network providers, and you will pay more to use their services.

To compare UMP Plus networks, consider your health care needs then review the health care providers in each network. Start by searching for providers:

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 three other UMP plans. The HSA is funded by pre-tax contributions from the UW. You have the option of contributing as well. Learn how a CDHP-HSA works.

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

Contact the Plans

Compare Plan Types

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.

Find a UMP Provider

Enroll in UMP

File a Claim

Medical claim forms are available at the UMP's website. These are most commonly used:

Change Your Medical 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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