UMP Plus Out-of-Pocket Provider Network Out-of-Network Prescription Facility/Hospital Premiums Deductibles Special Limits Networks Reimbursement Reimbursement Drugs Charges Mid-range $125 per Medical: More complex Providers Identical to UMP For preferred Coordinated Care UMP Plus: of UMP person, $375 $2,000/$4,000 than the network outside both the Classic facilities: by high-quality Plan rules Plans family family for UMP Classic UMP Plus and Member pays provider networks don’t allow Based on tier Regence maximum for maximum and UMP CDHP. $200 per Day, to improve patient system; for most three (3) or (same as UMP Networks are networks: up to $600 outcomes, reduce primary generic drugs, the more (lowest Classic) specific to UW Member pays 50% annually for cost, and enhance Members to Member of UMP and PSHVN of the allowed doesn’t inpatient patient be enrolled Prescription pay the Plans) providers except amount, plus any facility satisfaction. in UMP drugs: prescription drug for ancillary amount billed by charges. Plus. No deductible deductible. No-cost primary services the provider over $2,000 per for Professional care services (currently UMP the allowed person, no Member pays prescription providers bill when seeing a TPA network). amount. family more for certain drugs separately Primary Care maximum high-cost and Primary Care from the provider within the (same as UMP brand-name and Specialty facility, and UMP Member’s Classic) drugs. providers must are paid Plus network (not be in the according to just preventive UMP the services). Member’s provider’s Plus network to network Emergency care: be covered at status. Member pays a the network rate. $75 copay. ACN Ancillary May participate in Providers in the medical flexible UMP Plus spending Service Area are arrangement covered as under the PEBB. network for both UMP Plus networks Emergency and urgent care: May use Regence network providers and
UMP Plus Premiums Deductibles Out-of-Pocket Limits Provider Networks Network Reimbursement Out-of-Network Reimbursement Prescription Drugs Facility/Hospital Charges Special Mid-range of UMP Plans $125 per person, $375 family maximum for three (3) or more (lowest of UMP Plans) No deductible for prescription drugs Medical: $2,000/$4,000 family maximum (same as UMP Classic) Prescription drugs: $2,000 per person, no family maximum (same as UMP Classic) More complex than the network for UMP Classic and UMP CDHP. Networks are specific to UW and PSHVN providers except for ancillary services (currently UMP TPA network). Primary Care and Specialty providers must be in the Member’s UMP Plus network to be covered at the network rate. ACN Ancillary Providers in the UMP Plus Service Area are covered as network for both UMP Plus networks Emergency and urgent care: May use Regence network providers and Providers outside both the UMP Plus and Regence networks: Member pays 50% of the allowed amount, plus any amount billed by the provider over the allowed amount. Identical to UMP Classic Based on tier system; for most generic drugs, the Member doesn’t pay the prescription drug deductible. Member pays more for certain high-cost and brand-name drugs. For preferred facilities: Member pays $200 per Day, up to $600 annually for inpatient facility charges. Professional providers bill separately from the facility, and are paid according to the provider’s network status. Coordinated Care by high-quality provider networks to improve patient outcomes, reduce cost, and enhance patient satisfaction. No-cost primary care services when seeing a Primary Care provider within the Member’s UMP Plus network (not just preventive services). Emergency care: Member pays a $75 copay. May participate in medical flexible spending arrangement under the PEBB. UMP Plus: Plan rules don’t allow Members to be enrolled in UMP Plus. primary