This page contains benefit information for 2024. For 2025 open enrollment information visit the UMP PEBB Open Enrollment webpage.
The Centers of Excellence (COE) Program covers single knee and single hip replacement surgery at low to no cost to qualifying UMP Classic, UMP Select, and UMP Consumer-Directed Health Plan (CDHP) members. Premera administers the COE Program for UMP, and Virginia Mason Medical Center is the COE for knee and hip replacement.
Eligibility
If you have a UMP Classic, UMP Select, or UMP CDHP plan, are 18 or older, and not enrolled in Medicare as your primary coverage, you may qualify for this program. Medicare and UMP Plus members have access to covered services related to joint replacement outside of this program, which may be paid at the standard rate. Learn more about eligibility for the knee and hip replacement program.
Cost
For UMP Classic and UMP Select members, treatment is covered in full. For UMP CDHP members, treatment is covered in full after you meet your annual deductible.
How to participate
You may refer yourself, or your provider may refer you, by calling Premera at 1-855-784-4563 (TRS: 711). Premera will determine if you qualify for the program, and if you do, they will refer you to Virginia Mason Medical Center for further assessment. Learn more about the knee and hip replacement program.
The Centers of Excellence (COE) Program covers spine evaluation and/or lumbar fusion surgery at low to no cost to qualifying UMP Classic, UMP Select, and UMP CDHP members. Premera administers the COE Program for UMP and Virginia Mason Medical Center (in Seattle) is the COE for spine care.
Eligibility
If you have a UMP Classic, UMP Select, or UMP CDHP plan, are 18 or older, are not enrolled in Medicare as your primary coverage, and have had more than 12 weeks of lower back or leg pain (the pain must be of confirmed spinal origin with neurologic symptoms or signs) you may qualify for this program. Medicare and UMP Plus members have access to covered services related to spine care outside of this program, which may be paid at the standard rate. Learn more about eligibility for the spine care program.
Cost
For UMP Classic and UMP Select members, treatment is covered in full. For UMP CDHP members, treatment is covered in full after you meet your annual deductible.
How to participate
You may refer yourself, or your provider may refer you, by calling Premera at 1-855-784-4563 (TRS: 711). Premera will determine if you qualify for the program, and if you do, they will refer you to Virginia Mason Medical Center for further assessment. Learn more about the spine care program.
The below programs are not available to Medicare retirees enrolled in UMP.
Diabetes prevention
The Diabetes Prevention Program, offered through UMP’s partner, Omada Health, combines the latest technology with ongoing support to help you build healthy habits that last. You’ll get a professional health coach, a wireless scale, and a supportive peer group. Your UMP medical plan covers the entire cost of the program.
You are eligible for the program if you are enrolled in a UMP plan, age 18 or older, not enrolled in Medicare, and meet the criteria after completing the 1-minute screening questionnaire on the Omada Health website.
Learn more about the Diabetes Prevention Program powered by Omada Health.
Diabetes Control Program
If you have a diagnosis of diabetes, are over the age of 18, and are not enrolled in Medicare Part A and B, you can participate in the Diabetes Control Program. This program is administered by the Regence Care Management Program and covered by UMP at no additional cost to you.
Case managers are trained to help you reduce the risk of complications of diabetes by tracking and controlling blood sugar, cholesterol levels, blood pressure, and weight in a series of quarterly consultations.
If you have been diagnosed with diabetes, sign up for the program by calling 1-866-543-5765. See Diabetes Control Program in your plan's certificate of coverage for more information.
Palliative care is specialized medical care for people living with serious illness or significant injury. Palliative care is not hospice care and the patient does not need to have a terminal diagnosis to receive palliative care. It is focused on providing relief from symptoms and stress, and the program goal is to improve quality of life for both the patient and their loved ones.
Palliative care is patient-centered, family-oriented, and compassionate. It provides physical and emotional support throughout all stages of a serious illness or injury.
Palliative care support includes adult and pediatric case management. Case managers help coordinate care, explain your benefits and resources, act as advocates, and provide support and advice.
The program also includes services, such as:
- Home health medical services - pain and symptom management
- Home health psychological and social services - counseling services and spiritual support visits
To learn more, visit the Palliative care webpage on the HCA website.
The Washington Death with Dignity Act allows terminally ill adults seeking to end their life to request lethal doses of prescription drugs. These terminally ill patients must be Washington residents who have less than six months to live. For more information about this Act, see Chapter 70.245 RCW.
Care described under this Act includes services covered by UMP, subject to standard plan requirements.
If you have questions about medical services UMP covers, contact UMP Customer Service. If needed, UMP may assign a case manager to support you. If you have questions about prescription drugs UMP covers, contact WSRxS Customer Service.
If your current provider is unable to meet your needs, or if you need assistance in finding a provider for these services, visit End of Life Washington’s website. End of Life Washington is a community resource available to support the public in finding available providers.
For more information about the Death with Dignity Act, visit:
The Pregnancy Program offers knowledge, support, and comfort for expectant parents. With the Pregnancy Program, you receive:
- Regular updates about what to expect during your pregnancy and at prenatal appointments
- Expert information about nutrition, breastfeeding, and common pregnancy concerns
- Tips for enjoying those first few weeks home with baby
- Access to a nurse by telephone 24/7
- Regular contact from an assigned program nurse (if high-risk)
- Personalized pregnancy milestones and activity/appointment reminders through the free Regence Pregnancy Program app
The Pregnancy Program is covered at no cost to you. To get started with the Pregnancy Program, sign in to your Regence account or call 1-888-569-2229.
The Expert Second Opinion program, provided by 2nd.MD, is a treatment decision support service that provides UMP Classic, UMP Select, and UMP CDHP members second opinions and treatment plan reviews from medical experts for select services. By using this program, you can learn more about your medical conditions and make an informed decision on your treatment plans alongside your provider. Visit the 2nd.MD website or call 1-866-982-1434 to learn more. Contact UMP Customer Service for a detailed list of services and criteria.
UMP offers access to programs and coaches to help you live tobacco-free. Find more information about the many tobacco cessation services available to you in your plan’s certificate of coverage.
Nicotine replacement therapy
Our plans cover certain nicotine replacement therapy products (such as gum, patches, sprays, inhalers, tablets, or lozenges) at the preventive rate. These are shown on the UMP Preferred Drug List with “Preventive” in the Tier column. UMP does not normally cover over-the-counter drugs, but UMP covers nicotine replacement products when they are purchased at a network pharmacy using your UMP member ID card. You may get nicotine replacement therapy directly from the Quit for Life program, or by following these steps:
- Get a prescription from your provider.
- Take the prescription to a network pharmacy.
- Make your purchase at a network pharmacy. Give your prescription and your UMP member ID card to the pharmacist. The purchase must be submitted through the prescription drug system to be covered.
UMP plans do not cover e-cigarettes or vaporizers (“vapes”).
Counseling
UMP also covers in-person counseling related to tobacco cessation at the preventive rate when you see a network provider. Phone or online counseling is covered only through the Quit for Life program. UMP members age 17 and under may use the Smokefree Teen program.
Quit for life
UMP members age 18 and older may participate in the Quit for Life tobacco cessation program. This program offers phone counseling, medications, and other tools and resources. Visit the Quit for Life website to learn more.
Smokefree Teen
UMP members age 17 and under may use the Smokefree Teen program in addition to nicotine replacement therapy and counseling.
myStrength is a self-guided health and resiliency online tool clinically proven to improve emotional health. This secure resource is available 24 hours a day, 7 days a week to members ages 13 and over at no cost to you. myStrength’s interactive and activity-based tools are personalized to you and address conditions such as depression, anxiety, stress, substance use disorders, and chronic pain. Visit the myStrength website to sign up and learn more.
Centers of Excellence does not provide BlueCross BlueShield services and is a separate company solely responsible for its products/services.
myStrength is a separate company that provides virtual behavioral health care services.
Omada Health is a separate company that provides care and disease management services.
2nd.MD is a separate company that provides treatment decision support through their Expert Second Opinions program.