UMP Plus providers and networks

You choose either UMP Plus–Puget Sound High Value Network (PSHVN) or UMP Plus–UW Medicine Accountable Care Network (UW Medicine ACN) when you enroll in UMP Plus. They are separate provider networks.

Some providers and facilities, but not all, are in both networks. If you see a provider that is not in your plan’s network (an out-of-network provider) you pay 50% of the allowed amount after you pay your medical deductible and the provider may balance bill you, which means you will pay any amount an out-of-network provider bills that is above the allowed amount. Read your plan’s certificate of coverage for more information on how services are covered.

You also need to be aware that some providers are network providers at one facility but not another. Please call UMP Customer Service if you have questions about the network status of a provider at a specific facility.

See the UMP Plus network providers section below for more information on how the provider networks work.

UMP Plus is available to the following Public Employees Benefits Board (PEBB) Program benefits-eligible members:

• Employees and their enrolled dependents
• PEBB Continuation Coverage (Unpaid Leave) members and their enrolled dependents
• PEBB Continuation Coverage (COBRA) members and their enrolled dependents not enrolled in Medicare Part A or Part B
• Retirees and their enrolled dependents not enrolled in Medicare Part A or Part B

You must also live in a county covered by a UMP Plus network. You may not enroll if you work in one of the counties, but do not live in that county.

UMP Plus–PSHVN:

• Chelan
• Douglas
• King
• Kitsap
• Pierce
• Snohomish
• Yakima

UMP Plus–UW Medicine ACN:

• Benton
• Franklin
• King
• Pierce
• Skagit
• Snohomish
• Spokane
• Thurston

If you move out of your UMP Plus network service area, you have to change your plan within 60 days. You can change plans by contacting the following:

• Employees: contact your payroll or benefits office
• Retirees and Continuation Coverage members: contact the PEBB Program

Network providers are in either the core or support networks:

• Core network: Contains primary care providers (PCP), specialty providers, and facilities (such as hospitals, surgery centers, and clinics) contracted with your UMP Plus network. You do not pay anything for a primary care office visit when you see your primary care provider in the core network (or a naturopath in the support network). Related services, like x-rays or labs, you receive during a primary care visit may be subject to the medical deductible and coinsurance. For most covered services, you pay 15% of the allowed amount when you see other providers in the core network after you meet your medical deductible. Providers and facilities will not bill you for charges that exceed the allowed amount.

• Support network: Includes certain providers contracted with Regence to supplement the core network and ensure network adequacy. Most of the providers in this network are specialty providers. For most covered services, you pay 15% of the allowed amount when you see providers in the support network after you meet your medical deductible. Providers and facilities cannot bill you for charges above the allowed amount (balance billing).

If your provider or facility is not in the core or support network, they are considered out-of-network. If you see an out-of-network provider, for most covered services you will pay 50% of the allowed amount after you meet your medical deductible, plus any amount the provider charges above the allowed amount (balance billing). Use the UMP provider search tool or call UMP Customer Service to locate a provider in your network.

Note: Some providers are network providers at one facility but not another. Please contact UMP Customer Service if you have questions about the network status of a provider at a specific location prior to receiving services.

This list includes most of the major health organizations that are network providers for UMP Plus–PSHVN. To learn more, visit the UMP Plus–PSHVN network website.

• CHI Franciscan, as part of Virginia Mason Franciscan Health and independent providers as part of Rainier Health Network
• ConfluenceHealth (Chelan and Douglas Counties)
• The Everett Clinic as part of Optum
• The Polyclinic as part of Optum
• Seattle Children’s Hospital
• Virginia Mason as part of Virginia Mason Franciscan Health
• Yakima Valley Memorial

This list includes most of the major health organizations that are network providers for UMP Plus–UW Medicine ACN. To learn more, visit the UMP Plus–UW Medicine ACN network website.

• MultiCare Capital Medical Center
• MultiCare Connected Care
• Fred Hutchinson Cancer Center (formerly Seattle Cancer Care Alliance)
• Seattle Children's Hospital
• Skagit Regional Health
• UW Medicine
• Trios Health
• Lourdes Health

You have access to network primary care providers through the core and support networks.

To receive full coverage for primary care office visits, you must see a primary care provider (PCP) in the core network (or a naturopath from the support network). A PCP provides, coordinates, and helps you access a range of health care services, such as covered immunizations. When you see a PCP for primary care services, office visits are paid at 100 percent. However, related services like s-rays or labs that you may receive during a primary care visit, may be subject to your medical deductible and coinsurance.

You are not required to choose a PCP. However, a PCP may help prevent and treat health care conditions early, promoting your health and well-being. A core network PCP can refer you to specialty providers and help request a network consent when needed (see the “Network consent for out-of-network services” section in your COC). Patients who have a PCP have better health outcomes and a better care experience. To be designated as a PCP, a provider must be one of the provider types and practice under one of the specialties listed below.

Provider type:

• Doctor of Osteopathic Medicine (D.O)
• Medical Doctor (M.D.)
• Naturopathic Physician (N.D.)
• Nurse Practitioner (A.R.N.P.)
• Physician Assistant (P.A.)

PCP Specialties:

• Adult medicine
• Family practice
• General practice
• Geriatrics
• Internal medicine
• OB/GYN or Obstetrics and gynecology
• Pediatrics (for members under age 18)
• Preventive medicine

When you see a core network PCP for primary care services, office visits are paid at 100%. However, related services, like x-rays or labs that you may receive during a primary care visit, may be subject to the medical deductible and coinsurance.

If you see an out-of-network provider for primary care services, you will pay 50% of the cost, and services will be subject to the medical deductible. You may be balance billed, which means you may be billed any amount the provider charges above the allowed amount.

A core network specialty provider is in the core network and specializes in a certain area of care. Examples include cardiologists, allergists, and dermatologists. Find a complete list of specialty provider types by visiting the UMP provider search tool. For most covered services with specialty providers, you pay 15% of the allowed amount after meeting your medical deductible. If you see an out-of-network specialist, you pay 50% of the allowed amount and the provider may balance bill you, which means you may be billed any amount the provider charges above the allowed amount.

Support network providers include providers such as chiropractors, acupuncturists, and massage therapists. Examples of support providers are listed in the chart below, and may be in both core and support networks. However, for chiropractors, acupuncturists, and massage therapists in either the core or support networks, you pay a $15 copay per visit and do not pay coinsurance.

You pay 15% of the allowed amount for covered services from providers in either the core or support network. If you see an out-of-network support provider, you pay 50% of the allowed amount and the provider may balance bill you, which means you may be billed any amount the provider charges above the allowed amount. Use the UMP provider search tool or call UMP Customer Service to locate a provider in your network.

• Network facilities Clinics and other outpatient facilities: At clinics and other outpatient facilities in the core network, you pay 15% of the allowed amount for covered services after you pay your deductible.

• Hospitals Inpatient services: For inpatient services at hospitals in the core network, you pay an inpatient copay of $200 per day, up to an annual maximum of $600. You pay 15% of the allowed amount for professional services after you meet your deductible. Outpatient services: For outpatient services at hospitals in the core network, you pay 15% of the allowed amount after you meet your deductible.

Make sure the provider and the facility are in your network. When you see a network provider at a facility (such as a clinic or hospital), confirm that the facility is also a network provider. Some providers are network providers at one location but not another. Please contact UMP Customer Service if you have questions about the network status of a provider at a specific location.

Emergency care

You may see any provider for emergency care, regardless of network status, and the plan pays at the network rate. You may also have an emergency room copay. However, when you receive nonemergency services at a network hospital, network hospital outpatient department, network critical access hospital, or network ambulatory surgical center in Washington State, you pay the network rate and cannot be balance billed regardless of the network status of the provider. For nonemergency services performed at one of these facilities outside of Washington State, you still pay the network rate, but in some states, an out-of-network provider may be allowed to ask you to waive some of your balance billing protections. For more information, read the "Emergency room" section of your plan's certificate of coverage.

Urgent care

You may visit urgent care clinics in the core or support network, and you will pay 15% of the allowed amount after you pay your deductible. If you visit an out-of-network provider, you will pay 50% of the allowed amount and the provider may balance bill you.

For specific services, like bariatric surgery, see your plan's certificate of coverage for a description of how services are covered.

When you travel, you can see any provider for a medical emergency, regardless of network status, and receive the network rate and cannot be balance billed.

UMP Plus members have access to the BlueCard and BlueCard (Global Core) programs, which are extensive networks of emergency and urgent care facilities around the world. For details, call BlueCard (Global Core) at 1-800-810-2583.

Check your network’s provider lists to make sure that your doctor is in your UMP Plus network. Even if your doctor is located in a clinic or hospital that is in your UMP Plus network, confirm that they are also in the network before scheduling an appointment. Use the UMP provider search tool or call UMP Customer Service to locate a provider in your network.

You may request a travel override to get an extra supply of prescription drugs for extended travel. You may request no more than two travel overrides per calendar year, including all travel within or outside the U.S. Additional conditions apply. There are no network pharmacies outside of the U.S. so requesting an early refill due to a travel override may save you money. To request a travel override, call WSRxS Customer Service at 1-888-361-1611 (TRS: 711).

For help finding a provider, call UMP Customer Service or call your network:

• PSHVN: 1-855-776-9503 (TRS: 711)
• UW Medicine ACN: 1-888-402-4237 (TRS: 711)