UMP Plus providers and networks - PEBB

Important message for UMP Plus–PSHVN members

UMP Plus–Puget Sound High Value Network (PSHVN) does not have primary care network providers for adults in Thurston County at this time due to limited access. Pediatric primary care as well as adult and pediatric specialty care remains available in the Olympia area. You and any adult dependents may need to travel to another county served by UMP Plus–PSHVN for primary care services from a network provider. Telehealth services through PSHVN may also be an appropriate option for some primary care needs.

UMP Plus providers and networks

UMP Plus offers two plans: Puget Sound High Value Network and UW Medicine Accountable Care Network. To find out if you are eligible for these plans, read the "Who can enroll" section below.

UMP Plus provides high-quality care at a lower cost. Providers who join UMP Plus agree to be accountable for delivering and evaluating the quality of your care. When you receive covered preventive care and coordinated treatment, the overall cost of that care is lower. This helps keep your costs down without limiting necessary care.

Most primary care office visits with primary care providers, including pediatricians, are covered at no cost to you. 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.

The UMP Plus network is a limited network compared to UMP Classic. To find out if your provider is in the UMP Plus network, use the UMP provider search tool or call UMP customer service.

 How UMP Plus works

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.

When you enroll in one, the providers and facilities in the other network are considered out of network. Most covered services you receive from out-of-network providers and facilities are paid at 50% of the allowed amount, and you may be balance billed. Read your plan’s certificate of coverage for more information on how services are covered.

However, some providers and facilities are in both UMP Plus networks. 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.

 Who can enroll

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.

PSHVN:

  • King
  • Kitsap
  • Pierce
  • Snohomish
  • Thurston
  • Yakima

UW Medicine ACN:

  • King
  • Kitsap
  • 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 personnel, payroll, or benefits office
  • Retirees and Continuation Coverage members: contact PEBB Benefits Services
 UMP Plus network providers

Network providers are in either the core or support networks:

  • Core network: Contains primary care providers (PCP), specialty providers, ancillary providers, and facilities (such as hospitals and clinics) contracted with your UMP Plus network. Most covered services are paid at 100% when you see your PCP, and 85% for all other providers in this network. Providers and facilities will not bill you for charges that exceed the allowed amount.

  • Support network: Contains certain providers and facilities contracted with Regence but not in your UMP Plus network. All of the providers and facilities in this network are ancillary. Most services are paid at 85%, and providers and facilities will not bill you for charges that exceed the allowed amount (balanced billing).

If your provider or facility is not in the core or support network, they are considered out-of-network. Most covered services are paid at 50% of the allowed amount, and providers and facilities may bill you for charges that exceed the allowed amount. 

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.

 Major network provider groups in UW Medicine Accountable Care Network

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

  • Capital Medical Center
  • MultiCare Connected Care
  • Seattle Cancer Care Alliance
  • Seattle Children's Hospital
  • Skagit Regional Health
  • UW Medicine
 Major network provider groups in Puget Sound High Value Network

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

  • The Polyclinic
  • CHI Franciscan, Rainier Health Network which includes, Franciscan Medical Group, and independent providers
  • Seattle Children’s Hospital
  • SignalHealth
  • Virginia Mason

Note: The hospital at Capital Medical Center (Olympia) is a network facility. You can receive emergency care or hospital services there at the network rate. However, other services provided by Capital Medical Center physicians, such as primary care or surgery, are covered at the out-of-network rate.

 Network provider types

You have access to the following provider types through the core and support networks.

  • Network primary care providers, such as family practice, adult medicine or women’s health.

To receive the most coverage for primary care office visits, you must see a PCP in the core network (or a naturopath from the support network).  A PCP must be a medical doctor, doctor of Osteopathic Medicine, naturopathic physician, nurse practitioner, or physician’s assistant in the core network (or a naturopath in the support network) who specializes in one of the following:

  • Adult medicine
  • Family practice
  • General practice
  • Geriatrics
  • Internal medicine
  • Obstetrics, Gynecology, or OB/GYN
  • Pediatrics (for patients under age 18)
  • Preventive medicine
  • Women’s health

If you see an out-of-network PCP, you pay 50% of the allowed amount and the provider may balance bill you.

  • Network specialty providers, such as cardiologists, dermatologists, or allergists. A specialty provider is in the core network and specializes in a certain area of care. 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.

  • Ancillary providers, such as chiropractors, mental (behavioral) health providers, or physical therapists. An ancillary provider is one of the provider or facility types listed in the chart below. Ancillary providers may be available in both the core and support networks.

For ancillary providers in the core or support network, you pay 15% of the allowed amount for covered services. If you see an out-of-network ancillary provider, you pay 50%  of the allowed amount and the provider may balance bill you.

  • Network facilities, such as hospitals or clinics. At clinics and other outpatient facilities in the core network, you pay 15% of the allowed amount for covered services.

For inpatient services at hospitals in the core network, you pay a copay of $200 per day, up to an annual maximum of $600. You pay 15% of the allowed amount for professional services.

For outpatient services at hospitals in the core network, you pay 15% of the allowed amount. You may be balance billed at out-of-network hospitals.

When you see a network provider at a facility (such as a hospital), check that the facility is also in the network.

 Emergency and urgent care

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 copayment. However, if you see an out-of-network provider, they may balance bill you. If your emergency room visit is not the result of a medical emergency, the plan may not pay for emergency services.

Urgent care

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

 Other services

For specific services like bariatric surgery, see your certificate of coverage for a description of how services are covered. For most covered services, this means you will pay 15% of the allowed amount after meeting your deductible.

See your plan’s certificate of coverage PSHVN or UW Medicine ACN for a full list of services that fit into this category.

 Travel coverage

When you travel, you can see any provider for a medical emergency, regardless of network status, and receive the network rate. However, if you see an out-of-network provider, they may balance bill you.

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.

 Need help?

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

  • PSHVN: 1 (855) 776-9503 (TRS: 711)
  • UW Medicine ACN: 1 (855) 520-9500 (TRS: 711)

Ancillary facilities

Ancillary providers

Birth centers

Acupuncturists

Dialysis

Anesthesiologists

Durable medical equipment suppliers

Audiologists

Hearing aid dispensary

Chiropractors

Home health providers

Massage therapists, licensed

Hospice

Maxillofacial surgeons

Laboratories (lab testing)

Mental (behavioral) health providers (including M.D.s, such as psychiatrists)

Mental (behavioral) health facilities

Midwives, licensed

Rehabilitation, inpatient

Occupational therapists

Skilled nursing facility

Pathologists

Substance use disorder facilities

Physical therapists

Urgent care

Registered dietitians

Speech therapists

Substance use disorder providers