UMP Plus providers and networks - PEBB

Important message for UMP Plus–PSHVN members

Beginning January 1, 2022, UMP Plus–PSHVN will no longer be available in Thurston County. UMP Plus–UW Medicine ACN will continue to be available in Thurston County in 2022.

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.

When you see a core network primary care provider (or naturopath from the support network) for primary care services, you pay $0 for office visits. Related services (like x-rays or labs) that you receive during these office visits may be subject to the medical deductible and coinsurance.

The UMP Plus network is a geographically limited network compared to UMP Classic, UMP Select, and UMP CDHP. To find out if your provider is in the UMP Plus network, use the UMP provider search tool or call UMP Customer Service.

 Selecting a UMP Plus network

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.

 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.

UMP Plus–PSHVN:

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

UMP Plus–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 payroll or benefits office
  • Retirees and Continuation Coverage members: contact the PEBB Program
 UMP Plus network providers

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.

 Major network provider groups in UMP Plus–Puget Sound High Value Network

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
  • Confluence Health (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

Note: The hospital at MultiCare 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.

 Major network provider groups in UMP Plus–UW Medicine Accountable Care Network

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
  • Seattle Cancer Care Alliance
  • Seattle Children's Hospital
  • Skagit Regional Health
  • UW Medicine
 Network provider types

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). To be designated as a PCP, a provider must be a doctor of Osteopathic Medicine (D.O.), medical doctor (M.D.), naturopathic physician (N.D.), nurse practitioner (A.R.N.P.), or physician’s assistant (P.A.) in the core network (or a naturopath in the support network) and practice under one of the specialties listed below:

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

When you see a 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.

  • Network specialty providers

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

  • Support providers

Support 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. 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. You may be balance billed at out-of-network hospitals.

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 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 copay. 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. 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.

 Other services

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

 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. Use the UMP provider search tool or call UMP Customer Service to locate a provider in your network.

Get an extra supply of prescription drugs for extended travel

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. To request a travel override, call WSRxS Customer Service at 1-888-361-1611 (TRS: 711).

 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 (888) 402-4237 (TRS: 711)

Examples of support providers

Acupuncturists

Mental (behavioral) health facilities

Anesthesiologists

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

Audiologists

Midwives, licensed

Birth centers (nonhospital)

Occupational therapists

Chiropractors

Pathologists

Dialysis

Physical therapists

Durable medical equipment (DME) suppliers

Registered dietitians

Hearing aid dispensary

Rehabilitation, inpatient

Home health providers

Skilled nursing facility

Hospice

Speech therapists

Laboratories (lab testing)

Substance use disorder facilities

Massage therapists, licensed

Substance use disorder providers

Maxillofacial surgeons

Urgent care