Care programs - SEBB

Care programs

UMP plans offer several programs to help you improve your health, including knee and hip replacement, spine care, diabetes prevention and management, tobacco cessation, and maternity support.

 Knee and hip replacement

The Centers of Excellence (COE) Program covers single knee and single hip replacement surgery at low to no cost to qualifying UMP Achieve 1, UMP Achieve 2, and UMP High Deductible members. Premera administers the COE Program for UMP, and Virginia Mason is the COE for knee and hip replacement.

Eligibility

If you have a UMP Achieve 1, UMP Achieve 2, or UMP High Deductible 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 Achieve 1 and UMP Achieve 2 members, treatment is covered in full. For UMP High Deductible 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 for further assessment. Learn more about the knee and hip replacement program.

 Spine care

The Centers of Excellence (COE) Program covers spine evaluation and/or surgery at low to no cost to qualifying UMP Achieve 1, UMP Achieve 2, and UMP High Deductible members. Premera administers the COE Program for UMP, and Capital Medical Center (in Olympia) and Virginia Mason (in Seattle) are the COEs for spine care.

Eligibility

If you have a UMP Achieve 1, UMP Achieve 2, or UMP High Deductible 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 Achieve 1 and UMP Achieve 2 members, treatment is covered in full. For UMP High Deductible 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 or Capital Medical Center for further assessment. Learn more about the spine care program.

 Diabetes programs

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 Case 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’ve 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.

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.

 Palliative care

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 be terminal to receive palliative care. It’s focused on providing relief from symptoms and stress, and its 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 that layer of physical and emotional support throughout all stages of a serious illness or injury.

Personalized care support includes adult and pediatric case management. Case managers help coordinate care, explain your benefits and resources, act as an advocate, 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.

 Tobacco cessation

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 “P” 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:

  1. Get a prescription from your provider.
  2. Take the prescription to a network pharmacy.
  3. Make your purchase at the pharmacy counter of 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.

 Maternity support

The BabyWise program offers knowledge, support, and comfort for expectant parents. With BabyWise, 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 BabyWise app

BabyWise is covered at no cost to you. To get started with BabyWise, sign in to your Regence account or call 1 (888) 569-2229.

 Expert Second Opinions program

The Expert Second Opinions program, provided by 2nd.MD, is a treatment decision support service that provides UMP Achieve 1, UMP Achieve 2, and UMP High Deductible members second opinions 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.

The Centers of Excellence (COE) Program, Omada Health, and 2nd.MD are separate and independent companies; they do not provide Blue Cross and Blue Shield products or services and are solely responsible for their services.

BabyWise is a separate and independent company that provides maternity services for Regence Uniform Medical Plan (UMP) members.