Uniform Medical Plan Forms

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Uniform Medical Plan (UMP) - Washington

https://www.hca.wa.gov/about-hca/programs-and-initiatives/uniform-medical-plan-ump

Uniform Medical Plan (UMP) is a self-insured health plan offered through the Washington State Health Care Authority’s (HCA) Public Employees Benefits Board (PEBB) Program and the School Employees Benefits Board (SEBB) Program. UMP is administered by Regence BlueShield and Washington State Rx Services. The PEB Board and SEB Board's role in UMP

Uniform Medical Plan (UMP) | Washington State Health …

https://www.hca.wa.gov/employee-retiree-benefits/school-employees/uniform-medical-plan-ump

What are my plan options? With the Uniform Medical Plan, you may choose from the plans listed below. Remember, if you cover eligible dependents, everyone must enroll in the …

Uniform Medical Plan - Regence

https://www.regence.com/provider/products/large-groups-administrators/ump

Uniform Medical Plan (UMP) is a health plan offered through the Washington State Health Care Authority’s (HCA) Public Employees Benefits Board (PEBB) and the School …

Uniform Medical Plan | Washington State Health Care …

https://www.hca.wa.gov/employee-retiree-benefits/pebb-virtual-benefits-fair/uniform-medical-plan

Uniform Medical Plan (UMP) is a collection of high-quality, self-insured preferred provider organization (PPO) health plans and accountable care plans offered through Washington …

Uniform Medical Plan (UMP) and PEBB for public …

https://ump.regence.com/pebb

Uniform Medical Plan (UMP) is a collection of high-quality, self-insured preferred provider organization (PPO) health plans offered through Washington State’s Public Employees …

Commonly used forms - PEBB

https://ump.regence.com/pebb/forms/common-forms

Medical forms Vision form Prescription drug forms Health Savings Account (HSA) form Eligibility and enrollment forms Medical forms Medical Reimbursement Claim form: for …

Uniform Medical Plan

https://ump.regence.com/member/ump/

Uniform Medical Plan Welcome to UMP Please choose whether you are a member of the Public Employees Benefits Board (PEBB) Program or the School Employees Benefits …

MEDICAL CLAIM FORM - Washington

https://www.hca.wa.gov/assets/pebb/ump-regence-medical-claim-form.pdf

MEDICAL CLAIM FORM Use this form to submit reimbursement requests for services received from a non-network provider. Please complete a separate form for each family …

Claims - PEBB - Regence

https://ump.regence.com/pebb/benefits/claims-appeals

If you have questions on how to fill out this claim form, contact VSP Member Services at 1-800-877-7195. Deaf, DeafBlind, Late Deafened and Hard of Hearing members call: 1-800 …

Forms and documents - Regence

https://www.regence.com/provider/forms-documents

Forms & documents for providers. Access all the forms and documents you need to support your Regence patients, manage your claims payments and more. Search by …

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