Uniform Medical Plan Prescription Claim Form

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UMP (WSRxS) Prescription Drug …

https://www.hca.wa.gov/assets/pebb/ump-wsrxs-prescription-drug-claim-form.pdf

UMP PEBB | Prescription drug benefits, coverage and costs

https://ump.regence.com/pebb/benefits/prescriptions

To submit a claim, download the Prescription Drug Claim Form, fill it out, and send it, along with your pharmacy receipts, to the address listed on the form. Your pharmacy …

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 …

Claims - PEBB - Regence

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

To submit a claim by mail download and complete the VSP Request for Reimbursement form and mail it to the address below. If you have questions on how to fill out this claim …

Uniform Medical Plan (UMP) | Washington State Health …

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

Online: Uniform Medical Plan for school employees Phone: 1-800-628-3481 TRS: 711. UMP Plus–Puget Sound High Value Network Online: UMP Plus–Puget Sound High Value …

Commonly used forms - PEBB

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

VSP Request for Reimbursement form: for services from an out-of-network provider or for the purchase of prescription contact lenses and eyeglasses. If you have questions on …

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 …

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 …

Forms and documents for members - Regence

https://www.regence.com/member/resources/forms-documents

Forms and Documents for Individuals and Families Access all the forms and documents you need to manage your health plan—from claims forms to health information …

Members: Forms - Moda Health

https://www.modahealth.com/members/forms.shtml?dn=ods

Prescription drug claim form - Uniform Medical Plan (UMP) - (use this form for claims incurred on or after January 1, 2022) OTC COVID-19 at home test pharmacy member …

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