Uniform Medical Plan Vision Claim Form

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Your new UMP vision benefits

https://www.hca.wa.gov/assets/pebb/ump-vision-service-plan-2021.pdf

To submit a claim by mail, contact VSP Member Services at 1 (800) 877-7195 to request a VSP Member Reimbursement Form. The form can be sent to a preferred address or …

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

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 …

Commonly used forms - PEBB

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

Vision form 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 …

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 …

VISION CLAIM FORM - d2l2jhoszs7d12.cloudfront.net

https://d2l2jhoszs7d12.cloudfront.net/state/Washington/Health%20Care/form-ump-vision-claims.pdf

4. Sign the completed form where indicated at the bottom of this page and submit the completed claim form to: Regence BlueShield Attn: UMP Claims PO Box 1106 …

Forms and documents for members - Regence

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

Forms and documents for members Sign in × Find a doctor Contact us Loading... Forms and Documents for Individuals and Families Access all the forms and documents you …

Members: Forms - Moda Health

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

Rx Drug Claim Form - Commercial for Major Medical Plans; Prescription Compound Drug Claim Form; Tobacco Cessation Claim Form; Dental claim form - members can access …

Health Insurance & Medical Forms for Customers | Cigna

https://www.cigna.com/individuals-families/member-guide/customer-forms/

Uniform Medical Prior Authorization [PDF] Virginia Specific Forms These forms may onlybe used if your employer is head quartered in the Commonwealth of Virginia, and you …

Get Regence Uniform Vision Claim Form - US Legal Forms

https://www.uslegalforms.com/form-library/308042-regence-uniform-vision-claim-form

Select the orange Get Form button to begin editing and enhancing. Switch on the Wizard mode in the top toolbar to have more pieces of advice. Fill every fillable area. Be sure the …

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