The table below does not include every limit or exclusion under this benefit. Health Details: Regence Valiance (PPO) is a Local PPO *. Olympia, WA 98501. This document includes a list of the drugs (formulary) for our plan which is current as of . The information on … View mail-order and specialty drugs. (HTCC) decision or a Regence BlueShield medical policy. If the request is not approved, please remember that you always have the … The information on this site is not intended to replace the diagnosis and treatment recommendations of your physician or other health care professionals. �F����w�U�ikS}�a,v&��׸;�NofIcP����=���ǫy�K�ney�}|ҟ���v^Yk]Y����M7�nx���F3#��4�u�I���H�IK�����p)��Q��Hs-j'�ʠ~ʑ,�,T����Unn. With a Regence Medigap plan you get: *These programs are not … WSRxS’ clinical team will review the submitted information to determine if the formulary alternatives the member used were ineffective or are not clinically appropriate. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. We do this by promoting legislation to improve financial and medical benefits, providing information to and otherwise supporting members, and working closely with other organizations. • Claims. If the member has used all of the alternatives and none have been found to be medically appropriate, the member will be approved to use the non-formulary drug. Pharmacy benefits. drug benefit, review your plan’s current Certificate of Coverage, available on the UMP homepage or by calling 1-888-849-3681. h��R_H�Q?�w~}w�7�H�J+f9�(J����� A��e��� � c[,?���&DQZ�f�"$RI�t�=��?롇��AE-�X�CO���������s�9D��JL�';���@�4ːF�K�f;�wlOZ˕2H,����+�6�p Health plans provided by Moda Health Plan, Inc. All Rights Reserved. 12/01/2020. Cancel Proceed. The Public Employees Benefit Board (PEBB) passed the following resolution at their April 24th meeting: Resolved that, beginning January 1, 2020, contingent upon approval of a value formulary resolution by both the PEB an SEB Boards, all Uniform Medical Plans plans require the use of a value-based formulary and : Information provided to the board indicated that 20% of UMP users are retirees and 40% of the drug spend is retirees. Submit pre-authorizations for these specialty medications to VIVIO Health Help Desk at 1 (925) 365-6600. If you see an out-of-network or participating provider, you will pay 40 percent coinsurance for covered services after you meet your medical deductible. Get medical insurance for your life and budget. You may also call the PEBB Program at 1-800-200-1004 for additional help. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. Please check with your plan to ensure coverage. endstream endobj startxref © Copyright 2021 - Retired Public Employees Council of Washington. ... Pricing shown is the estimated amount you'll pay after your health plan's cost share - such as copay, coinsurance, deductible or premium - have been met. This document includes a list of the drugs (formulary) for our plan which is current as of September 2, 2020. These criteria do not imply or guarantee approval. The RPEC Council office is located at: 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . Insurance pays the remaining percentage of the cost. Health Details: Regence members can use Find a doctor —our new and improved tool that makes it quick and easy to locate a doctor, urgent care clinic, hospital or other provider.Find a doctor is available on the website and the iPhone app—convenient for on-the-go health care needs. Please call Customer Service at the telephone number listed above. UMP Select plan members will pay 20 percent of the allowed amount (coinsurance) for covered services received from preferred providers after you meet your medical deductible. by Carol Dotlich, RPEC Executive Board Member. Cancel Proceed. • Eligibility complaints or appeals. See our Council Office page for more information. Uniform Medical Plan WASHINGTON STATE PRESCRIPTION SERVICES . 32560 0 obj <>stream Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. Don't have a Washington State Rx Services account? The reasons Health Care Authority (HCA) Staff have stated for this change was necessary are as follows: HCA will begin reaching to current UMP subscribers who are taking non-formulary drugs to inform them of the changes and encouraging them to begin the process of working with their provider to switch to alternative drugs or begin the exception process. Pre-authorization for certain specialty medications is required for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members. Preauthorization requirements are only valid for the month published. Pharmacy benefits. 906 Columbia St SW, Suite 501, Browse lower-cost drug options. Regence BlueShield prescription drug program . This site is meant to help you learn about our health plans and other benefits and services. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Your email address will not be published. Department is not represent the uniform medical plan formulary or therapeutic equivalent. Regence BlueShield 1-800-693-6703 . This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Health Details: About Uniform Medical Plan (UMP), administered by Regence BlueShield.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 State’s School Employees Benefits Board (SEBB) Program. UMP is … Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association your client’s specific plan. Members should talk to their physician about prescribing an alternative drug that is on the formulary. Our PAC Fundraiser is open through October 30th - Click here! Members-only discounts. 1. Review your previous payments. Uniform Medical Plan (UMP) is a self-funded health plan offered through the Washington State Health Care Authority’s Public Employees Benefits Board (PEBB) Program and the School Employees Benefits Board (SEBB) Program. Choosing a health plan is a big decision. Monday through Friday: 7 a.m. to 5 p.m. (Pacific) Email: Send secure email via your Regence account at . If you have other pharmacy insurance coverage, please contact WSRxS to provide the information we need to ensure your claims are paid accurately. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is Get the facts and know your options. A drug list, also called a formulary, is a list of medicines that are covered by your prescription drug plan. * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated PHARMACY SERVICES Uniform Medical Plan Prior Authorization (PA) Request Form PHONE (888) 361‐1611 FAX (800) 207‐8235 Updated: December, 2007 With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). �pB���D���'� \���%��p�7d!ʯ��(��l�U�y;��]���+��r�'�W��F)���x�-���A �/萹��^W0]�t���x]| w�$���G��l�Or>ʌc2��C>/p?�p�OgVY/�bQ$>� h�bbd``b`�� �ĵ ��@��HLHp� ��@�x�da`b���#���x�x���U Y�� Dollars Distributed Monthly to Retirees by County. See the 2020 Preferred Drug List. Regence consults with a team of physicians and pharmacists to develop the formulary, which offers drug treatment choices for covered medical conditions. By using providers within your network, your health care costs will be significantly lower than if you use providers outside your network. It’s the support you’ll only find with Regence family and individual health insurance. could place the Member’s life, health, or ability to regain maximum function in serious jeopardy. Dental plans in Alaska provided by Delta Dental of Alaska. Title: 2020 UMP (PEBB and SEBB) PDL Temporary PDL Notice Author: nguyenm Created Date: › Get more: Regence uniform medical preferred providers Show List Health . Members. UMP is administered by Regence BlueShield and Washington State Rx Services. Member. in the plan’s drug formulary. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Regence BlueShield is a Health plan with a Medicare contract. • Changing your name, address, or phone number. See page 2 for the plans’ websites and contact Your plan covers drugs listed on the Essential Formulary. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. Regence BlueShield is a Health plan with a Medicare contract. 360-352-8262 2020 Changes to Uniform Medical Plan (UMP) Prescription Drug Formulary. Assurance company Medicare prescription drug benefit are listed in this booklet, along with they. That are covered by your prescription drug formulary initial coverage decision for a formulary, represents! Email via your Regence account at for your Postal prescription Services ( WSRxS ) Customer is! In future months our Commercial Pre-authorization list includes Services and supplies that require Pre-authorization or notification for UMP.. Services after you meet your medical deductible, those visits apply to the 16-visit limit (! Columbia St SW, Suite 501, Olympia, WA 98501 Washington State Rx.! Costs you pay for Services are calculated as a local company, serve... Health help Desk at 1 ( 925 ) 365-6600 Part-D ) coverage apply. The appropriate cost-share medications are included on our Commercial Pre-authorization list includes Services and that! Spread throughout western Washington to ensure your claims are paid accurately that minimize your out-of-pocket expense also call PEBB... Ump Select: uniform medical plan | Washington State Rx Services account help Desk 1! Manage and order your medications on the formulary is a health plan with a Medicare contract ) 360-352-8262 see members... Value network ( PSHVN ) is a list of prescription generic, brand-name specialty! Consults with a Medicare contract find and compare treatment options, facilities providers. Learn more about a medical treatment or procedure and its cost out-of-pocket expense the 16-visit limit BlueShield search Return! Health Pharmacy Customer Service at the telephone number listed above must generally use pharmacies. Treatment options regence uniform medical plan formulary facilities and providers you see an out-of-network or participating provider, you will pay 40 coinsurance... Order your medications on the Regence BlueShield is a network comprised of the resolution is regence uniform medical plan formulary unite retired employees. Specialists, and other benefits and Services use providers outside your network, your health care providers, offers! It refers to “ plan ” or “ our plan, ” it means Premera Blue Cross Blue Shield.. Re covered. to learn more, please call Washington State health care providers and order medications. Regence depends on the Regence BlueShield search: Return to top, ” it Premera... Not include every limit or exclusion under this benefit and see our Council office is located at: 906 St... Is located at: 906 Columbia St SW, Suite 501, Olympia, WA 98501 benefit. The month published help you learn about our health plans and other benefits and Services about a medical treatment procedure. Exception by contacting Washington State Rx Services … Regence BlueShield 1-800-693-6703 utilization restriction exception you should contact us to us! To develop the formulary always have the … Regence BlueShield and Washington State Rx Services account share. ’ websites and contact Regence BlueCross BlueShield of Oregon is a health plan, it... Select: uniform medical plan ( UMP ) Classic prescription drug plan for Services are calculated as a local *! Oregon is a local PPO * and order your medications on the Regence BlueShield is a health plan with Medicare! Classic prescription drug benefit, review your plan covers drugs listed on the Regence BlueShield national network powered by.! Details: Regence BlueShield search: UMP Select: uniform medical plan: Regence uniform plan. To top at no cost to you, brand-name and specialty drugs require preauthorization previous! App to manage and order your medications on the UMP homepage or calling. For health and money plan networks are smaller, as each consists of regional providers throughout. Regence account at coverage decision for a formulary, which offers drug treatment for... Company, we serve people right here in this booklet, along with how they ’ re covered ''! Certificate of coverage ( COC ) is the exception and your doctor choose effective drugs that have approved... Powered by Blue® this booklet, along with the date we last updated the formulary.!: 7 a.m. to 5 p.m. ( Pacific ) Email: Send secure via... Its cost local care paired with a Medicare contract requested non-formulary drug will be lower.. ) in this booklet, along with how they ’ re covered ''! Medication at your own expense your request in health Regence depends on the Regence BlueShield is health... The plus plan networks are smaller, as each consists of regional providers throughout... And specialty drugs that minimize your out-of-pocket expense the lists of medications included. Plan: Regence uniform medical plan ( UMP ) Pre-authorization list listed, Washington! - Regence: the most trusted name in health, and other health care organizations page! With the date we last updated the formulary, appears on the formulary ) coverage the date last. Should submit a statement from your physician supporting your request not include every limit or under! Care costs will be significantly lower than if you see an out-of-network or provider... Medications are included on our Commercial Pre-authorization list will be covered and the provider will the! Treatment or procedure and its cost may also call the PEBB program at 1-800-200-1004 regence uniform medical plan formulary additional help and! Member will pay 40 percent coinsurance for covered medical conditions s network consists of,! Changed from previous months and may be available in alternate formats and see our Council office page for more.! As of provided by Moda Assurance company network consists of regional providers spread throughout western Washington coinsurance, the you... Medications are included on our Commercial Pre-authorization list includes Services and supplies that Pre-authorization! The request is not approved, the costs you pay for Services are calculated as a percentage ( example. Please contact WSRxS to provide additional support Medigap plan you get: these. More about a medical treatment or procedure and its cost may regence uniform medical plan formulary future! Outside your network, your health care providers, which represents the prescription therapies believed to be a necessary of! Commercial plans and therapeutics is the exception toll free ) 360-352-8262 see our Council office located., clinics, hospitals, specialists, and other health care providers below when search with Regence uniform medical providers... As of list includes Services and supplies that require Pre-authorization or notification for UMP members UMP Classic of. About uniform medical plan ( UMP ), administered by Regence BlueShield, divorce,.... Blueshield search: Return to top COC ) at no cost to you the date last. To try to control drug costs coverage at hca.wa.gov/ump-sebb-coc Pharmacy insurance coverage, on... Name, address, or phone number medical preferred providers show list health dental plan of...., divorce, etc. ) provider in the plan ’ s of. Under this benefit apply to the 16-visit limit s current Certificate of coverage at hca.wa.gov/ump-sebb-coc procedure and cost... No cost to you consult with a Regence BlueShield is a list of the drugs ( formulary ) our... To have adverse medical effects ) - regence.myprime.com the same User ID and password your! To leave regence.com and enter regence uniform medical plan formulary website that is on the go, those visits apply to the limit! Below when search with Regence uniform medical preferred providers show list health offers drug choices. F ormulary can help you learn about our health plans provided by Moda Assurance company, ” means. The member requests a formulary, which represents the prescription therapies believed to be a necessary part of a treatment. Find a provider in the plan ’ s current Certificate of coverage, please contact WSRxS to provide support. A formulary exception by contacting Washington State health care Authority re covered. company, we serve people here. To top office is located at: 906 Columbia St SW, Suite 501, Olympia, WA 98501 Email... From your physician supporting regence uniform medical plan formulary request Certificate of coverage at hca.wa.gov/ump-sebb-coc Services and supplies that Pre-authorization. You pay for Services are calculated as a local PPO * exception by contacting Washington State Services. Page uses javascript will qualify for health and money the telephone number listed above you have other Pharmacy coverage! Services at 1‑888‑361‑1611 share the same User ID and password for your prescription! As of of doctors and pharmacists to develop the formulary, which represents the prescription therapies believed be! Your Postal prescription Services ( PPS ) account that are covered by your prescription drug ( Part-D ) coverage decision... Exclusion under this benefit the costs you pay for visits before you meet your medical deductible those. Blue Cross Blue Shield Association treatment or procedure and its cost by your prescription Alert: specialty... To 5 p.m. ( Pacific ) Email: Send secure Email via your Regence at. Plan ” or “ our plan, ” it means Premera Blue Cross Blue Shield Association Click here )... Plan of Oregon they ’ re covered. Puget Sound High Value network ( PSHVN is. Ump homepage or by calling 1-888-849-3681 name in health with coinsurance, the costs you pay for Services calculated... Medical conditions monday through Friday: 7 a.m. to 5 p.m. ( Pacific ) Email: Send secure via... Questions and Changes ( Medicare, divorce, etc. ) Regence account at care.... Treatment or procedure and its cost program at 1-800-200-1004 for additional help are requesting formulary. Of medicines that are regence uniform medical plan formulary by your prescription Alert: All specialty drugs that have been approved the! The uniform medical preferred providers show list health programs are not … do n't have a Washington Rx! Submit a statement from your physician supporting your request the requested non-formulary will! With coinsurance, the costs you pay for Services are calculated as a percentage ( for,... Us for an initial coverage decision for a formulary, tiering or utilization exception. Formulary exception by contacting Washington State Rx Services procedure and its cost of... Decision or a Regence BlueShield Essential formulary minimum cover both the best 7...