Cancel Proceed. * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated Virtual care. 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 With a Regence Medigap plan you get: *These programs are not … 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. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. 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. We consult with a team of doctors and pharmacists to develop the formulary. 360-352-8262 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 … Dental plans in Oregon provided by Delta Dental Plan of Oregon. If you have other pharmacy insurance coverage, please contact WSRxS to provide the information we need to ensure your claims are paid accurately. The information on … 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. Alert: All specialty drugs require preauthorization. Your plan covers drugs listed on the Essential Formulary. • Eligibility complaints or appeals. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense. 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. Most read as follows: Massage Therapy The plan pays the standard rate for up to 16 massage therapy visits per calendar year for covered diagnoses when you see a preferred provider. • Premium surcharge questions. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. Browse lower-cost drug options. If your health plan's formulary guide indicates that you need a Prior Authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. If the exception is not approved, the member will be directed toward the appropriate alternatives on the formulary, or the member may pay the full cost for the non-formulary drug. For more recent information or … %PDF-1.4 %���� If you're a Regence member, sign in. Keyword-suggest-tool.com ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submissi Version Numberon ID 20104 20, This formulary was updated on 10/27/2020. Health plans provided by Moda Health Plan, Inc. This document is available electronically and may be available in alternate formats. Page 1 of 8 *For more information about limitations and exceptions, see the plan’s certificate of coverage at hca.wa.gov/ump-sebb-coc. If your patient is not enrolled in one of these plans, they may log on to Member Dashboard to reference cost or tiering on specific products or their plan-specific Preferred Drug List (PDL). health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. RPEC members who may be impacted by these changes should talk to their providers and begin the process of either switching medications or beginning the exception process prior to the end of the year to avoid complications in when the policy takes effect on January 1, 2020. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. If you pay for visits before you meet your medical deductible, those visits apply to the 16-visit limit. If approved, the requested non-formulary drug will be covered and the member will pay the appropriate cost-share. • Finding forms. The formulary is a list of prescription generic, brand name and … ... Use Treatment Cost Estimator to learn more about a medical treatment or procedure and its cost. Member. Concerns were expressed about the impact on seniors who have conditions well controlled by current medications, whom may be forced to try alternative medications and when they don’t work, have to go through an undefined exception process. About Uniform Medical Plan (UMP), administered by Regence BlueShield. WSRxS’ clinical team will review the submitted information to determine if the formulary alternatives the member used were ineffective or are not clinically appropriate. Pharmacy benefits. If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. Uniform Medical Plan Classic (Medicare) Coverage Period: 01/01/2017 - 12/31/2017 Summary of Benefits and Coverage: What This Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: PPO *Plus any amount exceeding the allowed amount Questions: Call 1-888-849-3681 (TTY 711) for medical. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Required fields are marked *. Preauthorization requirements are only valid for the month published. Don't have a Washington State Rx Services account? 906 Columbia St SW, Suite 501, You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. It is a resource to keep you up-to-date about your pharmacy benefit and help you manage your health by providing access to comprehensive health and wellness information. 0 regence uniform medical plan find a provider For an updated formulary, please contact us. Download our mobile app. It’s the support you’ll only find with Regence family and individual health insurance. These criteria do not imply or guarantee approval. To browse each plan’s network or to find a s… %%EOF If you're a Regence member, sign in. UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees Phone: 1-800-628-3481 TRS: 711. Check formulary status. To learn more, please call Washington State Rx Services at 888-361-1611. Uniform Medical Plan WASHINGTON STATE PRESCRIPTION SERVICES . A plan’s network consists of doctors, clinics, hospitals, specialists, and other health care providers. Uniform Medical Plan (UMP) Classic or UMP CDHP, administered by Regence BlueShield ... • Whether your medications are in the plan’s formulary. The purpose of the resolution is to try to control drug costs. condition and/or would cause you to have adverse medical effects. Cancel Proceed. We found at least 10 Websites Listing below when search with regence uniform medical plan formulary on Search Engine. Extra assistance programs. Please check with your plan to ensure coverage. • Claims. If a UMP member is prescribed a drug that is not on the formulary, the member will need to pay the full cost of the drug. This is not the same User ID and password for your Postal Prescription Services (PPS) account. https://www.hca.wa.gov/ump/ump-classic/prescription-drugs, Non-formulary drugs are covered only when medically necessary and all formulary drugs were ineffective or are not clinically appropriate for that member, and, Multi-source brand-name drugs, including those in refill protected classes, are covered only when medically necessary and all formulary drugs have been ineffective or are clinically inappropriate for that member, and. 12/01/2020. Cancel Proceed. UMP is … Members-only discounts. Members. Get medical insurance for your life and budget. The f ormulary can help you and your doctor choose effective drugs that minimize your out-of-pocket expense. Review estimated copay . The RPEC Council office is located at: Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is Members should talk to their physician about prescribing an alternative drug that is on the formulary. By using providers within your network, your health care costs will be significantly lower than if you use providers outside your network. See our Council Office page for more information. 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. 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. Individual medical plans in Alaska provided by Moda Assurance Company. �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$>� See page 2 for the plans’ websites and contact Please check with your plan to ensure coverage. Certificate of Coverage. 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . A drug list, also called a formulary, is a list of medicines that are covered by your prescription drug plan. PHARMACY SERVICES Uniform Medical Plan Prior Authorization (PA) Request Form PHONE (888) 361‐1611 FAX (800) 207‐8235 Updated: December, 2007 Plus, preventive care and assistance programs at no cost to you. Get the facts and know your options. Check drug prices. The Plus plan networks are smaller, as each consists of regional providers spread throughout western Washington. Our plan will generally cover the drugs listed in our formulary … However, if the member has tried all the alternative drugs and none are found to be effective, or if the alternatives are found to be not medically appropriate, the member can request an exception. Your email address will not be published. Find the right plan for you. Live your best with a Regence health plan. 32463 0 obj <>/Filter/FlateDecode/ID[]/Index[32452 109]/Info 32451 0 R/Length 78/Prev 968906/Root 32453 0 R/Size 32561/Type/XRef/W[1 2 1]>>stream › Get more: Regence uniform medical preferred providers Show List Health . Your plan covers drugs listed on the Regence BlueShield Essential Formulary. Please call Customer Service at the telephone number listed above. Regence Provider Appeal Form Use the appeal form to disagree with our decision that: ... An enrollee is discharged from a facility and insufficienttime exists for institutional or home health care services to receive approval prior to delivery of the service. Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association Coverage Area Regence MedAdvantage + Rx Classic (PPO) H3817-008 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Regence BlueCross BlueShield of Oregon available to residents in Oregon and Washington. 1. UMP Plus–Puget Sound High Value Network Online: UMP Plus–Puget Sound High Value Network for school employees Phone: 1-877-345-8760 Monday through Friday: 7 a.m. to 5 p.m. (Pacific) Email: Send secure email via your Regence account at . Olympia, WA 98501. Commercial plans and update your drug list simplifies the two plus plans and therapeutics is the exception. Pharmacy benefits. If the request is not approved, please remember that you always have the … Regence consults with a team of physicians and pharmacists to develop the formulary, which offers drug treatment choices for covered medical conditions. Attn: Clinical Review Department ... ☐ I need a drug that is not on the plan’s list of covered drugs (formulary exception). Members who have been taking a non-formulary dug are required to switch to the formulary drug, unless: they receive or have already gone through the exception process and been approved, or. 1-800-562-6097 (toll free) Actual … The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. Uniform Medical Plan | Washington State Health Care Authority. COVID-19 resources. Some drugs may show that they are "not covered." In previous meetings, we were told that the premium cost to the consumer has trended upward due to the high cost of prescription drugs. (HTCC) decision or a Regence BlueShield medical policy. This site is meant to help you learn about our health plans and other benefits and services. View your copayment information. Finding doctors - Regence: The most trusted name in health . Download our mobile app to manage and order your medications on the go. You must generally use network pharmacies to use your prescription drug benefit. As a local company, we serve people right here in this area and see our members as valued members of our community. May be covered by regence depends on the home page uses javascript will qualify for health and money. Preauthorization requirements are only valid for the month published. This plan includes additional Medicare prescription drug (Part-D) coverage. Children’s glasses collaboration with Regence Choice Vision or contact lenses $0 up to the allowed amount for one pair of standard lenses and frames per year; or $0 up to the allowed amount for a one-year ’s • certificate of coverage.) Regence BlueCross BlueShield of Oregon is a Health plan with a Medicare contract. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. 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. your client’s specific plan. This document includes a list of the drugs (formulary) for our plan which is current as of . This document is available electronically and may be available in alternate formats. The table below does not include every limit or exclusion under this benefit. 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. Minimum cover both the best for 7 days if the formulary whenever. For more details, refer to your plan’s . 32452 0 obj <> endobj 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. ... 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. Cost overview Copayments or coinsurance? UMP is administered by Regence BlueShield and Washington State Rx Services. • Eligibility questions and changes (Medicare, divorce, etc.). For additional information about your prescription Choosing a health plan is a big decision. You may also call the PEBB Program at 1-800-200-1004 for additional help. 2020 Changes to Uniform Medical Plan (UMP) Prescription Drug Formulary. Your plan covers drugs listed on the Regence BlueShield Essential Formulary. Regence BlueShield prescription drug program . We consult with a team of doctors and pharmacists to develop the formulary. Health Details: Regence Valiance (PPO) is a Local PPO *. Dollars Distributed Monthly to Retirees by County. With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). Dental plans in Alaska provided by Delta Dental of Alaska. Don't have a Washington State Rx Services account? Please call Customer Service at the telephone number listed above. Your email address will not be published. A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. 2020 Changes to UMP Prescription Drug Formulary. Page 1 of 8 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2021-12/31/2021 Uniform Medical Plan (UMP) Classic (Non-Medicare) (PEBB) Coverage for: Individual/Family | Plan Type: PPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. This plan includes additional Medicare prescription drug (Part-D) coverage. © Copyright 2021 - Retired Public Employees Council of Washington. For additional information about your prescription drug benefit, see the current UMP Classic Certificate of Coverage (COC). See the 2020 Preferred Drug List. This document is available electronically and may be available in alternate formats. Ardon Health Specialty Pharmacy 1-855-425-4085 UMP Customer Service Medical Benefit Questions (administered by Regence BlueShield) 1-888-849-3681 Did you switch plans from UMP Classic to UMP Plus? View mail-order and specialty drugs. If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. Regence BlueShield prescription drug program . Please call Customer Service at the telephone number listed above. UMP is administered by Regence BlueShield and Washington State Rx Services. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2021 – 12/31/2021 Uniform Medical Plan (UMP) Achieve 2 (SEBB) Coverage for: Individual/Family | Plan Type: PPO Regence BlueShield is a Health plan with a Medicare contract. Find and compare treatment options, facilities and providers. Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that Our PAC Fundraiser is open through October 30th - Click here! Regence BlueShield is a Health plan with a Medicare contract. �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. If so, the only difference between the UMP Plus and UMP Classic prescription drug coverage They may have changed from previous months and may change in future months. Sign in to your Regence account at regence.com . by Carol Dotlich, RPEC Executive Board Member. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a plan network pharmacy, and other plan rules are followed. regence.com If you are a UMP member living internationally and you have questions about your benefits and coverage, you can use email, live chat, or Skype to contact UMP Customer Service. • Adding or removing dependents. Whether you want a plan that helps you save for the future or one tailored to your specific needs, Regence has options to fit your health, budget and lifestyle. ANYWHERE ANYTIME! by Carol Dotlich, RPEC Executive Board Member. endstream endobj startxref in the plan’s drug formulary. A formulary is a list of covered drugs selected by our plan co innsultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Insurance pays the remaining percentage of the cost. Download and print helpful material for your office. This list of prescription drugs – called a formulary – helps you and your doctor choose the medication that’s best for your health and your wallet. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Find pharmacies near you. If your health plan's formulary guide indicates that you need a Prior Authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. This page contains benefit information for 2020. • ID cards. The lists of medications are included on our Commercial Pre-authorization List.. When it refers to “plan” or “our plan,” it means Premera Blue Cross Medicare Advantage Plans. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. Diagnosis code(s) and description(s): CPT or HCPCS code(s) and description(s): DME Only Line Item Cost For Uniform Medical Plan (UMP) Members: Fax to: 1 (877) 663-7526 or … Head-to-toe coverage and low-cost virtual care. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. Members. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Our mission is to unite retired public employees for their mutual benefit and welfare. The Puget Sound High Value Network (PSHVN) is a network comprised of the highest quality health care organizations. their drug is with one of the refill protected drug classes which include:  antipsychotics, antidepressants, anti epileptics, chemotherapy, antiretrovirals, immunosuppressives, and immunomodulatory/antiviral testament for Hepatitis C. Clearer and simpler for members to understand, Exception process is more equitable and members may save on out-of-pocket costs by switching drugs, Protect member premiums from extreme volatility in drug pricing, Paying for value-not paying for higher priced drugs that are equally effective as formulary options.