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Certificate of Coverage. UMP is … Download our mobile app. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. If you're a Regence member, sign in. 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. If so, the only difference between the UMP Plus and UMP Classic prescription drug coverage Cancel Proceed. Download our mobile app to manage and order your medications on the go. This plan includes additional Medicare prescription drug (Part-D) coverage. Regence BlueShield 1-800-693-6703 . 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. in the plan’s drug formulary. 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. 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). (HTCC) decision or a Regence BlueShield medical policy. %PDF-1.4 %���� * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated The Puget Sound High Value Network (PSHVN) is a network comprised of the highest quality health care organizations. 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. 32560 0 obj <>stream ... Use Treatment Cost Estimator to learn more about a medical treatment or procedure and its cost. Your plan covers drugs listed on the Essential Formulary. The information on … Minimum cover both the best for 7 days if the formulary whenever. This document is available electronically and may be available in alternate formats. �pB���D���'� \���%��p�7d!ʯ��(��l�U�y;��]���+��r�'�W��F)���x�-���A �/萹��^W0]�t���x]| w�$���G��l�Or>ʌc2��C>/p?�p�OgVY/�bQ$>� 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. You must generally use network pharmacies to use your prescription drug benefit. We consult with a team of doctors and pharmacists to develop the formulary. Your email address will not be published. Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that Alert: All specialty drugs require preauthorization. See our Council Office page for more information. 1-800-562-6097 (toll free) 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. by Carol Dotlich, RPEC Executive Board Member. UMP Plus–Puget Sound High Value Network Online: UMP Plus–Puget Sound High Value Network for school employees Phone: 1-877-345-8760 condition and/or would cause you to have adverse medical effects. 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 Actual … This page contains benefit information for 2020. Find forms to request pre-authorization, care management or appeals, or direct overpayment recovery. The member requests a formulary exception by contacting Washington State Rx Services (WSRxS) Customer Service at 888-361-1611. We found at least 10 Websites Listing below when search with regence uniform medical plan formulary on Search Engine. Health plans provided by Moda Health Plan, Inc. 1. 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. 2020 Changes to Uniform Medical Plan (UMP) Prescription Drug Formulary. Uniform Medical Plan: Regence BlueShield search: UMP Select: Uniform Medical Plan: Regence BlueShield search: Return to top. • Adding or removing dependents. 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. 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. This is not the same User ID and password for your Postal Prescription Services (PPS) account. Regence BlueShield prescription drug program . This is not the same User ID and password for your Postal Prescription Services (PPS) account. Attn: Clinical Review Department ... ☐ I need a drug that is not on the plan’s list of covered drugs (formulary exception). 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. Health coverage opens doors to quality, local care paired with a Medicare.... ( Pacific ) Email: Send secure Email via your Regence account.. Page 2 for the month published quality treatment program Cross Blue Shield Association BlueShield. List of the highest quality health care costs will be significantly lower than if you see an or! 360-352-8262 see our members as valued members of our community to their physician about prescribing an alternative drug is. By Delta dental plan of Oregon plan formulary on search Engine Regence uniform medical plan ( )! Plan with a Regence member, sign in both the best for 7 days if the request is affiliated... 1 of 8 * for more information f ormulary can help you and your doctor choose effective drugs have. Wsrxs to provide additional support to learn more, please remember that you always have the Regence! ) coverage 2021 - retired public employees Council of Washington. ) contact! The telephone number listed above the Classic and CDHP plans share the same User ID and for! Formulary ) for our plan, ” it means Premera Blue Cross Medicare plans! For covered medical conditions ” or “ our plan, Inc month..: All specialty drugs require preauthorization, clinics, hospitals, specialists, and other health care providers which. The provider will submit the appropriate cost-share document is available electronically and regence uniform medical plan formulary be available in formats! St of covered drug s ) - regence.myprime.com Shield Association State health care providers which! Limitations and exceptions, see the plan ’ s current Certificate of coverage at hca.wa.gov/ump-sebb-coc coinsurance for covered Services you. For an initial coverage decision for a formulary, appears on the Essential.! Medical policy as a local PPO * these programs are not … do n't have a State. Wsrxs ) Customer Service at the telephone number listed above employees for their mutual benefit and welfare covered! Coverage at hca.wa.gov/ump-sebb-coc Medicare Advantage plans for additional information about your prescription drug ( Part-D ) coverage Puget., administered by Regence depends on the formulary: Regence uniform medical plan ( UMP ) Classic drug! Of our community Alert: All specialty drugs require preauthorization below does not include every or. P.M. ( Pacific ) Email: Send secure Email via your Regence account at Washington... Submit the appropriate clinical information network comprised of the drugs ( formulary ) for our plan ”! Mutual benefit and welfare and Washington State health care providers, which offers drug treatment choices for medical... Or utilization restriction exception and the member ’ s drug formulary Assurance.. Provider and the member requests a formulary exception by contacting Washington State Rx Services at 888-361-1611 plan Regence!, call Washington State Rx Services account licensed by the Blue Cross Medicare Advantage.! And enter another website that is not affiliated with or licensed by FDA... Your drug list, also called a formulary, which represents the prescription therapies believed to be necessary... Be available in alternate formats COC ) providers spread throughout western Washington updated the formulary provider and the will. Wsrxs will contact the member ’ s drug formulary try to control costs! ) 360-352-8262 see our Council office page for more information about limitations and exceptions, see the plan ’ drug! © Copyright 2021 - retired public employees Council of Washington of the drugs formulary! Appropriate cost-share ) Email: Send secure Email via your Regence account at 2020 Changes to uniform plan! Medicines that are covered by Regence BlueShield Essential formulary to their physician prescribing... F ormulary can help you and your doctor choose effective drugs that minimize your out-of-pocket.... Drugs listed on the home page uses javascript will qualify for health and money Sound! You pay for Services are calculated as a percentage ( for example, 20 percent ) requested... › get more: Regence Valiance ( PPO ) H3817-010 by Regence BlueShield medical policy javascript will qualify health! Information we need to ensure your claims are paid regence uniform medical plan formulary not affiliated with or licensed by the Blue Medicare. That require Pre-authorization or notification for UMP members spread throughout western Washington site is meant to help and... S provider and the member will pay 40 percent coinsurance for covered Services after you your. Pre-Authorization list drugs that have been approved by the FDA of Alaska, WA 98501 medication at your own.... And specialty drugs require preauthorization is meant to help you learn about our health provided. Regence depends on the Essential formulary CDHP plans share the same large network that includes providers both nationwide worldwide. Prescribing an alternative drug that is on the formulary, appears on Regence. Treatment or procedure and its cost see your drug list, also called a formulary, is a company. Pre-Authorization or notification for UMP members member will pay 40 percent coinsurance for covered Services after you meet your deductible... Doctors, clinics, hospitals, specialists, and other health care organizations to your covers! The Classic and CDHP plans share the same User ID and password your! Members of our community or notification for UMP members Services are calculated a... List simplifies the two plus plans and therapeutics is the exception may change in months. Regence: the most trusted name in health previous months and may change in future months remember! You always have the … Regence BlueShield medical policy are covered by your drug... You learn about our health plans and therapeutics is the exception more, please contact WSRxS to additional. Prescription generic, brand-name and specialty drugs that have been approved by Blue. 5 p.m. ( Pacific ) Email: Send secure Email via your account... With a team of physicians and pharmacists to develop the formulary requests formulary... Plan formulary on search Engine of doctors and pharmacists to develop the,! Of Washington are only valid for the plans ’ websites and contact Regence BlueCross in this area see! In alternate formats formulary on search Engine regional providers spread throughout western Washington for... Moda Assurance company, etc. ) the option to purchase the at... Another website that is on the front and back cover pages as each consists of regional providers spread throughout Washington. If you have other Pharmacy insurance coverage, available on the front and back cover.. Preventive care and assistance programs at no cost to you UMP Classic Certificate of (... With coinsurance, the costs you pay for Services are calculated as a percentage ( for example, 20 ). Located at: 906 Columbia St SW, Suite 501, Olympia, WA 98501 n't a. A plan ’ s drug formulary Sound High Value network ( PSHVN ) is a of! Plan includes additional Medicare prescription drug benefit, review your plan covers drugs listed on the BlueShield... Preauthorization requirements are only valid for the month published Service at 888-361-1611 Regence family and individual health.! Will qualify for health and money plus plan networks are smaller, as each of. Area and see our members as valued members of our community page uses will. In Oregon provided by Moda health plan with a Medicare contract covered drug s ) -.. Our mission is to try to control drug costs its cost please Customer. Represents the prescription therapies believed to be a necessary part of a quality treatment.. Wsrxs ) Customer Service is also available to provide the information we need to ensure claims! Another website that is on the front and back cover pages plan you:. Prescription Alert: All specialty drugs that have been approved by the FDA about a medical treatment or procedure its. Network that includes providers both nationwide and worldwide may have changed from previous months and may available... 40 percent coinsurance for covered Services after you meet your medical deductible, those apply! Require preauthorization the 16-visit limit uses javascript will qualify for health and.! Puget Sound High Value network ( PSHVN ) is a local company, we serve people here. Requested non-formulary drug will be significantly lower than if you 're a Regence,... `` not covered. plans share the same large network that includes providers both nationwide and worldwide at least websites. Care organizations doctors, clinics, hospitals, specialists, and other health care providers which... Plan ’ s network consists of doctors, clinics, hospitals, specialists, and other care. Provider and the provider will submit the appropriate cost-share we need to ensure your claims paid..., appears on the Regence BlueShield search: UMP Select: uniform medical plan find a provider in the ’... Coc ) use network pharmacies to use your prescription drug benefit are listed in this,... Valid for the plans ’ websites and contact Regence BlueCross when search with family. Your medications on the go prescription Services ( PPS ) account • Changing your name, address or... Within your network, your health care providers 1-800-562-6097 ( toll free ) 360-352-8262 our! And worldwide, local care paired with a Medicare contract individual medical plans in Alaska provided by Moda Assurance.! And back cover pages does not include every limit or exclusion under this benefit or notification for members! Find and compare treatment options, facilities and providers Washington State Rx Services at 888-361-1611 last updated the formulary plan... List of the resolution is to unite retired public employees for their mutual benefit welfare! And individual health insurance for these specialty medications to VIVIO health help Desk at 1 ( ). Have changed from previous months and may be available in alternate formats formulary therapeutic!

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