Dental plans in Alaska provided by Delta Dental of Alaska. This plan includes additional Medicare prescription drug (Part-D) coverage. 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. PHARMACY SERVICES Uniform Medical Plan Prior Authorization (PA) Request Form PHONE (888) 361‐1611 FAX (800) 207‐8235 Updated: December, 2007 Review estimated copay . 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. Find forms to request pre-authorization, care management or appeals, or direct overpayment recovery. This is not the same User ID and password for your Postal Prescription Services (PPS) account. UMP is … About Uniform Medical Plan (UMP), administered by Regence BlueShield. Live your best with a Regence health plan. Cost overview Copayments or coinsurance? The purpose of the resolution is to try to control drug costs. Your email address will not be published. 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. �pB���D���'� \���%��p�7d!ʯ��(��l�U�y;��]���+��r�'�W��F)���x�-���A �/萹��^W0]�t���x]| w�$���G��l�Or>ʌc2��C>/p?�p�OgVY/�bQ$>� If you have other pharmacy insurance coverage, please contact WSRxS to provide the information we need to ensure your claims are paid accurately. Download our mobile app to manage and order your medications on the go. We consult with a team of doctors and pharmacists to develop the formulary. This document includes a list of the drugs (formulary) for our plan which is current as of September 2, 2020. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Regence MedAdvantage + Rx Primary (PPO) Regence MedAdvantage + Rx Classic (PPO) 2019 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID 00019241, Version Number 22 This formulary was updated on 11/19/2019. May be covered by regence depends on the home page uses javascript will qualify for health and money. • Premium surcharge questions. Please call Customer Service at the telephone number listed above. 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. For an updated formulary, please contact us. 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. Find the right plan for you. Review your previous payments. 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. 360-352-8262 Get medical insurance for your life and budget. * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated Regence consults with a team of physicians and pharmacists to develop the formulary, which offers drug treatment choices for covered medical conditions. It’s the support you’ll only find with Regence family and individual health insurance. 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. You must generally use network pharmacies to use your prescription drug benefit. 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? Please call Customer Service at the telephone number listed above. Our mission is to unite retired public employees for their mutual benefit and welfare. 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. 2020 Formulary (Li st of Covered Drug s) - regence.myprime.com. Pre-authorization for certain specialty medications is required for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members. Uniform Medical Plan WASHINGTON STATE PRESCRIPTION SERVICES . Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that • Adding or removing dependents. Dental plans in Oregon provided by Delta Dental Plan of Oregon. If so, the only difference between the UMP Plus and UMP Classic prescription drug coverage 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. 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. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Moda Health Pharmacy Customer Service is also available to provide additional support. Check drug prices. The f ormulary can help you and your doctor choose effective drugs that minimize your out-of-pocket expense. 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. 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. 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. 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. 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. Search drug details. The lists of medications are included on our Commercial Pre-authorization List.. The Puget Sound High Value Network (PSHVN) is a network comprised of the highest quality health care organizations. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. regence uniform medical plan find a provider 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. 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 The Plus plan networks are smaller, as each consists of regional providers spread throughout western Washington. Certificate of Coverage. 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. 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. The information on this site is not intended to replace the diagnosis and treatment recommendations of your physician or other health care professionals. Member. This document is available electronically and may be available in alternate formats. To learn more, please call Washington State Rx Services at 888-361-1611. If approved, the requested non-formulary drug will be covered and the member will pay the appropriate cost-share. Head-to-toe coverage and low-cost virtual care. Members should talk to their physician about prescribing an alternative drug that is on the formulary. Cancel Proceed. Don't have a Washington State Rx Services account? We found at least 10 Websites Listing below when search with regence uniform medical plan formulary on Search Engine. When this drug list (formulary) refers to “we,” “us”, or “our,” it means Premera Blue Cross. Insurance pays the remaining percentage of the cost. Commercial plans and update your drug list simplifies the two plus plans and therapeutics is the exception. Health Details: Regence Valiance (PPO) is a Local PPO *. 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. UMP Plus–Puget Sound High Value Network Online: UMP Plus–Puget Sound High Value Network for school employees Phone: 1-877-345-8760 Some drugs may show that they are "not covered." This is not the same User ID and password for your Postal Prescription Services (PPS) account. You may also call the PEBB Program at 1-800-200-1004 for additional help. Download and print helpful material for your office. 32560 0 obj <>stream By using providers within your network, your health care costs will be significantly lower than if you use providers outside your network. drug benefit, review your plan’s current Certificate of Coverage, available on the UMP homepage or by calling 1-888-849-3681. If you pay for visits before you meet your medical deductible, those visits apply to the 16-visit limit. %%EOF h�bbd``b`�� �ĵ ��@��HLHp� ��@�x�da`b���#���x�x���U Y�� If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. 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. Title: 2020 UMP (PEBB and SEBB) PDL Temporary PDL Notice Author: nguyenm Created Date: Please check with your plan to ensure coverage. Your plan covers drugs listed on the Regence BlueShield Essential 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. Pharmacy benefits. 32452 0 obj <> endobj You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. Don't have a Washington State Rx Services account? For more recent information or … 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 Cancel Proceed. 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. Please call Customer Service at the telephone number listed above. Dollars Distributed Monthly to Retirees by County. Members. Uniform Medical Plan: Regence BlueShield search: UMP Select: Uniform Medical Plan: Regence BlueShield search: Return to top. For additional information about your prescription 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. If the request is not approved, please remember that you always have the … 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. Preauthorization requirements are only valid for the month published. Department is not represent the uniform medical plan formulary or therapeutic equivalent. The RPEC Council office is located at: For more details, refer to your plan’s . • Eligibility questions and changes (Medicare, divorce, etc.). Required fields are marked *. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Olympia, WA 98501. When it refers to “plan” or “our plan,” it means Premera Blue Cross Medicare Advantage Plans. UMP is administered by Regence BlueShield and Washington State Rx Services. Choosing a health plan is a big decision. �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. Individual medical plans in Alaska provided by Moda Assurance Company. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. Minimum cover both the best for 7 days if the formulary whenever. 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. Get the facts and know your options. Regence BlueShield is a Health plan with a Medicare contract. • Finding forms. your client’s specific plan. Submit pre-authorizations for these specialty medications to VIVIO Health Help Desk at 1 (925) 365-6600. Regence BlueCross BlueShield of Oregon is a Health plan with a Medicare contract. 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. Regence BlueShield prescription drug program . Uniform Medical Plan | Washington State Health Care Authority. In previous meetings, we were told that the premium cost to the consumer has trended upward due to the high cost of prescription drugs. 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. Pharmacy benefits. The formulary is a list of prescription generic, brand name and … Members. See page 2 for the plans’ websites and contact 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 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. • ID cards. 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . See our Council Office page for more information. With a Regence Medigap plan you get: *These programs are not … 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. Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association This document is available electronically and may be available in alternate formats. ... Use Treatment Cost Estimator to learn more about a medical treatment or procedure and its cost. 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. 0 1. (HTCC) decision or a Regence BlueShield medical policy. Your plan covers drugs listed on the Regence BlueShield Essential Formulary. Extra assistance programs. 2020 Changes to Uniform Medical Plan (UMP) Prescription Drug Formulary. condition and/or would cause you to have adverse medical effects. Check formulary status. Preauthorization requirements are only valid for the month published. With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). Find and compare treatment options, facilities and providers. COVID-19 resources. ANYWHERE ANYTIME! Cancel Proceed. The information on … A plan’s network consists of doctors, clinics, hospitals, specialists, and other health care providers. As a local company, we serve people right here in this area and see our members as valued members of our community. Plus, preventive care and assistance programs at no cost to you. See the 2020 Preferred Drug List. A drug list, also called a formulary, is a list of medicines that are covered by your prescription drug plan. 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. Uniform Medical Plan (UMP) Classic or UMP CDHP, administered by Regence BlueShield ... • Whether your medications are in the plan’s formulary. Regence BlueShield 1-800-693-6703 . Download our mobile app. We consult with a team of doctors and pharmacists to develop the formulary. 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 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. © Copyright 2021 - Retired Public Employees Council of Washington. health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Our PAC Fundraiser is open through October 30th - Click here! Members-only discounts. The member requests a formulary exception by contacting Washington State Rx Services (WSRxS) Customer Service at 888-361-1611. These criteria do not imply or guarantee approval. Your email address will not be published. Our plan will generally cover the drugs listed in our formulary … 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. Sign in to your Regence account at regence.com . UMP is administered by Regence BlueShield and Washington State Rx Services. Regence BlueShield prescription drug program . If the request is not approved, please remember that you always have the option to purchase the medication at your own expense. This document includes a list of the drugs (formulary) for our plan which is current as of . Virtual care. Actual … For additional information about your prescription drug benefit, see the current UMP Classic Certificate of Coverage (COC). 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 … 906 Columbia St SW, Suite 501, If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. › Get more: Regence uniform medical preferred providers Show List Health . 12/01/2020. View your copayment information. 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. View mail-order and specialty drugs. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is WSRxS will contact the member’s provider and the provider will submit the appropriate clinical information. Health plans provided by Moda Health Plan, Inc. • Changing your name, address, or phone number. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. The table below does not include every limit or exclusion under this benefit. 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. 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. %PDF-1.4 %���� The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. 2020 Changes to UMP Prescription Drug Formulary. 1-800-562-6097 (toll free) This plan includes additional Medicare prescription drug (Part-D) coverage. These criteria do not imply or guarantee approval. Your plan covers drugs listed on the Essential Formulary. All Rights Reserved. by Carol Dotlich, RPEC Executive Board Member. This site is meant to help you learn about our health plans and other benefits and services. WSRxS’ clinical team will review the submitted information to determine if the formulary alternatives the member used were ineffective or are not clinically appropriate. 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). Finding doctors - Regence: The most trusted name in health . This page contains benefit information for 2020. endstream endobj startxref 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. If you're a Regence member, sign in. by Carol Dotlich, RPEC Executive Board Member. 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. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. *Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in WA, and the Portland, OR, area. Browse lower-cost drug options. Regence BlueShield is a Health plan with a Medicare contract. They may have changed from previous months and may change in future months. Attn: Clinical Review Department ... ☐ I need a drug that is not on the plan’s list of covered drugs (formulary exception). 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. 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. Monday through Friday: 7 a.m. to 5 p.m. (Pacific) Email: Send secure email via your Regence account at . could place the Member’s life, health, or ability to regain maximum function in serious jeopardy. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. Find pharmacies near you. • Claims. • Eligibility complaints or appeals. Please check with your plan to ensure coverage. ... 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. Regence is a nonprofit health plan, and we have a long history with Medicare. 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. in the plan’s drug formulary. We provide flexible, affordable health care for members of the School Employees Benefits Board (SEBB) and Public Employees Benefits Board (PEBB) programs.. PSHVN has a large geographic footprint with over 6,500 providers and 1,100 locations. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. 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.) Alert: All specialty drugs require preauthorization. This document is available electronically and may be available in alternate formats. To browse each plan’s network or to find a s… If you're a Regence member, sign in.