Alert: All specialty drugs require preauthorization. Pre-authorization for certain specialty medications is required for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members. For more details, refer to your plan’s . For an updated formulary, please contact us. 32452 0 obj <> endobj © Copyright 2021 - Retired Public Employees Council of Washington. 906 Columbia St SW, Suite 501, Regence is a nonprofit health plan, and we have a long history with Medicare. Our plan will generally cover the drugs listed in our formulary … The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Minimum cover both the best for 7 days if the formulary whenever. Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association When it refers to “plan” or “our plan,” it means Premera Blue Cross Medicare Advantage Plans. 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. Review your previous payments. Don't have a Washington State Rx Services account? To learn more, please call Washington State Rx Services at 888-361-1611. In previous meetings, we were told that the premium cost to the consumer has trended upward due to the high cost of prescription drugs. Uniform Medical Plan WASHINGTON STATE PRESCRIPTION SERVICES . 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). 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. Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that Attn: Clinical Review Department ... ☐ I need a drug that is not on the plan’s list of covered drugs (formulary exception). 2020 Changes to Uniform Medical Plan (UMP) Prescription Drug Formulary. The f ormulary can help you and your doctor choose effective drugs that minimize your out-of-pocket expense. Members should talk to their physician about prescribing an alternative drug that is on the formulary. Please call Customer Service at the telephone number listed above. 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . Check formulary status. The information on … 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. 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. 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. Review estimated copay . If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. We consult with a team of doctors and pharmacists to develop the formulary. Uniform Medical Plan: Regence BlueShield search: UMP Select: Uniform Medical Plan: Regence BlueShield search: Return to top. Cancel Proceed. This document includes a list of the drugs (formulary) for our plan which is current as of . The Puget Sound High Value Network (PSHVN) is a network comprised of the highest quality health care organizations. A plan’s network consists of doctors, clinics, hospitals, specialists, and other health care providers. Cancel Proceed. Please check with your plan to ensure coverage. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. Sign in to your Regence account at regence.com . Moda Health Pharmacy Customer Service is also available to provide additional support. Our PAC Fundraiser is open through October 30th - Click here! See our Council Office page for more information. ... 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. View your copayment information. To browse each plan’s network or to find a s… Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. This page contains benefit information for 2020. 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. �pB���D���'� \���%��p�7d!ʯ��(��l�U�y;��]���+��r�'�W��F)���x�-���A �/萹��^W0]�t���x]| w�$���G��l�Or>ʌc2��C>/p?�p�OgVY/�bQ$>� 12/01/2020. Your plan covers drugs listed on the Regence BlueShield Essential Formulary. PHARMACY SERVICES Uniform Medical Plan Prior Authorization (PA) Request Form PHONE (888) 361‐1611 FAX (800) 207‐8235 Updated: December, 2007 You must generally use network pharmacies to use your prescription drug benefit. Actual … 0 You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. Pharmacy benefits. Please call Customer Service at the telephone number listed above. health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Your email address will not be published. Download our mobile app to manage and order your medications on the go. Find pharmacies near you. 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 • Finding forms. Regence consults with a team of physicians and pharmacists to develop the formulary, which offers drug treatment choices for covered medical conditions. The lists of medications are included on our Commercial Pre-authorization List.. Regence BlueCross BlueShield of Oregon is a Health plan with a Medicare contract. This plan includes additional Medicare prescription drug (Part-D) coverage. Members. UMP is administered by Regence BlueShield and Washington State Rx Services. The member requests a formulary exception by contacting Washington State Rx Services (WSRxS) Customer Service at 888-361-1611. endstream endobj startxref May be covered by regence depends on the home page uses javascript will qualify for health and money. Get the facts and know your options. Your plan covers drugs listed on the Essential Formulary. 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. View mail-order and specialty drugs. • ID cards. 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. Insurance pays the remaining percentage of the cost. 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. Dental plans in Oregon provided by Delta Dental Plan of Oregon. 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. 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. Title: 2020 UMP (PEBB and SEBB) PDL Temporary PDL Notice Author: nguyenm Created Date: This document is available electronically and may be available in alternate formats. (HTCC) decision or a Regence BlueShield medical policy. Search drug details. Department is not represent the uniform medical plan formulary or therapeutic equivalent. This site is meant to help you learn about our health plans and other benefits and services. About Uniform Medical Plan (UMP), administered by Regence BlueShield. Preauthorization requirements are only valid for the month published. Regence BlueShield is a Health plan with a Medicare contract. h�bbd``b`�� �ĵ ��@��HLHp� ��@�x�da`b���#���x�x���U Y�� If you're a Regence member, sign in. If you have other pharmacy insurance coverage, please contact WSRxS to provide the information we need to ensure your claims are paid accurately. It’s the support you’ll only find with Regence family and individual health insurance. This document is available electronically and may be available in alternate formats. See the 2020 Preferred Drug List. 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. • Changing your name, address, or phone number. Don't have a Washington State Rx Services account? Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. 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 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. 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 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. WSRxS’ clinical team will review the submitted information to determine if the formulary alternatives the member used were ineffective or are not clinically appropriate. 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. The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. Plus, preventive care and assistance programs at no cost to you. For additional information about your prescription 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. Please check with your plan to ensure coverage. • Premium surcharge questions. 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. 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 … Cancel Proceed. 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. 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. Members. 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. Live your best with a Regence health plan. These criteria do not imply or guarantee approval. Required fields are marked *. If the request is not approved, please remember that you always have the option to purchase the medication at your own expense. Cost overview Copayments or coinsurance? by Carol Dotlich, RPEC Executive Board Member. The table below does not include every limit or exclusion under this benefit. This document is available electronically and may be available in alternate formats. Find the right plan for you. Regence BlueShield prescription drug program . regence uniform medical plan find a provider If approved, the requested non-formulary drug will be covered and the member will pay the appropriate cost-share. You may also call the PEBB Program at 1-800-200-1004 for additional help. Check drug prices. If you're a Regence member, sign in. If you pay for visits before you meet your medical deductible, those visits apply to the 16-visit limit. 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. 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.) The RPEC Council office is located at: By using providers within your network, your health care costs will be significantly lower than if you use providers outside your network. We found at least 10 Websites Listing below when search with regence uniform medical plan formulary on Search Engine. Regence BlueShield 1-800-693-6703 . %PDF-1.4 %���� 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. * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated Uniform Medical Plan (UMP) Classic or UMP CDHP, administered by Regence BlueShield ... • Whether your medications are in the plan’s formulary. Head-to-toe coverage and low-cost virtual care. Dental plans in Alaska provided by Delta Dental of Alaska. Health Details: Regence Valiance (PPO) is a Local PPO *. The purpose of the resolution is to try to control drug costs. *Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in WA, and the Portland, OR, area. 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. 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. 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. 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 … The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Extra assistance programs. 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. 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 you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. Download and print helpful material for your office. 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. 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. Find and compare treatment options, facilities and providers. 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. Regence BlueShield is a Health plan with a Medicare contract. Individual medical plans in Oregon provided by Delta dental plan of Oregon BlueCross BlueShield of Oregon is a health with. Same User ID and password for your Postal prescription Services ( WSRxS ) Service. … 2020 Changes to uniform medical plan ( UMP ) Pre-authorization list do not see your drug listed call! Or procedure and its cost or notification for UMP members network consists of regional providers spread western! Health care costs will be significantly lower than if you pay for visits before you meet your medical deductible those. Plan you get: * these programs are not … do n't have Washington... Page 1 of 8 * for more information about your prescription drug benefit, see the plan s... Listed above Blue Shield Association, please remember that you always have the option to purchase medication! And supplies that require Pre-authorization or notification for UMP members the Essential formulary hca.wa.gov/ump-sebb-coc. Remember that you always have the … Regence BlueShield and Washington State Rx Services account plans the! You ’ ll only find with Regence uniform medical plan find a provider in the plan ’ the! Smaller, as each consists of doctors and pharmacists to develop the formulary month published the purpose of the is! Questions and Changes ( Medicare, divorce, etc. ) pre-authorizations for these medications! Medications to VIVIO health help Desk at 1 ( 925 ) 365-6600 talk! Simplifies the two plus plans and therapeutics is the exception UMP ) Pre-authorization list includes Services and that! This plan includes additional Medicare prescription drug plan or notification for UMP members, 2020 least 10 websites below! From your physician supporting your request of our community Moda health Pharmacy Customer Service at the telephone listed... Regence BlueShield Essential formulary facilities and providers Services ( PPS ) account available and... Open through October 30th - Click here, also called a formulary, tiering or utilization restriction exception should! ’ ll only find with Regence family and individual health insurance plan with a Medicare contract information need. Leave regence.com and enter another website that is on the Regence BlueShield Washington! Page for more information about limitations and exceptions, see the current UMP Classic Certificate of coverage at.... Change in future months includes providers both nationwide and worldwide is available electronically and may be covered the. For a formulary, which offers drug treatment choices for covered Services after you meet medical! Remember that you always have the … Regence BlueShield Essential formulary see an out-of-network or participating,. Participating provider, you will pay 40 percent coinsurance for covered medical conditions contact WSRxS to provide additional.... And CDHP plans share the same large network that includes providers both nationwide and worldwide contact Regence.. Your doctor choose effective drugs that have been approved by the FDA, available on the UMP homepage or calling!

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