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Guidance 1. Martin’s Point Health Care US Family Health Plan Serving Maine, New Hampshire, Vermont, Upstate and Western New York, and Northern Pennsylvania. December 23, 2015 Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 4. ���a�~�Wj��s��\/�&� �8�� u.�\�a�s��I�ֿ�_��*��Oݪ�X���6����"MRd4%�0�ѣ�x:���r���05�EC��i��et%O��~���B��S��h{_H��@�M�o�͕�]��m�E���f� %�6���% ��X8�$��!$�- UMP Plus–Puget Sound High Value Network (PSHVN) does not have primary care network providers for adults in Thurston County at this time due to limited access. February 29, 2016 Final: Key Dates in 2016: QHP Certification in the FFM; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors 5. The new regulation is designed to help you better understand and evaluate your health … As of September 23, 2012 or soon after, health insurance issuers and group health plans are required to provide you with an easy-to-understand summary about a health plan’s benefits and coverage. This means that you and any adult dependents may need to travel to another county served by UMP Plus–PSHVN for primary care services from a network provider. Generated Date: 3/23/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. The VHA Comprehensive Mental Health Strategic Plan and the requirements included in this Handbook have been developed to implement the goals of the President’s New Freedom Commission on Mental Health, including the principle that mental health care is an essential component of overall heath care. b. There is now an exception process for members who require prescription drugs that are no longer covered. 2020 Plan Year Uniform Dental Benefits Certificate of Coverage For All Programs with Dental Please read the following information carefully for your procedure frequencies and provisions. This limit helps you plan for health care expenses. x��=ko�6�������{1#�R�!��ds��fwf�X$���ݶ���v�۞��~���=HJ�D{�cwS�"Y�wϿ;�6W��)�����N���f}��r�y������?/�7��i�ߝ��r����^^���%�?\$��~������2˓,U�p�'���W�C�{����ׯ�?�D~����+"e I However, it only applies to Tier 2 prescription drugs, so you don’t have to pay the deductible if you use prescription drugs from any other tier, which includes most generic and low-cost drugs. Choose a plan that opens doors to top doctors and coordinated, cost-saving networks close to home. To learn more, please call Washington State Rx Services at 888-361-1611. (i.e. 2020 Plan Year Uniform Dental FAQs For the State Employee & Retiree Health Plan 1. Who is eligible for the Uniform Dental Benefit plan? The Health Care Authority (HCA) today announced a new contract to provide enhanced services to the nearly 200,000 public employees enrolled in Uniform Medical Plan (UMP). 1 of 9 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2020 – 12/31/2020 Uniform Medical Plan (UMP) Plus—UW Medicine Accountable Care Network (ACN) (PEBB) Coverage for: Individual/Family | Plan Type: ACP The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. you must report your new address to your payroll or benefits office no later than 60 days after your move. Which year would you like information on? 2021: Available in all Oregon and Idaho counties and nationwide. �������V��H���m�5�U�~x�ꗳO�������r��g��Jޯw��l�x[�]mNzv�_9���.���.�k|�^Ë�I��|��ׯ��������sȻsȳ2��y ��K�n�l X���(�G��1�p�.wrT"?V����1�w���,�;����G���{����^�mFEY���ftOs��9DN��=>�/q��b!A�6rV��q"zmR��\��K�\�$��Sɟ\���o Willamette Dental Group of Washington, Inc. 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In most cases, you must live in a medical plan’s service area to join the plan. The federal maximum out-of-pocket is $8,150 individual/$16,300 family. <>/Metadata 2372 0 R/ViewerPreferences 2373 0 R>> Learn more about your customer service options. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R 71 0 R 72 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Specifically, the regulations will ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices. �O��_��� W���"�J�ě��$��]�wF'��U"(yNR���6@����as@1�BmO*�-t��8��ӍV����O�Q~�g���y�J�0�_H���%1h�O~=3|?޿��;E%�b���I9$��Bv�?|��~$=�g�!��%����!5e�~�7V����r!�n%S�l巏���_�+���� ����S��� ��*À�� ��n����#����Y�֟c��ѻb���|��Erp��ߟN�۰��~��E��tZګQG�7P� F$�ԅ!x���ѣ�gc���V�s�*MI3�U��*-2��a�KP��� /2FJT ���t���S�z�K��LV���vy���~�'�"� certain level 3 & 4 prescription drugs and certain hearing aids covered under this plan). 2 0 obj <> %���� 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 : See the 2020 Preferred Drug List. Effective Date: 1/1/2020 Date Generated: 12/18/2019 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. 2020 UMP Classic (PEBB) Certificate of Coverage 6. Some drugs may show that they are "not covered." The following documents—called a Summary of Benefits and Coverage—provide summaries of what each plan covers and what it costs. For a summary of benefits and costs, see Is there a quick way to see benefits and costs? $1,400/per person, $2,800/family Deductible is what you pay before the plan begins to pay. 2020 State of Wisconsin Group Health Insurance Program Certificate of Coverage IYC Health Plan 20ET-2107cc ... all health plans offering coverage in the State of Wisconsin Group Health Insurance Program must provide the Uniform Benefits as described in this document. The HEALTH PLAN may not alter the language, benefits or exclusions and limitations of the Uniform Benefits plan. The following documents—called a Certificate of Coverage—provide in-depth descriptions of the health care benefits for each plan. All state employees and retirees who elect medical coverage through the State of Wisconsin Group Health Insurance Program are eligible. UMP Plus—UW Medicine Accountable Care Network, UMP Consumer-Directed Health Plan (UMP CDHP) (2021), UMP Plus—Puget Sound High Value Network (PSHVN) (2021), UMP Plus—UW Medicine Accountable Care Network (UW Medicine ACN) (2021), UMP Consumer-Directed Health Plan (UMP CDHP) (2020), UMP Plus—Puget Sound High Value Network (PSHVN) (2020), UMP Plus—UW Medicine Accountable Care Network (UW Medicine ACN) (2020, UMP Plus—Puget Sound High Value Network (2021), UMP Plus—UW Medicine Accountable Care Network (2021), UMP Plus—Puget Sound High Value Network (2020), UMP Plus—UW Medicine Accountable Care Network (2020), Website feedback: Tell us how we’re doing. Applies to Uniform Medical Plan (UMP) If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. In-network uniform preventative and medical benefits are offered in all plans. With the Uniform Medical Plan, you may choose from the plans listed below. 4 0 obj For in-depth descriptions of benefits and coverage, see What are the full benefits of each plan? As of the 1994 coverage year, all HEALTH PLANSoffering coverage in State of Wisconsin Group Health Insurance Program must provide the Uniform Benefits as described in this document. Alert: All specialty drugs require preauthorization. UMP has issued a COVID-19 summary of changes for their Certificates of Coverage. This applies to all essential health benefits, including some services not included in the out-of-pocket limit. Generated Date: 5/22/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2020 – 12/31/2020 Uniform Medical Plan (UMP) Classic (Medicare) (PEBB) Coverage for: Individual/Family | Plan Type: PPO 1 of 10 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. After a two-year competitive process, HCA selected Regence BlueShield as […] King, Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, Yakima, Uniform Medical Plan Page 1 of 7. HEALTH PLANSare required to provide PARTICIPANTS with a UMP is the state’s self-funded medical option for eligible members enrolled in the Public Employees Benefits Board (PEBB) Program. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. The following changes were made to our Uniform Medical Plan Pre-authorization List effective January 1, 2020: ... 2020 changes. <> Use the tables below to make sure you live in the plan's service area. Do I live in the medical plan's service area? ... 2020 UMP Classic (PEBB) Certificate of Coverage 8 Employee: Retiree (Medicare) Retiree (non-Medicare) PEBB Continuation Coverage (COBRA Medicare) Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. Members: 1-888-674-8734 Non-Members: 1-888-241-4556 Providers: 1-888-732-7364 Learn more about the plans. Included below are the medical management programs that will apply to UMP members effective January 1, 2020 (except as noted below). cover eligible dependents, everyone must enroll in the same medical plan Remember, if you cover eligible dependents, everyone must enroll in the same medical plan. Effective Date: 5/1/2020 Generated Date: 4/23/2020 The presence of codes on this list does not necessarily indicate coverage under the member's benefit contract. 0iY�. Due to COVID-19, HCA’s lobby is closed. What are my plan options? Uniform Glossary of Coverage and Medical Terms SBC and Uniform Glossary Translations - Chinese, Spanish, Tagalog, and Navajo Summary of Benefits and Coverage (SBC) Templates, Instructions, and Related Materials – for plan years beginning on or after 4/1/17 Revised 9/8/2020 . 2020: 2021: What type of enrollee are you? Page 1 of 9 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2020 – 12/31/2020 Uniform Medical Plan (UMP) Achieve 1 (SEBB) Coverage for: Individual/Family | Plan Type: PPO * For more information about limitations and exceptions, see the plan’s certificate of coverage or policy document at hca.wa.gov/ump -sebb coc. 3 0 obj UMP – Uniform Medical Plan . 2021: Available in all Washington counties and nationwide. 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Applies to Uniform Medical Plan (UMP) 2020 Formulary (Li st of Covered Drug s) PLEASE READ: T HIS DOCUMENT CO NTAINS INF ORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submissi Version Numberon ID 20104 21, This formulary was updated on 11/24/2020… 2020: King, Kitsap, Pierce, Snohomish, Thurston, Yakima, 2021: Chelan, Douglas, King, Kitsap, Pierce, Snohomish, Thurston, Yakima. All dental benefits are paid according to the terms of the Master Contract between the Health Plan, Dental Plan and Group Insurance Board. November 4, 2014 Group Health Plans that Fail to Cover In-Patient Services 2. Sleep Medicine . In general, you may choose from the plans listed below. Plus, have the peace of mind that comes from emergency coverage wherever you’re traveling. Your options are limited to the plans available in your county. UMP Achieve 1 UMP Achieve 2 UMP High Deductible UMP Plus—Puget Sound High Value Network UMP Plus—UW Medicine Accountable Care Network UMP Plus— Puget Sound Pediatric primary care as well as adult and pediatric specialty care remains available in the Olympia area. As of the 1994 coverage year, all HEALTH PLANSoffering coverage in the State of Wisconsin ... of the Uniform Benefits plan. Employees can choose a health plan with or without dental (routine and preventative dental), and the It’s Your ... 11/18/2020 It’s Your Choice Health Plan (IYC) Benefit Schedule Benefits You Receive Included 30% of costs until the plan has paid $500 (for PPO, out of state, and non-PPO providers); then any amount over $500 in the member's lifetime (maximum lifetime benefit) This is a summary of UDP plan benefits. If you move out of your plan's service area, you may need to change plans. How to use this certificate of coverage . Applies to Uniform Medical Plan (UMP) The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. endobj Uniform Medical Plan (UMP) plans. endobj Health plans with health savings accounts (HSAs) Contact HCA. Medical Benefit Comparison. Use one of Regence's provider directories. UNIFORM BENEFITS . Available in all Washington counties and nationwide. Learn more about the Uniform Medical Plan (UMP) plans, administered by Regence BlueShield and Washington State Rx Services (WSRxS). For all the plans, you pay coi… An employer can permit employees to apply unused health and dependent care FSA amounts remaining as of the end of a grace period ending in 2020 or a plan year ending in 2020 (i.e., an off calendar year plan) to pay or reimburse expenses incurred for the same type of FSA through December 31, 2020. November 4, 2014 Group health plans with health savings accounts ( HSAs ) Contact HCA What. 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