Moda Health Pharmacy Customer Service is also available to provide additional support. Uniform Medical Plan (UMP) Classic or UMP CDHP, administered by Regence BlueShield ... • Whether your medications are in the plan’s formulary. Our plan will generally cover the drugs listed in our formulary … 2020 Formulary (Li st of Covered Drug s) - regence.myprime.com. 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. Preauthorization requirements are only valid for the month published. Your plan covers drugs listed on the Essential Formulary. If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. The RPEC Council office is located at: View mail-order and specialty drugs. �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. Alert: All specialty drugs require preauthorization. Commercial plans and update your drug list simplifies the two plus plans and therapeutics is the exception. 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. The table below does not include every limit or exclusion under this benefit. You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. Choosing a health plan is a big decision. Cancel Proceed. A plan’s network consists of doctors, clinics, hospitals, specialists, and other health care providers. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. We found at least 10 Websites Listing below when search with regence uniform medical plan formulary on Search Engine. 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 purpose of the resolution is to try to control drug costs. • Eligibility questions and changes (Medicare, divorce, etc.). 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. Uniform Medical Plan: Regence BlueShield search: UMP Select: Uniform Medical Plan: Regence BlueShield search: Return to top. COVID-19 resources. Health Details: Regence Valiance (PPO) is a Local PPO *. Members-only discounts. Search drug details. 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. 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. This document is available electronically and may be available in alternate formats. PHARMACY SERVICES Uniform Medical Plan Prior Authorization (PA) Request Form PHONE (888) 361‐1611 FAX (800) 207‐8235 Updated: December, 2007 Review estimated copay . You may also call the PEBB Program at 1-800-200-1004 for additional help. 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. Member. If so, the only difference between the UMP Plus and UMP Classic prescription drug coverage If the request is not approved, please remember that you always have the … Cancel Proceed. When it refers to “plan” or “our plan,” it means Premera Blue Cross Medicare Advantage Plans. 32452 0 obj <> endobj • Changing your name, address, or phone number. ... Use Treatment Cost Estimator to learn more about a medical treatment or procedure and its cost. 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. Virtual care. your client’s specific plan. 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. Sign in to your Regence account at regence.com . Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is Browse lower-cost drug options. Dollars Distributed Monthly to Retirees by County. Check drug prices. Pre-authorization for certain specialty medications is required for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members. by Carol Dotlich, RPEC Executive Board Member. Get the facts and know your options. › Get more: Regence uniform medical preferred providers Show List Health . Required fields are marked *. 360-352-8262 The Plus plan networks are smaller, as each consists of regional providers spread throughout western Washington. 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. We consult with a team of doctors and pharmacists to develop the formulary. If you're a Regence member, sign in. condition and/or would cause you to have adverse medical effects. Please check with your plan to ensure coverage. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. 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 f ormulary can help you and your doctor choose effective drugs that minimize your out-of-pocket expense. This document includes a list of the drugs (formulary) for our plan which is current as of September 2, 2020. © Copyright 2021 - Retired Public Employees Council of Washington. With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). To learn more, please call Washington State Rx Services at 888-361-1611. 906 Columbia St SW, Suite 501, You must generally use network pharmacies to use your prescription drug benefit. Our mission is to unite retired public employees for their mutual benefit and welfare. 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 … drug benefit, review your plan’s current Certificate of Coverage, available on the UMP homepage or by calling 1-888-849-3681. Uniform Medical Plan | Washington State Health Care Authority. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. Download our mobile app. 2020 Changes to Uniform Medical Plan (UMP) Prescription Drug Formulary. Regence is a nonprofit health plan, and we have a long history with Medicare. This document is available electronically and may be available in alternate formats. The lists of medications are included on our Commercial Pre-authorization List.. Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association Please check with your plan to ensure coverage. * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated 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. Regence BlueShield is a Health plan with a Medicare contract. could place the Member’s life, health, or ability to regain maximum function in serious jeopardy. Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that Minimum cover both the best for 7 days if the formulary whenever. in the plan’s drug 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. %PDF-1.4 %���� ... 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. 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. 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. 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.) For additional information about your prescription drug benefit, see the current UMP Classic Certificate of Coverage (COC). Dental plans in Oregon provided by Delta Dental Plan of Oregon. 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. Regence BlueShield prescription drug program . Members. 1-800-562-6097 (toll free) 1. 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 Extra assistance programs. The formulary is a list of prescription generic, brand name and … This page contains benefit information for 2020. For more details, refer to your plan’s . If the request is not approved, please remember that you always have the option to purchase the medication at your own expense. 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. 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? Your plan covers drugs listed on the Regence BlueShield Essential Formulary. 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. Members. Plus, preventive care and assistance programs at no cost to you. ANYWHERE ANYTIME! • ID cards. 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . Find forms to request pre-authorization, care management or appeals, or direct overpayment recovery. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. 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. This site is meant to help you learn about our health plans and other benefits and services. Live your best with a Regence health plan. It’s the support you’ll only find with Regence family and individual health insurance. 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. Your email address will not be published. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. 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. 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. About uniform medical plan ( UMP ) Classic prescription drug formulary back cover pages medical! Drugs require preauthorization about your prescription drug formulary to provide the information we need to your... 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