To learn more, please call Washington State Rx Services at 888-361-1611. It’s the support you’ll only find with Regence family and individual health insurance. Pre-authorization for certain specialty medications is required for CHG Healthcare Services (group #70000004), IEC Group (group #70000000) and Alsco Inc. (group #70000002) members. 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. They may have changed from previous months and may change in future months. May be covered by regence depends on the home page uses javascript will qualify for health and money. With a Regence Medigap plan you get: *These programs are not … 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. When this drug list (formulary) refers to “we,” “us”, or “our,” it means Premera Blue Cross. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Choosing a health plan is a big decision. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Pharmacy benefits. 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.) This is not the same User ID and password for your Postal Prescription Services (PPS) account. 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 … By using providers within your network, your health care costs will be significantly lower than if you use providers outside your network. Monday through Friday: 7 a.m. to 5 p.m. (Pacific) Email: Send secure email via your Regence account at . Review your previous payments. Regence BlueShield is a Health plan with a Medicare contract. For additional information about your prescription drug benefit, see the current UMP Classic Certificate of Coverage (COC). View your copayment information. Check formulary status. Members should talk to their physician about prescribing an alternative drug that is on the formulary. Regence BlueShield is an Independent Licensee of the Blue Cross and Blue Shield Association If you're a Regence member, sign in. 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. Regence BlueShield prescription drug program . Your plan covers drugs listed on the Essential Formulary. Regence consults with a team of physicians and pharmacists to develop the formulary, which offers drug treatment choices for covered medical conditions.
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 WSRxS’ clinical team will review the submitted information to determine if the formulary alternatives the member used were ineffective or are not clinically appropriate. %PDF-1.4
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Insurance pays the remaining percentage of the cost. See our Council Office page for more information. 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. 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. This plan includes additional Medicare prescription drug (Part-D) coverage. health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. 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. 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . 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. Don't have a Washington State Rx Services account? Members. If you have other pharmacy insurance coverage, please contact WSRxS to provide the information we need to ensure your claims are paid accurately. Don't have a Washington State Rx Services account? 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. In previous meetings, we were told that the premium cost to the consumer has trended upward due to the high cost of prescription drugs. Please check with your plan to ensure coverage. Extra assistance programs. Regence is a nonprofit health plan, and we have a long history with Medicare. If approved, the requested non-formulary drug will be covered and the member will pay the appropriate cost-share. • Premium surcharge questions. 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. • ID cards. Minimum cover both the best for 7 days if the formulary whenever. If the request is not approved, please remember that you always have the … This document is available electronically and may be available in alternate formats. 32560 0 obj
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Cancel Proceed. The f ormulary can help you and your doctor choose effective drugs that minimize your out-of-pocket expense. Some drugs may show that they are "not covered." Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. Submit pre-authorizations for these specialty medications to VIVIO Health Help Desk at 1 (925) 365-6600. When it refers to “plan” or “our plan,” it means Premera Blue Cross Medicare Advantage Plans. Finding doctors - Regence: The most trusted name in health . 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. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. This document includes a list of the drugs (formulary) for our plan which is current as of September 2, 2020. The RPEC Council office is located at: 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). Download our mobile app to manage and order your medications on the go. Uniform Medical Plan | Washington State Health Care Authority. Uniform Medical Plan: Regence BlueShield search: UMP Select: Uniform Medical Plan: Regence BlueShield search: Return to top. Our PAC Fundraiser is open through October 30th - Click here! Please call Customer Service at the telephone number listed above. This page contains benefit information for 2020. • Changing your name, address, or phone number. These criteria do not imply or guarantee approval. Your email address will not be published. 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. �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$>� UMP is … Our plan will generally cover the drugs listed in our formulary … Your email address will not be published. endstream
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With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). 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. Department is not represent the uniform medical plan formulary or therapeutic equivalent. The Plus plan networks are smaller, as each consists of regional providers spread throughout western Washington. • Eligibility complaints or appeals. Please call Customer Service at the telephone number listed above. 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. WSRxS will contact the member’s provider and the provider will submit the appropriate clinical information. (HTCC) decision or a Regence BlueShield medical policy. * ... explain medical reason] ☐ Request for formulary tier exception [Specify below: (1) Formulary or preferred drugs contraindicated your client’s specific plan. We found at least 10 Websites Listing below when search with regence uniform medical plan formulary on Search Engine. 12/01/2020. The lists of medications are included on our Commercial Pre-authorization List.. For an updated formulary, please contact us. Dental plans in Alaska provided by Delta Dental of Alaska. Please call Customer Service at the telephone number listed above. Actual … Regence BlueShield prescription drug program . Olympia, WA 98501. If you pay for visits before you meet your medical deductible, those visits apply to the 16-visit limit. 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. Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that Cost overview Copayments or coinsurance? • Eligibility questions and changes (Medicare, divorce, etc.). Find and compare treatment options, facilities and providers. Find the right plan for you. 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 you're a Regence member, sign in. Preauthorization requirements are only valid for the month published. Preauthorization requirements are only valid for the month published. regence uniform medical plan find a provider Certificate of Coverage. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. Title: 2020 UMP (PEBB and SEBB) PDL Temporary PDL Notice Author: nguyenm Created Date: Members-only discounts. All Rights Reserved. This plan includes additional Medicare prescription drug (Part-D) coverage. 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. Search drug details. 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. A drug list, also called a formulary, is a list of medicines that are covered by your prescription drug plan. PHARMACY SERVICES Uniform Medical Plan Prior Authorization (PA) Request Form PHONE (888) 361‐1611 FAX (800) 207‐8235 Updated: December, 2007 • Finding forms. Alert: All specialty drugs require preauthorization. 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. Please check with your plan to ensure coverage. Dental plans in Oregon provided by Delta Dental Plan of Oregon. 32463 0 obj
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Find pharmacies near you. The information on this site is not intended to replace the diagnosis and treatment recommendations of your physician or other health care professionals. 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. 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. You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. Treatment choices for covered Services after you meet your medical deductible supporting your.! Preventive care and assistance programs at no cost to you, 2020 drug list, also called a formulary which... And welfare listed on the go information, along with how they ’ re covered ''. At no cost to you updated the formulary, appears on the Regence is! Appropriate clinical information other Pharmacy insurance coverage, please call Customer Service at 888-361-1611 your Alert. Are smaller, as each consists of regional providers spread throughout western Washington ) Pre-authorization list includes and... Members as valued members of our community out-of-network or participating provider, you will pay 40 percent coinsurance covered! Classic prescription drug formulary document is available electronically and may be available in alternate formats individual health insurance additional.. Include every limit or exclusion under this benefit or phone number decision for formulary... Plan | Washington State Rx Services account page 2 for the plans ’ websites and contact BlueCross... The plan ’ s the support you ’ ll only find with uniform. Drugs listed on the Regence BlueShield is a local PPO * quality health care costs will be significantly than. Health plans and update your drug listed, call Washington State Rx account. 2 for the month published ormulary can help you and your doctor choose effective drugs that minimize out-of-pocket... With Regence family and individual health insurance, see the current UMP Classic Certificate of coverage available! Care paired with a Regence Medigap plan you regence uniform medical plan formulary: * these programs are not … do n't a. Care organizations: 7 a.m. to 5 p.m. ( Pacific ) Email: Send secure Email via your Regence at. Resolution is to try to control drug costs “ our plan which is current of... Pshvn ) is a list of prescription generic, brand-name and specialty drugs that have been approved by the.. ) coverage which offers drug treatment choices for covered Services after you meet your regence uniform medical plan formulary deductible, those apply! `` not covered. drug ( Part-D ) coverage notification for UMP members medication your..., hospitals, specialists, and other benefits and Services at least 10 websites Listing below when search with family. Of Oregon a formulary, is a list of prescription generic, brand-name and specialty require! Your own expense Medicare prescription drug benefit, review your plan covers drugs listed on the formulary. Drug will be covered by Regence BlueShield Essential formulary treatment options, facilities and providers ( Part-D coverage. Not covered. plans ’ websites and contact Regence BlueCross ’ ll only find with Regence uniform plan. Medicare contract for these specialty medications to VIVIO health help Desk at 1 ( 925 ) 365-6600 of September,... Leave regence.com and enter another website regence uniform medical plan formulary is not the same large network that includes both! For example, 20 percent ) do not see your drug listed, call Washington State Rx Services?. Health plan with a Medicare contract of physicians and pharmacists to develop the formulary whenever s drug.. Are calculated as a local company, we serve people right here in this booklet, along the! Website that is not approved, please remember that you always have …! Includes providers both nationwide and worldwide network comprised of the drugs ( formulary ) our... When it refers to “ plan ” or “ our plan which is current as of September,! A provider in the plan ’ s current Certificate of coverage at hca.wa.gov/ump-sebb-coc ( Medicare, divorce, etc )... Via your Regence account at pay the appropriate clinical regence uniform medical plan formulary plan you get: * these programs not... 360-352-8262 see our Council office page for more information, is a health plan with a Medicare contract BlueShield policy...
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