Contact Information
Uniform Medical Plan (administered by Regence BlueShield)
Toll-Free: 1-888-849-3681
TTY: 711
Find a Provider | Visit the Plan's Website
Benefits Booklet (Certificate of Coverage)
If you have questions about the certificate of coverage, or to receive a copy, contact the plan.
Benefits Summary
| Annual Costs | 2013 Coverage |
|---|---|
| Member Pays | |
Deductible |
$1,400/individual |
Out-of-pocket maximum |
$4,200 individual/$8,400 family (must meet family out-of-pocket maximum before plan pays 100%) |
Prescription drug deductible |
Included in deductible |
| Medical Benefits | 2013 Coverage |
|---|---|
| Member Pays | |
Ambulance |
|
Per trip, air |
20% |
Per trip, ground |
20% |
Diagnostic tests, laboratory, and x-rays |
15% |
Durable medical equipment, supplies, and prostheses |
15% |
Emergency room (Copay waived if admitted) |
15% |
Hearing |
|
Hardware |
Any amount over $800 every 36 months after deductible has been met for hearing aid and rental/repair combined. |
Routine annual exam |
15% |
Hospital services |
|
Inpatient |
15% |
Outpatient |
15% |
Office visit |
|
Chemotherapy |
15% |
Mental health |
15% |
Primary care |
15% |
Radiation |
15% |
Specialist |
15% |
Urgent care |
15% |
Physical, occupational, and speech therapy (Per-visit cost for 60 visits/year combined) |
15% |
Prescription drugs |
|
Mail order (up to a 90-day supply) Value tier |
15% |
Mail order (up to a 90-day supply) Tier 1 |
15% |
Mail order (up to a 90-day supply) Tier 2 |
15% |
Mail order (up to a 90-day supply) Tier 3 |
15%* |
Retail pharmacy (up to a 30-day supply) Value tier |
15% |
Retail pharmacy (up to a 30-day supply) Tier 1 |
15% |
Retail pharmacy (up to a 30-day supply) Tier 2 |
15% |
Retail pharmacy (up to a 30-day supply) Tier 3 |
15%* |
Preventive care |
$0; See certificate of coverage or check with plan for full list of services. |
Spinal manipulations |
15% |
Vision care |
|
Exam (annual) |
$0 |
Glasses and contact lenses |
Any amount over $150 every 24 months (or two calendar years for UMP) for frames, lenses, contacts, and fitting fees combined. |

