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Uniform Medical Plan

Contact Information

Employees

Local Phone: 425-670-3000
Toll-Free Phone: 1-800-762-6004
TTY/TDD Phone: 1-888-923-5622
Find a Provider
Visit the Plan's Website

Retirees

Local Phone: 425-686-1350
Toll-Free Phone: 1-800-352-3968
TTY/TDD Phone: 1-888-923-5622 or 360-923-2701
Find a Provider
Visit the Plan's Website

Benefit Summary

Medical Benefit 2008 Coverage 2009 Coverage

Lifetime maximum

None

None

Annual deductible

Medical services: Enrollee pays $200 per person/$600 per family (three or more people)

Annual deductible does not apply to some benefits

Brand-name prescription drug deductible: Applies to Tier 2 and Tier 3 drugs only; enrollee pays $100 per person/$300 per family (three or more people)

Medical Services:

Enrollee pays $200 per person/$600 per family (three or more people)

Annual deductible does not apply to some benefits, including preventive care.

Brand-name prescription drug deductible:

Applies to Tier 2 and Tier 3 drugs only; enrollee pays $100 per person/$300 per family (three or more people)

Annual out-of-pocket maximum

Enrollee pays $1,500 per person/$3,000 per family

(Expenses as defined in the Certficate of Coverage do not count toward the out-of-pocket maximum.)

Enrollee pays $1,500 per person/$3,000 per family

Office and clinic visits

Enrollee pays 10% coinsurance

Enrollee pays 10% coinsurance

Ambulance services (air)

Enrollee pays 20% coinsurance

Enrollee pays 20% coinsurance

Ambulance services (ground)

Enrollee pays 20% coinsurance

Enrollee pays 20% coinsurance

Chemical dependency services (inpatient)

Facility: Enrollee pays inpatient hospital copay

Professional services: Enrollee pays 10% coinsurance

Maximum payment for all plans is $14,500 per 24 consecutive calendar month period for any combination of inpatient/outpatient treatment

  • Facility
    Enrollee Pays inpatient hospital copay
  • Professional Services
    Enrollee pays 10% coinsurance

Chemical dependency services (outpatient)

Enrollee pays 10% coinsurance

Enrollee pays 10% coinsurance

Diabetic education
Additional education programs available; costs vary

Enrollee pays 10% coinsurance; up to 10 hours per calendar year (see Certificate of Coverage for details).

Enrollee pays 10% coinsurance; up to 10 hours per calendar year (see Certificate of Coverage for details)

Diagnostic tests, laboratory, and X-rays

Enrollee pays 10% coinsurance

Enrollee pays 10% coinsurance

Durable medical equipment, supplies, and prostheses

Enrollee pays 10% coinsurance;; preauthorization required for equipment rentals beyond three months and rentals or purchases of more than $1,000

Enrollee pays 10% coinsurance

Emergency room (copay waived if admitted directly to hospital)

$75 copay per visit, then enrollee pays 10% coinsurance for physician and other professional provider fees

$75 copay per visit, then enrollee pays 10% coinsurance for physician and other professional provider fees

Hearing (examination)

Hearing exam covered in full under preventive care benefit; one exam per calendar year

Covered in full under preventive care benefit; one exam per calendar year

Hearing (hardware)

Maximum plan payment of $400 every three calendar years for hearing aid and rental/repair combined

$800 maxiumum plan payment every three calendar years for hearing aid, and rental/repair combined

Home health care

Enrollee pays 10% coinsurance

Enrollee pays 10% coinsurance

Hospice care (including respite care)

If preapproved by plan, covered in full

$5,000 lifetime maximum plan payment for respite care

Covered in full; $5,000 lifetime maximum plan payment for respite care

Hospital services (inpatient)

$200 copay per day (maximum $600 per person per calendar year), plus 10% coinsurance for professional services

$200 copay per day (maximum $600 per person per calendar year), plus 10% coinsurance for professional services

Hospital services (outpatient)

Enrollee pays 10% coinsurance

Enrollee pays 10% coinsurance

Massage therapy

Enrollee pays 10% coinsurance, up to 16 visits per calendar year

Enrollee pays 10% coinsurance, up to 16 visits per calendar year

Mental health care (inpatient)

Facility: Enrollee pays inpatient hospital copay; preauthorization required

Professional services: Enrollee pays 10% coinsurance per visit, up to 50 visits per year

  • Facility
    Enrollee pays inpatient hospital copay
  • Professional Services
    Enrollee pays 10% coinsurance

Mental health care (outpatient)

Enrollee pays 10% coinsurance per visit, up to 50 visits per year

Enrollee pays 10% coinsurance per visit, up to 50 visits per year

Physical, occupational, speech, and massage therapies (inpatient)

Does not include massage therapy (see massage therapy benefit)

Includes neurodevelopmental therapy

Enrollee pays inpatient hospital copay; preauthorization required

Does not include massage therapy (see massage therapy benefit)

Includes neurodevelopmental therapy

Enrollee pays inpatient hospital copay

Physical, occupational, speech, and massage therapies (outpatient)

Does not include massage therapy (see massage therapy benefit)

Includes neurodevelopmental therapy

Enrollee pays 10%, coinsurance per visit, up to 60 visits per calendar year

Does not include massage therapy (see massage therapy benefit)

Includes neurodevelopmental therapy

Enrollee pays 10% coinsurance per visit, up to 60 visits per calendar year

Prescription drugs, insulin, and disposable diabetic supplies

Up to a 90-day supply (annual prescription-drug deductible applies only to Tier 2 and Tier 3 drugs)

Retail:

  • Tier 1 (generic and preferred specialty drugs): 10% enrollee coinsurance
  • Tier 2 (preferred brand): 30% enrollee coinsurance
  • Tier 3* (nonpreferred brand): 50% enrollee coinsurance
  • Note: Tier 1 and 2 drugs purchased through a network retail pharmacy have a maximum enrollee cost share of $75 (per 30-day supply)

Mail order:

  • Tier 1: $10 copay
  • Tier 2: $50 copay
  • Tier 3*: $100 copay

*Multi-source Tier 3 drugs are subject to an ancillary charge—the enrollee pays the Tier 1 copay, plus the difference between the Tier 3 drug and the generic equivalent

Up to a 90-day supply for both retail and mail order (annual prescription-drug deductible applies only to Tier 2 and Tier 3 drugs)

Retail

Tier 1, (generic): 10% coinsurance
Tier 2, (preferred brand): 30% coinsurance
Tier 3*, (nonpreferred brand): 50% coinsurance

Note: Tier 1 and 2 drugs purchased through a network retail pharmacy have a prescription cost-limit of $75 per 30-day supply.

Mail order

Tier 1, $10 copay
Tier 2, $50 copay
Tier 3*, $100 copay

*Enrollees pay more for Tier 3 drugs that have a generic equivalent. The plan pays as if the enrollee purchased the generic; the enrollee pays the rest.

Preventive care

Covered in full, subject to preventive care schedule (not subject to annual medical deductible)

Only services listed in the Certificate of Coverage are covered as preventive care.

Covered in full (not subject to annual medical deductible)

Radiation and chemotherapy services

Enrollee pays 10% coinsurance

Enrollee pays 10% coinsurance

Skilled nursing facility care (150 days per benefit period)

Enrollee pays inpatient hospital copay; covered up to 150 days per calendar year

Medicare retirees: The first 100 days covered by Medicare count toward your 150-day limit under UMP.

Enrollee pays inpatient hospital copay

Spinal manipulations

Enrollee pays 10% coinsurance, up to 10 visits per year

Enrollee pays 10% coinsurance, up to 10 visits per year

Vision (examinations)

Enrollee pays 10%; coinsurance; one annual eye exam (not subject to annual medical deductible)

Enrollee pays 10% coinsurance; one annual eye exam (not subject to annual medical deductible)

Vision (hardware)

$150 maximum plan payment every two calendar years for frames, lenses, contacts, and fitting fees combined (not subject to annual medical deductible)

$150 maximum plan payment every two calendar years for frames, lenses, contacts, and fitting fees combined (not subject to annual medical deductible)