Summary of Benefits and Coverage: Uniform Medical Plan Achieve 1
This file provides a comprehensive overview of the benefits and coverage details for the Uniform Medical Plan (UMP) Achieve 1. It includes information about deductibles, out-of-pocket limits, network providers, and specific coverage for prescription drugs and medical services. Essential for those considering or enrolled in the Washington State UMP Achieve 1 plan.
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How do I fill this out?
To fill out this file, start by reviewing the summary of benefits and coverage details provided. Ensure you understand the terms, such as deductibles, copayments, and out-of-pocket limits, as well as the services covered. Follow the instructions listed within each section and use the provided contact information for further assistance if needed.
How to fill out the Summary of Benefits and Coverage: Uniform Medical Plan Achieve 1?
1
Review the benefits and coverage details listed in the document.
2
Understand key terms like deductibles, copayments, and out-of-pocket limits.
3
Identify the services covered and their respective costs.
4
Follow the instructions provided within each section.
5
Use the contact information provided for any further assistance.
Who needs the Summary of Benefits and Coverage: Uniform Medical Plan Achieve 1?
1
Individuals considering enrolling in the Washington State UMP Achieve 1 plan to understand their benefits and coverage.
2
Current members of the UMP Achieve 1 plan for reference about their coverage details.
3
Healthcare providers seeking information on what is covered under the UMP Achieve 1 plan.
4
Pharmacies checking for prescription drug coverage details.
5
Insurance agents assisting clients with their health plan options.
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What are the instructions for submitting this form?
Submit the completed form through the provided online submission form at ump.regence.com/sebb. Alternatively, you can email it to the specified email address or send it via fax to the number provided. For physical submissions, mail the completed form to the address listed in the document. Ensure all details are accurately filled to avoid any delays.
What are the important dates for this form in 2024 and 2025?
Coverage Period: 01/01/2024 - 12/31/2024. Ensure timely enrollment and submission to make the most of your benefits.
What is the purpose of this form?
The purpose of this form is to provide detailed information on the benefits and coverage offered by the Uniform Medical Plan (UMP) Achieve 1. It includes essential details about deductibles, out-of-pocket limits, network providers, and coverage for specific medical services and prescription drugs. This information is crucial for members and potential enrollees to understand their healthcare options and make informed decisions.
Tell me about this form and its components and fields line-by-line.
- 1. Overall Deductible: Specifies the deductible amounts for individual and family per calendar year.
- 2. Out-of-Pocket Limit: Details the maximum amount you could pay in a year for covered services.
- 3. Network Providers: Information on the use of network providers and their benefits.
- 4. Prescription Drugs: Coverage details for various tiers of prescription drugs, including copayments and coinsurance.
- 5. Medical Services: Details on coverage and costs for common medical events, including primary care visits, specialist visits, and preventive care.
What happens if I fail to submit this form?
Failing to submit this form could result in paying more out-of-pocket costs for medical services and prescription drugs.
- Higher Costs: You may have to pay full costs for services until the deductible is met.
- Coverage Issues: Lack of documentation can lead to coverage delays or denials for services.
How do I know when to use this form?
- 1. New Enrollment: Helps potential members understand coverage before enrolling.
- 2. Annual Review: Useful for existing members to review their benefits for the coverage period.
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