Frequently Asked Questions

An accountable care network is a group of healthcare organizations and providers that join together to offer affordable, high-quality healthcare and a coordinated care team. Our primary care providers focus on wellness and disease prevention, and if you need specialty care, your providers closely communicate and coordinate your care to achieve the best possible outcomes. The Public Employee Benefits Board (PEBB) offers UMP Plus, a plan that contains two accountable care networks. The UW Medicine Accountable Care Network (ACN) is one of the UMP Plus networks.

UMP Plus focuses on making healthcare more affordable and on keeping members healthy with preventive medicine and better coordinated care so they don’t develop more serious or chronic conditions. The state’s choice to offer these options aligns with the PEBB Program’s commitment to providing high-quality medical benefits for PEBB members.

The UMP Plus – UW Medicine ACN is currently available to PEBB benefits-eligible members who live in Benton, Franklin, King, Pierce, Skagit, Snohomish, Thurston, or Spokane counties, including:

• Employees and their enrolled dependents.
• PEBB Continuation Coverage (Unpaid leave) members and their enrolled dependents.
• Retirees and their enrolled dependents not enrolled in Medicare Part A or Part B.
• PEBB Continuation Coverage (COBRA) members and their enrolled dependents not enrolled in Medicare Part A or Part B.

The UMP Plus – UW Medicine ACN is the most comprehensive healthcare network in the Puget Sound region. It includes many of the area’s finest healthcare organizations. All share a commitment to high-quality, affordable care as well as excellent patient service and access to care. Click here to find a provider. 

The UW Medicine ACN brings together the skills, services, and geographic reach of exceptional healthcare organizations. Our network supports close coordination of care and shared decision-making between you and your care team about preventive health and treatment of any chronic or acute health conditions. We offer a complete range of services, from preventive and primary care to advanced specialty care, all available within a single network.

By selecting UMP Plus — UW Medicine ACN, you will have access to:

More than 1,200+ primary care providers

• More than 11,000+ specialists
• More than 1,600+ clinics,
• 20 hospitals, including the number 1 ranked hospital in Washington State by U.S. News & World Report
• More than 60+ urgent care clinics
• 19 emergency departments

Additional benefits include:

• A single access point for all appointments and information
• Emphasis on primary and preventive care to keep you healthy
• An industry-leading outpatient program to manage care for chronically ill patients
• 24/7 access to a registered nurse care line
• A virtual care clinic that provides 24/7 care by board-certified doctors and nurse practitioners for minor medical problems
• Online access to your electronic health records so you can have view test results as they become available

 
And if you need specialty services in the Puget Sound region, our teams provide the following:

• The only Level 1 adult and pediatric trauma and burn center in the region, and 11 other trauma centers
• Level 1 stroke centers
• Level 1 cardiac care centers
• An extensive network of pediatric services and western Washington’s only two dedicated children’s hospitals
• An extensive network of maternity services and four neonatal intensive care units
• The region’s only proton therapy center
• The only UMP Plus network that provides all organ and bone marrow transplants for the region
• Solid organ transplantation (liver, kidney, lung, heart, pancreas, intestinal)
• The region’s leading cancer care and research organization
• Close coordination of care and shared decision making between you and your care team about preventive health and treatment of any chronic or acute health conditions.

Please check with your employer’s personnel, payroll, or benefits office for more specific information on monthly premiums and any other costs associated with UMP Plus – UW Medicine ACN.

State and higher employees can find plan premium information here. Employees who work for an educational service district, city, county, port, tribal government, water district, hospital, etc., need to contact their payroll or benefits office to get their monthly premiums.

 

Patients who are currently seen at one of the UMP Plus – UW Medicine ACN hospitals or clinics will continue to receive the same high-quality care they receive today, regardless of their chosen benefits plan.
If you choose UMP Plus – UW Medicine ACN, you will have access to the following services and benefits:

• The most comprehensive healthcare network in the Puget Sound region
• High-quality care that is more affordable
• Primary care office visits are covered at 100% (even for non-preventive visits)*
• A single, centralized contact center for all services – one call does it all
• Fast scheduling for appointments
• A coordinated care team – including easy referrals to specialists
• A 24-hour nurse care line for immediate, professional advice on health questions

* some services, such as labs, might have a cost share.

UMP Plus – UW Medicine ACN offers access to a broad network of experienced pediatric providers and clinics, along with some of the best pediatric hospitals in the nation, including both Seattle Children’s Hospital and Mary Bridge Children’s Hospital.

UMP Plus – UW Medicine ACN provides the most advanced cancer care available, with comprehensive services that include expert diagnosis, surgical services, medical and radiation oncology, education and support. Several internationally renowned cancer care providers are members of the network, including the Seattle Cancer Care Alliance (SCCA), a world-class cancer treatment organization that is a partnership between UW Medicine, Fred Hutchinson Cancer Research Center and Seattle Children’s Hospital. SCCA patients have access to the latest cancer treatments including stem cell and bone marrow transplantation, gene therapy, high-dose chemotherapy, radiation therapy, immunotherapy, proton therapy, minimally invasive surgical techniques and other specialized therapies.

Choosing a primary care provider is always recommended, but it is not required under UMP Plus – UW Medicine ACN. Primary care providers are familiar with your health history and are the “first responders” to your healthcare needs. They are important in coordinating your care with other providers for consultations, procedures and services. When you sign up for UMP Plus – UW Medicine ACN, you will have many options for selecting a primary care provider who meets your health needs and is convenient to where you live or work.

No, you do not need a referral to see a specialist. However, in order to receive in-network benefits, the specialist must be in the UMP Plus – UW Medicine ACN network. We recommend working with your primary care provider to help coordinate care with network specialists.

Yes. You and your family members may use different facilities and providers within UMP Plus – UW Medicine ACN for your care. The UW Medicine ACN offers complete care, from primary to specialty, and from prevention to highly complex treatments. It also covers a wide geographic area that includes seven western Washington counties and is convenient and easily accessible from your home or office. No matter where you and your family members choose to get care within the network, we recommend working with a primary care provider to receive the most benefit from the coordinated care the network offers.

You may search a database of network providers, clinics and hospitals by visiting our providers page. You may also search a database of primary, specialty and support providers by visiting regence.com/ump/pebb/finding-doctors. Or simply call the dedicated UW Medicine ACN Contact Center at 888.402.4237 (TRS: 711). 

We encourage patients to stay within the network to minimize their out of-pocket expenses. Although there may be some exceptions, if you receive non-emergency services from providers outside the network, you can expect to have higher co-insurance (your share of the cost for covered services) payments.

If you plan to see a new provider or if your primary care provider refers you to a specialist, it’s a good idea to make sure those providers are in the network before you proceed with your appointment. If the service you need is not available in the network and if your in-network provider believes it is in your best interest to see an out-of-network provider, he or she can request a network waiver before out-of-network services are performed.
 
If this is the case, please be sure to follow these steps to avoid having to pay out-of-network costs:
Out-of-network care: The scenarios in which a UW Medicine ACN provider may initiate an out-of-network waiver are as follows:

• Provider has confirmed that the care you need is not available within the network
• You are already receiving an active course of treatment from an out-of-network specialist, and disruption of care could jeopardize your health
• The care you need is not available within 50 miles of your home or workplace

Referrals to out-of-network care:  Waivers for out-of-network care are rare. If one of the above situations applies to you, and your provider agrees it is in your best interest to receive out-of-network services, your provider may start the out-of-network referral process by submitting a waiver form. Your provider will update you about whether or not the request has been approved.

Waivers can only be submitted before you get care. Waivers for out-of-network care you have already received are not permitted. Your provider must submit the waiver form and receive approval before you can get care outside the network. If you receive out-of-network care without an approved waiver, you may be responsible for the charges for that care.

Submitting or having an approved waiver request does not guarantee your services will be covered. We will make every effort to process waiver requests for urgent or emergency referrals to out-of-network providers within 24 hours and non-emergency referrals within five business days. In some instances, more time may be required to process your request. If your request does not meet the eligible criteria, it will be denied. Your health plan will make all coverage decisions according to its normal policies and procedures. The type of care you receive must be covered under your plan, and you and the out-of-network provider must meet all your health plan’s requirements for coverage.
 
As a reminder, there are two UMP Plus plan options. To make sure your provider is in the UMP Plus – UW Medicine ACN network, visit our providers page or https://www.hca.wa.gov/employee-retiree-benefits/public-employees/uniform-medical-plan-ump-plans, or call the UW Medicine ACN Contact Center at 888.402.4237 (TRS: 711).

Support care refers to the wide range of healthcare services provided to support the work of primary and specialty providers. You do not need a referral to see a support provider. However, in order to receive in-network benefits, the support provider must be in the UMP Plus – UW Medicine ACN network or in the support network with Regence BlueShield.

Following are examples of support providers:

• Chiropractors
• Laboratories (lab testing)
• Physical therapists
• Registered dieticians
• Anesthesiologists
• Dialysis

You may search for providers, including support providers by visiting Find a Doctor and searching by the specialty or name of the provider you want to see.

You will receive in-network benefits for providers in the UMP Plus – UW Medicine ACN network, as well as certain providers contracted with Regence BlueShield.

If your current provider is already in UMP Plus – UW Medicine ACN, you do not have to do anything. If your provider is not in the network, your records will not be transferred automatically. We recommend contacting your current provider, who will ask you to fill out a “release of information” form. On this form, you can indicate where you would like your records transferred.

Patient privacy is critically important to each healthcare organization in UMP Plus – UW Medicine ACN. Your medical records are available only to those healthcare providers within our network who are directly involved in your care, and those records are protected by stringent privacy regulations.

PEBB benefits-eligible employees who live in a county covered by UMP Plus – UW Medicine ACN can enroll during the annual open enrollment period for coverage starting January 1 of each plan year. Here are some resources for employees to enroll or change their medical plan:

• During the annual open enrollment, you can log into PEBB My Account  or complete the required forms and return them to your payroll or benefits office.
• Newly-eligible for benefits see here for more information.
• Have a life event during a plan year that may qualify for a special open enrollment period? Go here.

Coverage under plans chosen during the annual open enrollment period (November 1 – 30) begins January 1 of the following year. So, if you enroll during November 1-30, 2023, your coverage will begin January 1, 2024.
For other coverage start dates:

• Employees should check with their payroll or benefits office;
• Retirees, PEBB or SEBB employees about to retire, and PEBB Continuation Coverage can call ERB Customer Service at
• 1-800-200-1004 (toll-free)
• 711 through Washington Relay.

Phone line hours: Monday through Friday, 8 a.m. to 4:30 p.m.

As a reminder, any appointments prior to the date your UMP Plus — UW Medicine ACN coverage begins will not be covered under UMP Plus – UW Medicine ACN unless you are already a member of that plan.

You can make appointments, find out if a provider is in the network, find clinic locations, get answers to billing questions and access other healthcare resources through a dedicated phone number and a single, centralized UW Medicine ACN Contact Center at 888.402.4237 (TRS: 711).

Hours of operation:

• Monday - Friday | 5:00am - 8:00pm Pacific time
• Saturday - Sunday | 6:00am - 2:00pm Pacific time

• Besides the information on this website, you can also call the dedicated UW Medicine ACN Contact Center at 888.402.4237 (TRS: 711).

• To find out more about all UMP Plus plans, visit this site.

• For information about prescription drug coverage under UMP Plus visit this site.

• For information on who to contact for specific questions about plan details and coverage, visit this site.

• For specific questions about plan details and coverage, including the following, please contact your employer’s, personnel, payroll or benefits office.