The UW Medicine Accountable Care Network provides eligible Washington state employees with access to high-quality, excellent service and affordable healthcare. The following Q&A will help you understand the details and benefits of your new healthcare option for coverage starting January 1, 2020.
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 King, Kitsap, Pierce, Skagit, Snohomish, Thurston, or Spokane counties, including:
- Employees and their covered dependents.*
- PEBB Continuation Coverage (Unpaid leave) members and their dependents.
- Retirees and their covered dependents not enrolled in Medicare Part A or Part B.
- PEBB Continuation Coverage (COBRA) members and their covered dependents not enrolled in Medicare Part A or Part B.
* Employees and their covered spouse or state-registered domestic partner who are enrolled in Medicare Part A and Part B are eligible for UMP Plus, even if the spouse or state-registered domestic partner is enrolled in Medicare.
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. The network currently includes the following organizations:
- Capital Medical Center
- Capital Physician Services
- Children’s University Medical Group
- MultiCare ConnectedCare
- MultiCare Allenmore Hospital
- MultiCare Auburn Medical Center
- MultiCare Deaconess Hospital
- MultiCare Deaconess North Emergency Center
- MultiCare Good Samaritan Hospital
- MultiCare Mary Bridge Children’s Hospital and Clinics
- MultiCare Tacoma General Hospital
- MultiCare Valley Hospital
- MultiCare Clinics
- Seattle Cancer Care Alliance
- Seattle Children’s Hospital
- Skagit Regional Health
- Skagit Valley Hospital
- Skagit Regional Clinics
- Cascade Valley Hospital and Clinics
- UW Medicine
- Harborview Medical Center and Clinics
- Northwest Hospital & Medical Center and Clinics
- UW Medical Center and Clinics
- UW Neighborhood Clinics
- UW Physicians
- Valley Medical Center and Clinics
- Airlift Northwest
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 1,000+ primary care providers
- More than 5,000+ specialists
- More than 1,300+ clinics,
- 18 hospitals, including the number 1 ranked hospital in Washington State by U.S. News & World Report
- More than 60+ urgent care clinics
- 17 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 free 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
- Two Level 1 stroke centers
- Seven 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.
- Premium — $69 monthly employee contribution for most groups (see note below)**
- Annual deductible — $125 individual/$375 family (reduced by $125 if subscriber qualifies for SmartHealth wellness incentive)
- Free office visits to network primary care providers
- No annual deductible for prescription drugs
- Virtual care clinic and 24-hour nurse care line at no cost
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.
**Premium applies to state agency and higher education employees. Non-Medicare retirees and COBRA members may have different premiums. Visit hca.wa.gov/ump and select “Your cost for care” under the UMP Plus plan for more information.K-12 and employer groups should check with their personnel, payroll or benefits office for premium information.
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
- A single, centralized contact center for all services – one call does it all
- Fast scheduling for appointments
- Access to the UW Medicine ACN Virtual Clinic at no cost
- A coordinated care team – including easy referrals to specialists
- A 24-hour nurse care line for immediate, professional advice on health questions
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.
The UW Medicine ACN Virtual Clinic provides patients with healthcare from the comfort of home, office or other location. It is offered to enrollees in UMP Plus – UW Medicine ACN at no cost.
The clinic is available 24 hours a day, seven days a week. During a virtual clinic visit, a board-certified family practice doctor or nurse practitioner provides assessment and treatment for urgent care issues over the phone or through a webcam on your smartphone, tablet or computer. Visits typically last about 20 minutes.
The virtual clinic provider can recommend home care options, suggest over-the-counter treatments, write a prescription, direct you to an urgent care facility or the ER if necessary, and help you find a convenient pharmacy.
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.
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 ancillary providers by visiting regence.com/ump/sebb/finding-doctors. Or simply call the dedicated UW Medicine ACN Contact Center at +1.855.520.9500 (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.
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 +1.855.520.9500 (TRS: 711)
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.
Ancillary 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 an ancillary provider. However, in order to receive in-network benefits, the ancillary provider must be in the UMP Plus – UW Medicine ACN network or contracted with Regence BlueShield.
Following are examples of ancillary providers:
- Laboratories (lab testing)
- Physical therapists
- Registered dieticians
You may search for providers, including ancillary providers by visiting Find a Doctor and searching by the specialty or name of the provider you wnat to see.
You will receive in-network benefits for providers in the UMP Plus – UW Medicine ACN network, as well as providers contracted with Regence Blue Shield.
As a member of the UW Medicine Accountable Care Network (ACN), you have access to comprehensive care services throughout the region. Patients who receive all their care from UW Medicine ACN providers benefit from better coordination of care at a more affordable cost. However, if you or your provider feels you need care outside the network, 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
- You are already receiving an active course of treatment from an out-of-network specialist, and disruption of care could jeopardize your
- The care you need is not available within 50 miles of your home or
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.
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.
New employees who live in a county covered by UMP Plus – UW Medicine ACN can enroll when they become eligible for benefits. All other PEBB benefits-eligible employees who live in counties covered by UMP Plus – UW Medicine ACN can enroll during the annual open enrollment period of November 1-30, 2017 for coverage starting January 1, 2018. Eligible members may also enroll outside of the annual open enrollment period when a special open enrollment event occurs, such as marriage or the birth of a child.
To find out more about when you can change your coverage, visit www.hca.wa.gov/pebb and select “Change your coverage” under your member type (employee, retiree, or COBRA/continuation coverage).
To enroll in UMP Plus – UW Medicine visit hca.wa.gov/pebb and log in to My Account or submit a enrollment change form within the required time frame.
Note: University of Washington employees must use Workday instead of My Account or forms to make changes.
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, 2018, your coverage will begin January 1, 2019.
For other coverage start dates, employees and retirees can visit www.hca.wa.gov/pebb, select “Eligibility and enrollment” under their member type, and then select “How to enroll.” COBRA and continuation coverage members can get more information about coverage start dates by reading the Continuation Coverage Election Notice booklet found at www.hca.wa.gov/pebb under “Forms and publications.”
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 option.
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 855.520.9500 (TRS: 711).
Assistance is available six days a week:
7:00 a.m. to 7:00 p.m., Monday through Saturday
- Besides the information on this website, you can also call the dedicated UW Medicine ACN Contact Center at 1.855.520.9500 (TRS: 711).
- To find out more about all UMP Plus plans, visit www.hca.wa.gov/ump/plan-ump-plus.
- For information about prescription drug coverage under UMP Plus visit www.hca.wa.gov/ump-drugs-plus.
- For information on who to contact for specific questions about plan details and coverage, visit ww.hca.wa.gov/public-employee-benefits/contact-pebb-program.
- For specific questions about plan details and coverage, including the following, please contact your employer’s, personnel, payroll or benefits office.
If you are a provider interested in joining the network, please visit uwmedicine.org/aco/for-providers and fill out the web form to submit your inquiry.