Uniform Medical Vision Claim Form

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Uniform Medical Plan (UMP) - Washington

https://www.hca.wa.gov/about-hca/programs-and-initiatives/uniform-medical-plan-ump

Uniform Medical Plan (UMP) is a self-insured health plan offered through the Washington State Health Care Authority’s (HCA) Public Employees Benefits Board (PEBB) Program …

Your new UMP vision benefits - hca.wa.gov

https://www.hca.wa.gov/assets/pebb/ump-vision-service-plan-2021.pdf

To submit a claim by mail, contact VSP Member Services at 1 (800) 877-7195 to request a VSP Member Reimbursement Form. The form can be sent to a preferred address or …

Your UMP vision benefits - Washington

https://www.hca.wa.gov/assets/pebb/ump-vision-service-plan-2022.pdf

To submit a claim by mail, download the VSP Member Reimbursement Form by visiting forms and publications at hca.wa.gov/ump-forms-pubs or contact VSP Member …

Claims - PEBB - Regence

https://ump.regence.com/pebb/benefits/claims-appeals

Submit a claim by mail or fax Mail or fax both the claim form and the provider's claim document (or bill) to: Regence BlueShield Attn: UMP Claims P.O. Box 1106 Lewiston, ID …

MEDICAL CLAIM FORM - Washington

https://www.hca.wa.gov/assets/pebb/ump-regence-medical-claim-form.pdf

MEDICAL CLAIM FORM Use this form to submit reimbursement requests for services received from a non-network provider. Please complete a separate form for each family …

Uniform Medical Plan - Regence

https://www.regence.com/provider/products/large-groups-administrators/ump

Uniform Medical Plan (UMP) is a health plan offered through the Washington State Health Care Authority’s (HCA) Public Employees Benefits Board (PEBB) and the School …

1800 Ninth Avenue

https://www.hca.wa.gov/assets/pebb/form-ump-vision-claims.pdf

VISION CLAIM FORM Use this form to submit reimbursement requests for services from a non-network provider or for the purchase of prescription contact lenses or eyeglasses. …

Commonly used forms - PEBB

https://ump.regence.com/pebb/forms/common-forms

Vision form VSP Request for Reimbursement form: for services from an out-of-network provider or for the purchase of prescription contact lenses and eyeglasses. If you have …

Uniform Medical Plan

https://ump.regence.com/member/ump/

Uniform Medical Plan Welcome to UMP Please choose whether you are a member of the Public Employees Benefits Board (PEBB) Program or the School Employees Benefits Board (SEBB) Program. Please choose …

Forms and documents for members - Regence

https://www.regence.com/member/resources/forms-documents

Forms and documents for members Sign in × Find a doctor Contact us Loading... Forms and Documents for Individuals and Families Access all the forms and documents you …

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