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.

1) What is an Accountable Care Network?

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.

2) Why is the state of Washington offering the UMP Plus option?

UMP Plus focus 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.

3) Who is eligible for the UMP Plus -- UW Medicine Accountable Care Network?

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

  • Employees and their covered dependents**
  • Continuation coverage (formerly Leave Without Pay) members and their dependents
  • Retirees not enrolled in Medical Part A and Part B, and their covered dependents
  • COBRA members not enrolled in Medicare Part A and Part B, and their covered dependents

**Employees and their covered spouses who are enrolled in Medicare Part A and Part B are eligible for UMP Plus, even if the spouse is enrolled in Medicare. Due to federal Medicare regulations, employees’ state- registered domestic partners who are enrolled in Medicare are not eligible for UMP Plus

4) What organizations are included in the UMP Plus -- UW Medicine ACN?

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
  • Island Hospital and Clinics
  • MultiCare ConnectedCare
    • MultiCare Allenmore Hospital
    • MultiCare Auburn Medical Center
    • MultiCare Good Samaritan Hospital
    • MultiCare Mary Bridge Children’s Hospital and Clinics
    • MultiCare Tacoma General Hospital
    • MultiCare Clinics
  • Overlake Hospital Medical Center
    • Overlake Medical Clinics
    • Snoqualmie Valley Hospital
  • 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

5) What does it mean that UMP Plus -- UW Medicine aACN is “the most comprehensive healthcare network in the Puget Sound region?”

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 to 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.

6) How much does UMP Plus cost?

  • Premium — $50 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.

7) How is UMP Plus -- UW Medicine ACN different from the care I’m already receiving at one of the network organizations?

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

8) What pediatric care is offered through UMP Plus – UW Medicine ACN?

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.

9) What type of cancer care is offered through UMP Plus – UW Medicine ACN?

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.

10) What is the UW Medicine ACN Virtual Clinic?

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.

11) If I choose UMP Plus -- UW Medicine ACN, do I have to choose a primary care provider?

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.

12) In UMP Plus - UW Medicine ACN, do I need a referral to see a specialist?

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.

13) How do I know if my provider is in UMP Plus – UW Medicine ACN?

You may search a database of network providers, clinics and hospitals by visiting uwmedicine.org/umpplus. You may also search a database of primary, specialty and ancillary providers at regence.com by clicking on “additional providers” beneath the provider search window. Or simply call the dedicated UW Medicine ACN Contact Center at 1-855.520.9500 (TRS: 711).

Note: The Regence provider search can help you find more ancillary providers. However, it may also bring up non-ancillary providers or facilities that are not in your UMP Plus network, and you may pay significantly more if you use these providers or facilities. If you are not sure how services will be covered, call UMP Customer Service at 1-888-849-3681.

14) Can I see a healthcare professional outside UMP Plus - UW Medicine ACN network?

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 uwmedicine.org/umpplus or www.hca.wa.gov/ump-providers-plus, or call the UW Medicine ACN Contact Center at 855.520.9500 (TRS: 711).

15) Can different family members go to different physicians and different hospitals or clinics within UMP Plus – UW Medicine ACN?

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.

16) What is an ancillary provider or service?

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:

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

17) How do I know if an ancillary provider is in the UMP-Plus plan network?

You may search for ancillary providers by visiting the provider search on the UMP Plus – UW Medicine ACN portal and clicking on “additional providers” to link through to the correct location on regence.com, where these providers are listed (see note below).**

You will receive in-network benefits for UW Medicine ACN-affiliated providers as well as providers contracted with Regence Blue Shield.

**Note: The Regence provider search can help you find more ancillary providers. However, it may also bring up non-ancillary providers or facilities that are not in your UMP Plus network, and you may pay significantly more if you use these providers or facilities. If you are not sure how services will be covered, call UMP Customer Service at 1-888-849-3681.

18) If I switch to the UMP Plus – UW Medicine ACN from another PEBB medical plan, do I have to transfer my medical records or will that be done for me?

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.

19) How do you safeguard the privacy of my medical records?

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.

20) Can I only enroll in UMP Plus -- UW Medicine ACN during open enrollment?

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.

21) When does my coverage start?

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.

22) Where do I call to make an appointment?

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 seven days a week:

6:30 a.m. to 8:00 p.m., Monday through Friday

7:00 a.m. to 8:00 p.m. on Saturdays

8:00 a.m. to 5:00 p.m. on Sundays

23) Where do I get more information about the UMP Plus -- UW Medicine ACN?

  • 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.

24) I’m a provider looking to join the UMP Plus – UW Medicine ACN. How do I make this request?

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.