Welcome to the United Employees Benefit Trust
What is my ID number?
Your identification number is located on your ID card, directly below the member’s name. If you are covered under one of the Trust’s medical plans, then your ID card will also show a prefix of UMX.
Where should claims be submitted?
All Dental, Vision Plan V3 and Short Term Disability claims should be submitted to:
220 S 27th St, Ste B
Tacoma, WA 98402
Facsimile: (253) 474-7180
All Medical claims and Vision claims for Plan AV8 and AV9 should be sent to Premera Blue Cross.
What is a preferred provider?
A preferred provider is a doctor or facility that has signed an agreement with a network.
How do I find a preferred provider?
Visit www.premera.com/sharedadmin or call 1-800-810-BLUE(2583).
How do I know if my doctor is a preferred provider?
You can find out if your doctor is preferred by visiting the network’s website or by contacting your provider’s billing office.
How do I request additional ID Cards?
You can request additional cards on the website or by calling the Trust office at (253) 474-1214.
How can I obtain a certificate of creditable coverage?
A Certificate of Creditable Coverage may be requested by calling the Trust office at (253) 474-1214.
- Agreement to Reimburse
- Claim Form
- Duplicate Insurance Information
- Enrollment Form (Medical)
- Enrollment Form (Dental and Vision Coverage Only)
- Enrollment Form (Time Loss Coverage Only)
- Nondiscrimination Statement (9/2016)
- Notice of COBRA Qualifying Event
- Notice of Privacy Practices
- Time Loss Application
- Time Loss Tax Form W-4S
- Waiver of Premium Application
- Application for Participation
- Application for Participation Demographic Sheet
- 2019 Rate Sheet
- 2019- 2015 Rate History
- 2019 Dental Plans Summary
- 2019 Medical Plans Summary
- 2019 Vision Plan Summary
- 2019 Time Loss Plans Summary
- Participation Agreement (Represented Group)
- Participation Agreement (Non-Represented Group)
|Benefits, Claims, and Eligibility|