Knee and Hip Replacement

  • Joint replacement is a big decision that requires working closely with your doctor. If the right move is surgery, we want you to have the information you need to make an empowered decision on where you go for care.

    A guide to your benefit through Premera Blue Cross

    Premera is focused on helping each patient have a great treatment experience. We offer concierge service with specially trained, experienced representatives to help guide you through your care.

    Knee or hip replacement is a big decision that requires working closely with your doctor.

    You may receive treatment at low to no cost to you if you:

    • Are a UMP Classic or UMP CDHP member
    • Decide on joint replacement surgery with specially chosen physicians at Virginia Mason (Seattle)

    Note: For UMP CDHP members, the surgery and related services are covered in full after you meet your annual medical deductible.

    We recognize you have many options for knee or hip replacement. You may still receive joint replacement through other providers under your UMP plan. However, the COE Program offers you 100% coverage (minus the deductible for UMP CDHP members) for your joint replacement. If you qualify, the COE Program will also assist with travel and lodging expenses for you and a care companion.

    Qualifying for care

    To help ensure that surgery is needed, and to encourage the smoothest recovery, knee or hip replacement surgery is recommended only for members aged 18 or older who have been diagnosed with osteoarthritis or another disabling condition that requires a total knee or hip replacement.

    To help ensure your safety and the best surgical results, the COE Program has pre-surgery requirements. These include:

    • Having a body mass index (BMI) of less than 40
    • Avoiding smoking for 4 weeks prior to surgery
    • Maintaining a hemoglobin A1c level of less than 8% in patients who have diabetes

    Read more about our surgery preparation and recovery guidelines.

    COE program highlights

    What’s covered What’s NOT covered
    (but may be covered at your typical UMP benefit level)
    Pre-operative services (office visit, laboratory work, x-ray) Yes Care received under your Virginia Mason prescribed plan for care that's necessary to become a surgical candidate under the Centers of Excellence Program No
    Hospitalization and surgery, including anesthesia Yes Physical therapy that's not provided during your hospitalization No
    Post-surgical assessments Yes Medications prescribed upon discharge from the hospital No
    Post-surgery physical therapy visit (in-hospital) Yes Follow-up care other than the initial post-operative checkup at your selected Centers of Excellence (Virginia Mason) No
    Travel coverage Yes    

    Questions?

    Call our concierge desk at 855-784-4563 (TRS: 711).

    You can find out more about your knee and hip replacement benefits through your UMP Classic and UMP CDHP coverage.