UPMC Health Plan is part of the Insurance Services Division of western Pennsylvania-based
University of Pittsburgh Medical Center (UPMC), a global health enterprise affiliated with the University of Pittsburgh Schools of the Health Sciences and one of the nation’s top-ranked health systems. We are committed to helping our members enjoy the best possible quality of life and health at every stage of life. Our commitment to members’ health is backed by our affiliation with UPMC, a world-class academic health system, and our extensive network of community health care providers. Our members enjoy access to the best doctors and hospitals in the region, the latest medical advances, and the most up-to-date medical protocols.
As part of an integrated health care delivery and finance system, UPMC Health Plan offers an innovative, consultative approach to health care that encompasses traditional benefit plans and proven solutions that promote health and productivity.
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Integrated Delivery & Finance
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Our partnership with the world-renowned medical experts and researchers at UPMC informs the programs and services we provide for members. Our wellness and chronic care programs incorporate the latest research findings, best practice preventive care and disease management protocols, and most advanced technologies available. We staff our clinical programs with our own professionals, many of them registered nurses, registered dieticians, certified diabetes educators, exercise physiologists, or certified health education specialists. Our network of quality providers offers clinical benefits and cost efficiencies available only within this uniquely integrated context.
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Integrated Products & Services
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The combined companies of the UPMC Insurance Services Division, including UPMC Health Plan, UPMC WorkPartners, and LifeSolutions among others, allow us to integrate members’ medical and pharmacy benefits with dental, vision, health and wellness programs, and employee assistance programs. Our comprehensive, integrated approach to member care supports improved health and productivity, encourages members to take a proactive role in their health care, and helps reduce medical costs.
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Integrated Data & Solutions
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We integrate member health data from a variety of sources into one global health and care management system. This integrated solution provides as complete a picture as possible of members’ health and allows multiple health care providers and support personnel to access clinically relevant information in near real time. Armed with this information, providers and other personnel are empowered to take action and recommend appropriate programs and services across the full spectrum of healthy, at-risk, and chronically ill member populations.
Our high-quality UPMC Health Plan insurance options include the following features.
Your employees will have access to the world-class academic, advanced care, and specialty hospitals of UPMC. Our provider network also includes community hospitals, cancer centers, physician practices, behavioral health programs, and long-term care facilities. In all, the network consists of more than 125 hospitals and facilities and more than 11,500 physicians — with one of the largest and most diverse teams of health care professionals in the area. We also provide nationwide coverage for our members traveling outside our service area.
Our pharmacy network has more than 30,000 locations nationwide, including independent pharmacies and retail chains such as Giant Eagle, Walmart, Target, CVS, Kmart, and Rite Aid.
UPMC Health Plan provides unmatched member support through our award-winning customer service team. Our Health Care Concierge team calls all new members to welcome them, help them understand their plan, and provide preventive health reminders. The Health Care Concierge team seeks to resolve all concerns in one call or online chat session.
- Dedicated account management
- MyHealth wellness services
- Employee assistance program
- Vision discounts
- Global emergency services
- 24/7 health advice line
- Discounts on LASIK procedures and hearing aids
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Medical Plans: 2 to 50 Employees
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UPMC Small Business Advantage: Premium Platinum and Premium Gold
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These plans use UPMC Health Plan’s PPO network, which means that members can go out of the network for routine care; however, there is a lower out-of-pocket expense if they receive care inside the network. They do not need referrals to see specialists. After members meet their deductible, the plan pays for 100 percent of costs for in-network services.
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Plan Name
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Premium Platinum $25
(fully insured)
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Premium Platinum $250 $10/$25
(fully insured)
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Premium Platinum $750 $10/$25
(fully insured)
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| Premium Gold $1,250
(fully insured)
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UPMC Small Business Advantage: Enhanced Silver
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This plan uses UPMC Health Plan’s EPO network, which means that members must receive care from network physicians and facilities to receive coverage (unless they are traveling outside the service area). They do not need referrals to see specialists. After members meet their deductible, the plan pays for 100 percent of costs for in-network services.
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Plan Name
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| Enhanced Silver $1,500
(fully insured)
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Medical Plans: 51 to 199 Employees
UPMC Business Advantage
This plan uses UPMC Health Plan’s EPO network, which means that members must receive care from network physicians and facilities to receive coverage (unless they are traveling outside the service area). They do not need referrals to see specialists. After members meet their deductible, the plan pays for 100 percent of costs for in-network services. Preventive care is always covered at 100 percent.
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Plan Name
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| EPO $500 $20/$20
(fully insured)
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This plan uses UPMC Health Plan’s PPO network, which means that members can go out of the network for routine care; however, there is a lower out-of-pocket expense if they receive care inside the network. They do not need referrals to see specialists. After members meet their deductible, the plan pays for 100 percent of costs for in-network services. Preventive care is always covered at 100 percent.
| Plan Name |
| PPO $20/$20
(fully insured)
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UPMC HealthyU is designed to help members understand their health status, improve their health, and partner with their doctor. These plans feature a health incentive account (HIA). Members can earn reward dollars in their HIA by completing healthy activities (up to $500 for an individual or $1,000 for a family).
Members can choose from more than 150 activities, including tasks they probably do already — like getting a flu shot, completing a wellness exam with their doctor, and having eligible preventive screenings. These plans use UPMC Health Plan’s PPO network, which means that members can go out of the network for routine care; however, the out-of-pocket expense is lower if they receive care inside the network. They do not need referrals to see specialists. Preventive care is always covered at 100 percent. These plans can be offered on both a fully insured and self-insured basis.
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Plan Name
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| HIA PPO $750-80% |
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HIA PPO $2,000-90%
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HIA PPO $750-90%
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UPMC Consumer Advantage® qualifies members for a health savings account (HSA). An HSA is an account for current and future health care expenses. Employers may contribute along with the member, but the member owns the HSA account, keeps it year after year as it grows, and takes it with them when they retire or leave the company. With these plans all in- and out-of-network coverage counts toward the deductible. Out-of-pocket maximums are lower for in-network care. Preventive care is covered at 100 percent and is not subject to the deductible. These plans can be offered on both a fully insured and self-insured basis.
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Plan Name
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HSA $1,250/100%
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HSA $2,500/100%
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UPMC Inside Advantage™ is a tiered network plan that provides members with the same type of coverage as other UPMC Health Plan offerings — but at a lower premium and with lower out-of-pocket costs when they receive care at select facilities. Members receive the highest level of benefits and lowest out-of-pocket costs when they seek care at UPMC Hamot, Warren General Hospital, Grove City Medical Center, Kane Community Hospital, Meadville Medical Center, UPMC Horizon, UPMC Northwest, and all other UPMC-owned facilities.
These plans use UPMC Health Plan’s PPO network, which means that members can go out of the network for routine care; however, the out-of-pocket expense is lower if they receive care inside the network. They do not need referrals to see specialists. After members meet their deductible, the plan pays for 100 percent of costs for in-network services. Preventive care is always covered at 100 percent.
UPMC Inside Advantage is offered to employers in the following counties: Clarion, Crawford, Elk, Erie, Forest, McKean, Mercer, Potter, Venango, and Warren.
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Plan Name
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PPO IA $500 $20/$40
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| UPMC Network Level 1
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PPO IA $500 $20/$40
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| UPMC Network Level 2
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PPO IA $500 $20/$40
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| Non-Participating Provider Level 3
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Plan Name
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PPO IA $500 $20/$40
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| UPMC Network Level 1
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PPO IA $500 $20/$40
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| UPMC Network Level 2
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PPO IA $500 $20/$40
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| Non-Participating Provider Level 3
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Medical Plans: 200 Employees and Up
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Employer groups with 200 or more employees can customize their medical and prescription drug plans in either fully insured or administrative services only (ASO) configurations, in addition to choosing one of the plan design outlined in the 51-199 market segment.
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Vision Plans (All Market segments)
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UPMC Vision Advantage offers three plan models — Basic, Standard, and Premium — and a network of credentialed vision providers within the regions where UPMC Vision Advantage is offered. UPMC Vision Advantage members receive a 20 percent discount on exams, frames, and lenses for glasses purchased through a participating UPMC Vision Advantage provider before their next eligibility period. UPMC Vision Advantage members also are eligible for discounts on LASIK procedures at the following locations: UPMC Eye Center, QualSight, and TLC Vision.
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Dental Plans (All Market segments)
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UPMC Dental Advantage offers members three plan models — Basic, Standard, and Premium — with a network of credentialed dentists. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. UPMC Dental Advantage does not require prior authorization for major services.
Enhanced benefits include one additional cleaning for members who are pregnant, during the course of pregnancy; increased coverage for non-surgical periodontal treatment, including topical application of fluoride, for adults with a history of surgical periodontal treatment; and coverage for microbial test and brush biopsies.