UPMC Health Plan developed UPMC Dental Advantage to offer a single source for all your health insurance
needs. Like your UPMC Health Plan medical coverage,
UPMC Dental Advantage focuses on preventive care
and encourages you and your dentist to actively work
together on your treatment plan.
There are many benefits to choosing UPMC
Our Basic, Standard, and Premium options are PPO plans, so you do not need to select a primary dentist.
We offer a broad network of fully credentialed
dentists; however, all plan options include coverage
for out-of-network care.
There is no waiting period and you can't be denied
coverage or benefits if you have a pre-existing dental
We want you and your dentist to be able to promptly
implement your treatment plan; therefore, UPMC
Dental Advantage does not require prior authorization
for major services, but does encourage members to
seek a predetermination.
No ID card is required. You will provide the dentist's
office with some basic demographic information and
the name of your employer.
UPMC Health Plan members who use the MyFlex Advantage® (FSA) program to pay for out-of-pocket
dental expenses will have those expenses autosubstantiated.
That means less paperwork for you.
If you are a current UPMC Health Plan or MyFlex Advantage member, our Health Care Concierge team will
have access to your medical, dental and FSA
plan information so they can help you with all of
If you are a current UPMC Health Plan or MyFlex
Advantage member, you will be able to access all
your dental, medical, FSA information, and tools
through MyHealth OnLine — you don't need to remember another
username and password. You can find a participating
dentist, chat with a Health Care Concierge, or review your
claims and predeterminations all online.
UPMC Dental Advantage offers coverage for out-of-network
care; however, the benefits are reduced and
your dentist may bill you for the difference between
his or her charge and the amount paid by the plan.
To receive the maximum reimbursement, we strongly
encourage you to select a participating dentist for all of
your dental treatments and services or to ask your
dentist to join the UPMC Dental Advantage network.
Yes. Transition of care is easy with UPMC Dental
Advantage. Your orthodontist will need to submit a
claim to UPMC Dental Advantage with the original
treatment plan (initial placement date and months of
treatment) and the number of months remaining. After
UPMC Dental Advantage reviews your child's treatment plan,
the remaining benefits will be calculated according to
your benefit plan and payments will continue. You
don't need to submit any explanation of benefits (EOBs)
or explanation of payments (EOPs) from your prior
dental insurance carrier. You will not lose benefits by
switching to UPMC Dental Advantage if you enroll in the
option with the same orthodontia maximum as your