Important Plan Information
Please use the links below to find important information about UPMC for Life and our plan documents.
Provider and Pharmacy Directories
- Searchable Provider Directory (allows you to search for a specific provider or hospital to see if it is participating in the UPMC for Life network)
Provider Directories (please click on the link that applies to the state and county in which you reside)
Pharmacy Directories (please click on the link that applies to the state in which you reside)
Prescription Drug Formulary Information
Important Plan Forms
- Personal Representative Designation Form
- Prescription Drug Coverage Determination Form/Exceptions Request Form
- Prescription Drug Coverage Redetermination Form
- Member Authorization to Use/Disclose PHI
- Express Scripts, Inc., Mail-Order Form
- Appointment of Representative
- Routine Vision Care Reimbursement Form for Out-of-Network Services
- Rights and Responsibilities for Members Participating in Health Management Programs
To ask for an appeal about a Part D drug and/or Part C medical care or service, a signed, written appeal request must be faxed to UPMC for Life or sent to the address listed below.
FAX: |
412-454-7920 |
| WRITE: | UPMC Health Plan |
| Attn: Appeals and Grievances | |
| P.O. Box 2939 | |
| Pittsburgh, PA 15230-2939 |
Appointment of Representative Instructions: In order to appoint a person to act on your behalf concerning your health care benefits, print the form above, complete the required fields, and fax or mail it us. Once you return this completed, signed, and dated form to us, we can verify your request, adjust our records accordingly, and speak to your appointed representative.
Please return this completed form either by fax or by mail:
FAX: |
412-454-7829 |
| WRITE: | UPMC for Life |
| P.O. Box 2965 | |
| Pittsburgh, PA 15230-2939 |
If you have any questions about this form, please call our Member Services Department at 1-877-539-3080, from 8 a.m. to 8 p.m.,* seven days a week.TTY/TTD users should call 1-800-361-2629.
This form is intended for use by members who receive services from providers outside of the OptiCare Managed Vision provider network. Please do not use this form to report services furnished by an OptiCare provider.
Plan Ratings Information
Filing an Appeal or Grievance
- Appeals & Grievances Information
How to obtain the aggregate number of grievances, appeals, and exceptions filed with UPMC for Life: Please call our Member Services Department seven days a week from 8 a.m. to 8 p.m.* at 1-877-539-3080 if you need more information about the number of appeals and grievances filed by our members. TTY/TDD users should call 1-800-361-2629.
Disenrollment Rights and Responsibilities
HIPAA Notice of Privacy Practices Click on the Notice of Privacy Practices for the plan in which you are enrolled.
Helpful Websites About Medicare
Our Medicare plans are available to persons entitled to Medicare Part A and enrolled in Part B. You must continue to pay Medicare premiums, reside in the service area, and not have end-stage renal disease (ESRD).
If you have any questions or would like to receive this information by mail, please call us at 1-877-381-3765 from 8 a.m. to 8 p.m.,* seven days a week or click on one of the links below. TTY/TDD usersshould call 1-800-361-2629.
- Join us for a seminar on Medicare and UPMC for Life
- Schedule a one-on-one meeting with an authorized UPMC for Life representative
- Speak with a sales representative over the phone
*From March 2 through November 14, you may receive a messaging service on weekends and holidays. Please leave a message and your call will be returned the next business day.