Applying for enrollment is easy

Follow the steps below to apply for enrollment in a UPMC for Life plan.

1. Choose the UPMC for Life plan in which you wish to apply for enrollment. Click here to compare plan options and benefits. You can find detailed benefit information by viewing the Summary of Benefits for a plan.
   
   
2. Apply for enrollment. We offer three different ways to apply:
   • Call us toll-free at 1-866-400-5077 to apply for enrollment over the phone. Representatives are available from 8 a.m. to 8 p.m.*, seven days a week. TTY/TDD users should call 1-800-361-2629.
   • Apply online using our secure enrollment website.
   • Print and mail your enrollment appllicaton. Select the state in which you reside. Print the application that applies to the plan in which you would like to enroll and mail it to us at the address below.
     
     

     Pennsylvania:		UPMC for Life HMO/PPO Enrollment Application
     Ohio:		UPMC for Life PPO Enrollment Application — coming soon
     West Virginia:		UPMC for Life PPO Enrollment Application — coming soon

   
   
   
3. Fill out the Payment Election Form below if you would like to pay your premium electronically. This form explains a safe and easy way for you to pay for your health care coverage electronically on a monthly basis. (You don't need to fill out this form if you have chosen a plan with a $0 monthly premium, have elected to be billed, or have elected for your premium to be withheld from your Social Security check.) If you are applying for enrollment in the UPMC for Life PPO High Deductible with Rx (PPO) plan and we determine that you owe a late enrollment penalty, we will send you a bill each month which you can pay by check, Electronic Funds Transfer (EFT), credit card, or automatic deduction from your Social Security benefit check.
   Payment Election Form
   
   
4. Mail your completed enrollment application and Payment Election Form (if applicable) to UPMC for Life. If you have applied for enrollment over the phone, you do not need to print and mail your enrollment application. Mail to:
   

   UPMC for Life
   P.O. Box 2967
   Pittsburgh, PA 15230-9474

   
   
   
5. We will contact you once your enrollment application has been processed.
   
   

You can also enroll online via the Medicare website at Medicare.gov.