Additional Plan Information and Documents

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)

• Provider Directory – Pennsylvania (Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Washington, and Westmoreland Counties), Ohio (Belmont and Jefferson counties), and West Virginia (Brooke, Hancock, Marshall, Monongalia, Ohio, Preston, and Wetzel counties)
• Provider Directory – Pennsylvania (Clarion, Crawford, Erie, Forest, Lawrence,  Mercer, and Venango counties)
• Provider Directory – Pennsylvania (Bedford, Blair, Cambria, Cameron, Clearfield, Elk, Jefferson, McKean, and Somerset counties)

Pharmacy Directories (please click on the link that applies to the state in which you reside)

• Pharmacy Directory – Pennsylvania and West Virginia
• Pharmacy Directory – Ohio
  
  

Prescription Drug Formulary Information

• UPMC for Life’s Searchable Prescription Drug Formulary

• UPMC for Life Prescription Drug Formulary
• 60-day Formulary Change Information
  

   Additional Part D Prescription Drug Coverage Information

Important Plan Forms

• Personal Representative Designation Form
• Prescription Drug Coverage Determination Form/Exceptions Request Form
• Prescription Drug Coverage Redetermination Form
  

  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

  
  You may also ask for an appeal by calling our Member Services Department seven days a week from 8 a.m. to 8 p.m. at 1-877-539-3080. TTY users should call 1-800-361-2629. 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.

• 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
  

  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.
  

   Rights and Responsibilities for Members Participating in Health Management Programs

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 users should call 1-800-361-2629. 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.

Disenrollment Rights and Responsibilities

• Disenrollment Rights and Responsibilities Information
• Medicare Beneficiary Rights

HIPPA Notice of Privacy Practices

• Privacy Statement
• Notice of Privacy Practices HMO/PPO Members
• Notice of Privacy Practices Prescription Drug Plan Only Members
• Notice of Privacy Practices Private Fee-for-Service Members

   Exclusions and Limitations of UPMC for Life Plans

Contract Termination

• Contract Termination Information

   Quality Assurance Policies and Procedures — coming soon

   Out-of-Network Coverage

Helpful Websites About Medicare

• Medicare Website
• Social Security Administration Website

UPMC for Life is a health plan with a Medicare contract. 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).

UPMC for Life is a product of and operated by UPMC Health Plan, Inc., UPMC Health Network, Inc., and UPMC Health Benefits, Inc.

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.

Ways to Learn More Join us for a seminar Schedule a one-on-one meeting with an authorized UPMC for Life representative Speak with a sales representative over the phone

Contact Us Find important phone numbers and the address of UPMC Health Plan

*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.