Click on the links below to learn more about the benefits of UPMC Health Plan.
PharmacyOur pharmacy program offers both value and freedom of choice by providing a variety of high-quality, effective generic and brand-name prescription drugs. You can review the comprehensive Your Choice drug list developed and maintained by leading UPMC physicians and pharmacists. Members with Pharmacy coverage may also be eligible for home delivery for maintenance medications and access to a broad network of more than 30,000 retail chain and independent pharmacies, including:
Learn more about our pharmacy services For more details about the specific pharmacy program offered by your employer, log in to MyHealth OnLine to review your pharmacy plan documents. |
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Condition ManagementOur approach to helping members manage chronic health conditions is a clinically grounded method that is tailored to each individual’s need. The goals of our condition management programs are to:
Personal care managers are available to members enrolled in our Condition Management programs, which currently include:
If you are interested in our Health Management programs, call 1-866-778-6073. Representatives are available Monday through Friday from 8 a.m. to 5:30 p.m. Member Rights and Responsibilities
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Consumer Advantage – Consumer Directed Health PlansHealth Reimbursement Account (HRA)The UPMC Consumer Advantage Health Reimbursement Account (HRA) is owned and funded by the employer and can be used by the employee to help pay for any covered health care expenses during the deductible period. An HRA can pay for:
Employees must be enrolled in UPMC Consumer Advantage to be eligible for the HRA that can help cover a portion of the deductible. Employees receive a tax benefit because payments for qualified medical expenses from the HRA are not taxed. Any additional costs for medical services are paid by the employee, out-of-pocket, until the deductible is met. Once the deductible is met, claims are paid in full through a PPO plan design, subject to any coinsurance for which the employee is responsible. The employer owns and funds the HRA and determines if any unused funds in the HRA can be rolled over for the next benefit year. Also, employees can only access and use the HRA funds while they are employed by the employer. Health Savings Account (HSA)UPMC Consumer Advantage offers a Health Savings Account (HSA) powered by ACS/Mellon. HSAs are an important part of a revolution in health care funding — a revolution offering health care savings, control, and ownership. With the UPMC Consumer Advantage HSA, your employees can take advantage of tremendous tax savings and build a reserve for current and future health care expenses so they can continue to enjoy the security of health care coverage that protects them and their families. An HSA is a savings account that is owned by the employee and can be funded by the employee, employer, or both. It is like a health care “piggy bank” with federal tax advantages:
Tax-free HSA funds can be used by your employees to pay for almost all health care expenses, such as doctor and hospital visits, or copayments, eyeglasses, and prescriptions. If the employee’s combined expenses — whether small expenses, routine costs, or a serious accident or injury — exceed their health plan deductible, an out-of-pocket maximum caps costs while coverage continues. You can view a full list of qualified health care expenses at the IRS website, www.irs.gov. Growing the HSA No “Use It or Lose It” Invest in Interest-bearing Savings Life Transitions Invest in the Future
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MyFlex Advantage — Flexible Spending AccountsMyFlex Advantage plans are designed for members to take advantage of the convenient and easy-to-use pre-tax benefit plans available through UPMC Health Plan. MyFlex Advantage helps members save money and gives them better control of their health care spending. Learn more about MyFlex Advantage Log in to MyHealth OnLine to access your account and balance information. |
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VisionIf your plan includes vision benefits, we offer coverage for exams, lenses, frames, and contacts. Our managed vision care programs are offered through Vision Benefits of America (VBA), which puts an extensive network of over 11,000 vision providers at your service. Please call 1-800-432-4966 or visit www.visionbenefits.com to locate participating VBA providers. UPMC Small Business Advantage members: |
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Care while traveling — Assist AmericaWe help members traveling outside the U.S. to find qualified doctors and hospitals wherever they are and to return home for future care. Support on Standby 1-800-872-1414 TTY users may contact Assist America using the Pennsylvania Relay Service at 1-800-654-5984. To find out more, visit the Assist America website. |
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MyHealth Advice Line24 hours a day/7 days a week, UPMC Health Plan members have immediate access to health care advice through our MyHealth Advice Line. Whether you are seeking general health advice or information regarding a specific medical issue, experienced registered nurses are available around the clock.
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MyHealth CommunitySave money and improve your health. All members are automatically enrolled in our MyHealth Community discount program free of charge. Simply by presenting your Health Plan member ID card at the time of purchase, you are eligible for discounts at hundreds of participating facilities. Here are the types of facilities that participate in our MyHealth Community program:
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Behavioral Health ManagementUPMC Health Plan Behavioral Health Services (UPMC HP BHS) is a department within the Health Plan staffed by licensed behavioral health clinicians who provide triage, referral, and case management services for Health Plan members with behavioral health issues. UPMC HP BHS assists Health Plan members in obtaining high-quality behavioral health care. Behavioral health services include treatment for:
Information and Assistance
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