UPMC Health Plan’s wide array of benefit plans are designed to improve members’ health, control costs, and maintain competitive rates. You can offer your employees plans ranging from PPOs and HMOs to high-deductible consumer-directed plans that include health savings accounts (HSAs) or health reimbursement accounts (HRAs).
We offer you the opportunity to work closely with our sales and account management team to select plan designs to match your business requirements and the needs of your employees.
Regardless of the plans you select, no referrals are needed and all UPMC Health Plan benefit plans cover emergency care at any medical facility — at 100% after copayment — whether or not that medical facility belongs to the Health Plan network.
Benefit Plans:
Preferred Provider Organization (PPO)
PPO plans give your employees the flexibility to go to the providers they prefer, whether those providers participate in our network or not. Our PPO plans do not require care to be coordinated through a primary care physician (PCP). Instead, members are free to go directly to their physician of choice — PCP, ob-gyn, or specialist — for covered services.
Exclusive Provider Organization (EPO)
EPO plans blend elements of a traditional HMO with elements of a PPO and offers lower premiums. Similar to a PPO, the EPO does not require members to select a PCP. But, like an HMO, the EPO does require members to receive care from network physicians and facilities in order to be covered.
Enhanced Access Point-of-Service (EAPOS)
EAPOS plans provide members with the best of both worlds — peace of mind knowing their network includes top-quality community providers as well as medical experts at the world-renowned University of Pittsburgh Medical Center, and the flexibility of being able to choose out-of-network care.
Health Maintenance Organization (HMO)
With HMO plans, your employees and their dependents select primary care physicians (PCPs) from thousands of highly trained, dedicated doctors who participate in the Health Plan’s network. These PCPs coordinate participants’ care by studying their medical history, monitoring their health, and reviewing records from any other doctors.
Consumer Directed
UPMC Health Plan offers a portfolio of consumer directed health plans called UPMC Consumer Advantage®. These high-deductible health plans are coupled with a tax-advantaged source to fund some, or all, of the plan’s deductible. This funding may come from the employer, the employee, or both. UPMC Consumer Advantage provides the best in health care coverage to smart consumers who want to take a more active role in their own health care decision-making.
Small Business Advantage
Knowing small businesses are unique, UPMC Health Plan designed a plan to specifically address the needs of companies with fewer than 100 employees. UPMC Health Plan’s Small Business Advantage is a comprehensive plan with a dedicated account management and customer service team who appreciate the unique challenges of small businesses. The plan includes a package of MyHealth wellness services, EAP services, a vision discount network, global emergency services from Assist America, and 24/7 online advice to help employees manage their health.
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