UPMC Health Plan gives you a wide variety of choices to help you get the most from your health care plan. All of our coverage plans encourage you to establish a relationship with a physician, while also providing easy access to specialists.
Regardless of your plan, 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
Depending on the plans chosen by your employer, you may have one or more of the following available
to you:
Preferred Provider Organization (PPO)
PPO plans give you the flexibility to go to the providers you 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 offer lower premiums. Similar to a PPO, the EPO does not require you to select a PCP. But, like an HMO, the EPO does require you to receive care from network physicians and facilities in order to be covered.
Enhanced Access Point-of-Service (EAPOS)
EAPOS plans provide you with the best of both worlds — peace of mind in knowing the 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, you select a primary care physician (PCP) from thousands of highly trained, dedicated doctors who participate in the Health Plan’s network. Your PCP coordinates your care by studying your medical history, monitoring your 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 you, your employer, 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 resources to help employees manage their health.
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