Welcome Kit Materials

As a member of UPMC Health Plan, you have direct access to the world-class hospitals
of the University of Pittsburgh Medical Center and a regional network of exceptional physicians, specialists, and community hospitals. 

Listed below are materials that will help you get the most out of your membership. 
Among the listed items are a certificate of coverage outlining your covered services
and a schedule of benefits describing the copayments and deductibles associated
with your plan.

If you would like to have a welcome kit mailed to your home, please contact Member Services at 1-888-876-2756.

The Certificate of Coverage is an overview booklet explaining the terms of coverage
of your health benefits. It sets forth what services are covered and what services
are not covered.

• Certificate of Coverage

The Schedule of Benefits is an overview of the copayment, deductible, and/or coinsurance amounts for your benefit plan.

• Schedule of Benefits

The Prescription Drug Rider is an overview of the copayment amounts and quantity limits permitted under your prescription drug benefits.

• Prescription Drug Rider

The Your Choice Pharmacy Program provides a detailed explanation of your pharmacy benefit and how to use it effectively.

• Your Choice Pharmacy Program

The Notice of Privacy Practices provides full disclosure of how UPMC Health Plan
may use and disclose your personal health information (PHI) and how you can access
this information.

• Notice of Privacy Practices

The Personal Representative Designation Form is used when you want to appoint
a personal representative to act on your behalf in discussing your health and
benefit coverage.

• Personal Representative Designation Form

The Member Authorization to Use/Disclose Protected Health Information form is used if you want to indicate that UPMC Health Plan/UPMC Health Benefits may use or disclose your protected health information (PHI) that it has received, collected, or maintained in its files for certain purposes that – according to federal law – require your written permission.

• Member Authorization to Use/Disclose PHI

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