Additional Participant Benefits
Health Care Concierge Services
Our Health Care Concierge team works hard to make things easy for you when you have questions or concerns. Health Care Concierges will provide personal service when and where you need it, at no cost to you.
Contact them by phone or through a private online chat. Our dedicated Health Care Concierge team will help you:
- Find a doctor or other provider.
- Get answers to benefit questions and explain how your health plan works.
- Check to see if a prescription or over-the-counter drug is covered.
- Schedule important care appointments, and much more.
Call the Health Care Concierge Services team at 1-844-833-0523 (TTY: 711). Representatives are available 24 hours a day, 365 days a year.
UPMC AnywhereCare
UPMC AnywhereCare* lets you access a specially trained UPMC provider via live video from your computer, tablet, or smartphone. You can use this service anytime, day or night. It works well for colds, flu, sore throats, skin rashes, and other nonemergency conditions.**
Use UPMC AnywhereCare to take care of minor health problems before they become more serious. It takes less time than a regular doctor visit. And it gives you peace of mind to have this nonemergency care option when you don't feel well.
Doctors are available 24/7 with no long wait, thanks to UPMC AnywhereCare. Register now at UPMC AnywhereCare.
If you would like more information on UPMC AnywhereCare, please contact the UPMC Community HealthChoices Health Care Concierge team at 1-844-833-0523 (TTY: 711). Representatives are available 24 hours a day, 365 days a year.
*UPMC Community HealthChoices participants located in Pennsylvania at the time of the virtual visit may select a UPMC-employed provider or a provider from Online Care Network II PC (OCN), subject to availability and discretion of the provider. During the COVID-19 emergency, UPMC Community HealthChoices participants located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC. After the COVID-19 emergency, UPMC AnywhereCare virtual visits will not be covered services when UPMC Community HealthChoices participants are traveling outside of Pennsylvania.
MyHealth OnLine
MyHealth OnLine is our participant-only website for tips and tools for better health. You can find a doctor, email a web nurse, view your medical history, and chat with a health coach who can help you manage conditions and meet your goals.
With online tools such as your personal health record, easy-to-use wellness programs, and detailed ways to search for providers, you are just a click away from great health information. Health resources including activity trackers, health coaches, and WebMD® make MyHealth OnLine an interesting place to visit and explore.
In addition, you can access your UPMC Community HealthChoices benefit information (medical, pharmacy, vision, and dental) for the current and past years, and you can see your claims information for medical and pharmacy.
UPMC Health Plan Mobile App
Manage your health care instantly with the UPMC Health Plan mobile app. It’s another safe, speedy, and secure way to stay in touch with us. The app puts all your health information in one place. And you can access your information instantly—anywhere, anytime.
The app makes it easy to explore the benefits you have as a UPMC Community HealthChoices participant. Simple icons make it a snap to use. Here are some great ways you can use the app:
- Access your member ID card right when you need it.
- Contact your UPMC Community HealthChoices doctor, pharmacist, and even the UPMC MyHealth 24/7 Nurse Line—instantly.
- View your personal medical history.
- Live text-chat with a Health Care Concierge.
Download the UPMC Health Plan app today in the iTunes App Store or Google Play.
Health Management Programs
A health management program has health coaches who help you understand your disease or condition. They help you manage your health care and take better care of yourself. Your provider may talk with you about enrolling in one of these programs for better health. However, you can be enrolled in a health management program without a referral from your PCP or other provider.
UPMC Community HealthChoices has several health management programs:
- Asthma
- Heart disease (coronary artery disease, atrial fibrillation, and congestive heart failure)
- Chronic obstructive pulmonary disease (COPD for short, a lung disease)
- Diabetes
- Maternity
- Hypertension (high blood pressure)
- Hyperlipidemia (high cholesterol)
- Low back pain
- Chronic kidney disease
Thanks to an innovative program called UPMC Prescription for Wellness, your UPMC Community HealthChoices doctor can now write you a prescription to work one-on-one with a UPMC Heath Plan health coach. Whether you are already working on making healthy changes or want to set a new goal, a coach can support you. The coach will let your doctor know how you are doing with your health goals, so everyone stays in the loop. Ask your UPMC Community HealthChoices doctor about writing a UPMC Prescription for Wellness today. Or call 1-855-395-8762 to speak with a health coach and get started.
To learn more about health management programs, call the Health Management Department at 1-866-778-6073 (TTY: 711) Monday through Friday from 7 a.m. to 8 p.m. and Saturday 8 a.m. to 3 p.m.
UPMC MyHealth 24/7 Nurse Line
Immediate access to health care advice is available around the clock through the UPMC MyHealth 24/7 Nurse Line. Whether you are seeking general health advice or need help with a medical issue, experienced registered nurses are available to provide you with prompt and efficient services. Call the UPMC MyHealth 24/7 Nurse Line at 1-866-918-1591 (TTY: 711).
Note: The UPMC MyHealth 24/7 Nurse Line is not a substitute for medical care. If you need emergency care, go to the nearest emergency room, or call 911 or the local ambulance service.
UPMC nurses who answer calls are licensed to assist UPMC Community HealthChoices participants. Nurses cannot answer plan or benefit questions. Please call the Health Care Concierge team at the phone number on your member ID card for nonclinical inquiries.
Additional Benefits
Extended Coverage of Personal Assistance Services
This service will provide personal assistance services to eligible participants who are unable to perform activities of daily living and are at risk of entering a nursing facility. Eligibility is based on state determination of nursing facility clinical eligibility and pending application with the county assistance office.
Medical Assistance Redetermination Assistance
This service provides assistance to help you maintain your Medical Assistance eligibility so you do not lose access to your Medical Assistance benefits.
UPMC Community HealthChoices participants who are Nursing Facility Clinically Eligible (NFCE) may be eligible for additional services, including:
Enhanced Community Transition Services
This service offers an allowance of up to $5,000 to assist qualified participants transitioning from long-term nursing facility stays into their communities. The allowance can be used for household supplies, essential furniture, general moving expenses, security deposits and other needed services associated with personal, environmental, health, and safety assurances. (This service exceeds the $4000 lifetime maximum benefit provided by the Office of Long-Term Living's waiver program). The participant works with a nursing home transition team to develop a plan for this benefit, in support of their facility-to-community transition.
Post-transition Follow-up Services
This service offers follow-up visits to participants who have used enhanced community transition services to move from a nursing facility to the community. Six follow-up visits are offered in-person and telephonically in the year following the transition. This service is in addition to activities performed by UPMC Community HealthChoices service coordinators. The additional support promotes the participant’s goals for successful community living.
To learn more about these and other member benefits, view the UPMC Community HealthChoices Handbook.