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Medical and Behavioral Health Coverage

With UPMC for Kids, children and teens have access to many benefits, including:

  • Doctor visits, including routine check-ups and immunizations, as well as visits when your child is sick
  • Specialists visits, including dermatologists, allergists, ear, nose, and throat specialists, and more
  • Urgent care
  • Emergency room visits
  • Hospital stays
  • Mental health services
  • Substance abuse treatment
  • Diagnostic tests (such as blood work and x-rays)
  • Physical, occupational, and speech therapy
  • Hearing exams
  • Nutritional counseling

Based on your family’s income, your child may be enrolled in free, low-cost, or full-cost CHIP. Depending on your child’s CHIP coverage, there may be copayments for some of the covered services. A copayment is the amount of money a UPMC for Kids member is responsible to pay for the service provided. The chart below provides a summary of these copayments.

Cost of Coverage

Free CHIP Low-Cost CHIP Full-Cost CHIP
Primary Care Provider Visits $0 $0 preventive care;
$5 other visits
$0 preventive care;
$15 other visits
Specialist Visits $0 $10 $25
Behavioral Health Visits $0 $0 $0
Emergency Department Visits $0 $25 (waived if admitted) $50 (waived if admitted)

You can also view the UPMC for Kids member handbook or Summary of Benefits for more information about covered benefits. Limits may apply to some services. The UPMC for Kids exclusions booklet has information about non-covered benefits.

Finding a Doctor

UPMC for Kids has a large network of physicians, hospitals, and other health care providers. Our members should receive services from a participating provider, unless it is an emergency or there is an urgent need for care while out of the service area.

The Find A Doctor search tool can help you find a participating doctor near you.

Your managed care plan may not cover all your health care expenses. Read your member handbook carefully to determine which health care services are covered.

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