$0 for the COVID-19 vaccine

All Pennsylvanians age 6 months and older can get a COVID-19 vaccine.

Vaccine recommendations are based on your age, the vaccine you first received, and time since your last dose. People who are moderately or severely immunocompromised have different recommendations for COVID-19 vaccines.

Details about COVID-19 vaccines and boosters by age

Keep in mind that these guidelines can change over time as we learn more about COVID-19 vaccines and boosters. For the most current information, check the CDC website.

COVID-19 vaccine and booster shots are covered at all licensed providers and pharmacies.

Purchase or reimbursement for COVID-19 self-tests

From Aug. 30, 2021 through Dec. 31, 2024, UPMC for Kids (CHIP) members can purchase FDA-approved COVID-19 self-tests, through an in-network pharmacy for $0 or request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. COVID-19 self-tests are home tests that can be purchased over-the-counter (OTC). You administer and read these tests on your own. They are also called OTC, rapid, or rapid antigen tests.

Purchasing COVID-19 self-tests at the pharmacy

UPMC for Kids (CHIP) members can purchase FDA-approved COVID-19 self-tests at an in-network pharmacy for $0. If a COVID-19 self-test is purchased at an out-of-network pharmacy, you will have to pay out-of-pocket and request reimbursement using the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form.

UPMC for Kids (CHIP) members can only get two COVID-19 self-tests per week when purchasing at a pharmacy.

No prescription is needed for purchasing COVID-19 self-tests at an in-network or out-of-network pharmacy. Tests that are mailed or dropped off at a lab or office, even if purchased over-the-counter (OTC), are not eligible for $0 purchase or reimbursement. These lab-read tests are eligible for coverage only when obtained with a prescription.

Requesting reimbursement

You can request reimbursement by submitting your COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online or by calling a Health Care Concierge.

To submit online, view the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form and instructions.

To speak with a Health Care Concierge call 1-800-650-8762 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m.

In addition to filling out the form, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to contact you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all members. If your claim is denied, you can submit it again to correct any problems or supply missing information. You can submit for reimbursement up to 365 days from the date of purchase.

UPMC for Kids (CHIP) will only accept requests for reimbursement of COVID-19 self-test purchased on or after Aug. 30, 2021.

UPMC for Kids (CHIP) members can request reimbursement for up to eight COVID-19 self-tests per 28 days, per member. Each individual COVID-19 self-test counts toward the total of eight per 28 days, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as two COVID-19 self-tests with six eligible COVID-19 self-tests remaining for the 28 days.

Any FDA-approved COVID-19 self-tests purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (for example, Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-19 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.

Members should exercise caution in buying from websites that are unfamiliar to them—especially those that only sell COVID-19 self-tests, require participants to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.

Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness.

Our reimbursement process is normally completed within 60 days, however processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all UPMC for Kids (CHIP) participants are able to receive reimbursement are able to receive reimbursement for their purchases.

Out-of-pocket costs for members for in-network COVID-19 treatment

Through September 30, 2024, we are waiving all deductibles, coinsurance, and copays for in-network, inpatient COVID-19 treatment for members.

Out-of-pocket costs for members for monoclonal antibody treatment

Monoclonal antibody treatment for COVID-19 is covered at no cost until September 30, 2024.^a,b

No-cost COVID-19 diagnostic testing^†

Through September 30, 2024, we are waiving copayments for COVID-19 diagnostic testing when ordered by your child’s medical provider.

Learn how to get tested

UPMC MyHealth 24/7 Nurse Line*

Our nurses offer support and advise on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).

Virtual visits for the diagnosis of suspected COVID-19, including UPMC AnywhereCare

Through September 30, 3024, we are waiving all member copayments for virtual health care visits for the diagnosis of suspected COVID-19. Preventive services that can be provided by telehealth will continue to be covered without member cost sharing.

With UPMC Children's AnywhereCare**, children ages 0-17 can have virtual visits 24/7 with UPMC Children's Hospital of Pittsburgh providers over live video. Anytime, day or night. Members who are 18 years old and older can use UPMC AnywhereCare***.

Learn how to download the app, enroll, and use UPMC AnywhereCare
Visit UPMC AnywhereCare

Resources for UPMC for Kids members

If you have experienced a financial hardship and are unable to pay your premiums because of a decrease or loss of income, please contact the Department of Human Services (DHS). You can use COMPASS, the myCOMPASS PA mobile app, or call the DHS Customer Service Center at 1-877-395-8930 (1-215-560-7226 in Philadelphia) to report any changes in your family's circumstances.

UPMC for Kids

Visit UPMC for Kids to learn more about member benefits.

UPMC for Kids members Health Care Concierge services

If you have questions, our UPMC for Kids Health Care Concierge team will help you and your child every step of the way. Call 1-800-650-8762 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m.

Health management programs

If your child needs day-to-day help with a health condition, UPMC for Kids is here for you, thanks to our care management programs. A nurse can help you and your child to better understand your child’s condition. Call 1-866-778-6073 (TTY: 711) Monday through Friday 8 a.m. to 6 p.m.

Additional resources

The United Way of Pennsylvania

The United Way of Pennsylvania helps you connect with resources in your community, such as food/meals, housing, clothing, community services, financial assistance, and more. Visit pa211.org, dial 211, or text your ZIP code to 898-211.

Pennsylvania Statewide Support and Referral Helpline for COVID-19

The Department of Human Services has partnered with the Center for Community Resources (CCR) to create and staff the Pennsylvania Statewide Support and Referral Helpline for COVID-19. The Support and Referral Helpline is a 24-7 listening and referral service provided to all of Pennsylvania during the COVID-19 crisis. Call 1-855-284-2494 (TTY: 724-631-5600) to speak with a caseworker who’s there to counsel Pennsylvanians struggling with anxiety and other challenging emotions due to the COVID-19 emergency. You can also visit the Center for Community Resources.

Pennsylvania Department of Human Services

For emergency cash and food assistance visit COMPASS.

Online resources

Food assistance resources

For the Food Bank’s Doorstep Delivery program, call 412-460-3663 ext. 655 Monday through Friday from 8 a.m. to 4:30 p.m. or visit Greater Pittsburgh Community Food Bank.

Behavioral health resources

It’s normal if you or your child(ren) are experiencing feelings of anxiety or depression right now. Resources are available to support you and your family’s mental well-being. Visit the websites or call the numbers below for more information.

UPMC Western Behavioral Health Services: 412-235-5444
UPMC Children’s Hospital of Pittsburgh Behavioral Health Services: 724-933-3910
UPMC Pinnacle Mental Health Counseling and Psychology: 717-231-8360
UPMC Susquehanna Behavioral Health Services: 570-320-7325
National Alliance of Mental Illness (NAMI): 1-800-950-NAMI (6264) or text "HelpLine" to 62640

If you have questions about your coverage, see your plan documents or contact Member Services for the most up-to-date information regarding your benefits.

*UPMC nurses who answer calls are licensed to assist members in Pennsylvania, West Virginia, Maryland, New York, and Ohio. Members must be in one of those states when calling the UPMC MyHealth 24/7 Nurse Line. The UPMC MyHealth 24/7 Nurse Line is not a substitute for medical care. If an emergency arises, please call 911 or your local ambulance service, go to the nearest emergency room, or call or text the Suicide and Crisis Lifeline at 988. Nurses cannot answer plan or benefit questions. For plan or benefit information, please contact Member Services at the phone number on your ID card or call 1-844-220-4785 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group, at the discretion of the provider. OCN is not an affiliate of UPMC. Providers are not available to treat members who are in Puerto Rico.

***UPMC for Kids members who are in Pennsylvania at the time of a virtual visit may select a UPMC- employed provider, subject to availability and discretion of the provider. Members temporarily traveling outside of Pennsylvania at the time of service will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. In order for a UPMC for Kids member to have a UPMC AnywhereCare visit, the member’s parent or legal guardian must be with the child during the video portion of the visit. UPMC AnywhereCare virtual visits are not covered services for UPMC for Kids members using Talk Therapy or Psychiatry services. Providers are not available to treat members who are in Puerto Rico.

^aUPMC Health Plan will cover these services from in-network providers with no member cost share until September 30, 2024, subject to permissibility under the current federal and/or state emergency declarations and associated guidance.

^bFor more information on monoclonal antibody treatments, visit UPMC.com/AntibodyTreatment or call 1-866-804-5251 from 7 a.m. to 8 p.m., seven days a week.

^†Until September 30, 2024, members can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.

Resources

COVID-19 coverage for members