UPMC Health Plan Employer Groups Plan Options

Inside Advantage

UPMC Inside Advantage is a tiered benefit plan for northwest Pennsylvania that provides lower out-of-pocket costs when employees receive care at a UPMC-owned facility or select Level 1 facilities near the places where they work and live. Level 1 includes all UPMC-owned facilities along with many community-owned providers and facilities, such as Grove City Medical Center, Meadville Medical Center, Titusville Area Hospital, and Warren General Hospital. UPMC facilities in northwest Pennsylvania include UPMC Hamot, UPMC Horizon, UPMC Jameson, UPMC Kane, UPMC Jameson, and UPMC Northwest. At Level 2, out-of-pocket costs may increase. Level 2 includes the rest of Premium Network-contracted facilities and the services affiliated with those contracted facilities, such as lab, x-ray, MRI therapy services, and more.

UPMC Inside Advantage is available to companies located in Clarion, Crawford, Elk, Erie, Forest, McKean, Mercer, Potter, Venango, and Warren counties.

UPMC MyCare Advantage

UPMC MyCare Advantage is a tiered benefit plan that focuses on patient-centered care to improve the health outcomes of its members. It offers the same type of coverage as other UPMC Health Plan products but maximizes in-network savings with lower cost sharing when members receive care from Level 1 hospitals and facilities, which include all UPMC-owned physician practices, hospitals, and facilities. Level 2 gives access to more than 15,000 additional providers within the UPMC Premium Network, but there is a higher cost share for Level 2 providers. Level 3 nonparticipating providers (PPO only) provide covered access to providers outside of our network at a greater cost share, offering members the greatest flexibility in provider choice. EPO participants do not have access to nonparticipating providers.

UPMC MyCare Advantage is available to companies located in Allegheny, Beaver, Bedford, Berks, Blair, Butler, Clinton, Cumberland, Dauphin, Fayette, Lawrence, Lycoming, Tioga, Washington, and Westmoreland counties.

UPMC Self Assure Level Funding

With UPMC Self Assure Level Funding, you pay a fixed amount on a monthly basis. The amount is based on the year’s expected claims determined at the time of sale along with your fixed costs. The only fluctuation you see throughout the year is if you add or drop members. Included in the payment are all administrative costs, stop loss insurance premiums, and your claim costs — no hidden charges or carryover to the next year.

UPMC Business Advantage

UPMC Business Advantage is a diverse portfolio of medical plan options. Several value-added services and benefits may be applied to these plans to further support the health and well-being of employees.

UPMC Small Business Advantage

UPMC Small Business Advantage is a portfolio of medical plan options for companies with fewer than 50 employees. UPMC Small Business Advantage comes standard with every small group plan. This unique plan design gives smaller businesses the opportunity to offer their employees a robust benefit package that addresses their total health and well-being.

UPMC Consumer Advantage

UPMC Consumer Advantage® offers many plan options for groups looking to add a qualified high-deductible health plan (QHDHP) to their medical plan offerings. A QHDHP qualifies members for a health savings account (HSA) or flexible spending account (FSA). These accounts help them pay for current and future health care expenses. Depending on the account selected, the employer and employee may contribute to the account, and the employee may be able to take the funds along when changing employers or at retirement.

UPMC HealthyU

UPMC HealthyU is an innovative plan that rewards members for making healthy choices. By completing healthy activities, subscribers and their covered spouse or covered domestic partner can earn reward dollars in a health incentive account (HIA) that helps pay for their health care expenses. Dependent children (including adult children) are not eligible to earn reward dollars. UPMC HealthyU recommends healthy activities that are uniquely customized to the individual, each with a reward dollar value to help encourage members to focus on what’s most important in understanding and improving their own health. UPMC Health Plan deposits reward dollars into the member’s HIA every time he or she completes a recommended activity. The reward dollars then help pay for out-of-pocket medical expenses, such as deductible, coinsurance, and pharmacy copayments. Employers may choose to offer this plan with claims-based reimbursement or with a debit card.