UPMC Insurance Services Division Products Earn High Ratings from NCQA
Contact: Denise Hughes, UPMC Health Plan
Phone: 412-983-3836
Email: HughesDR2@UPMC.edu
Contact: Gloria Kreps, UPMC
Phone: 412-417-2582
Email: Krepsga@upmc.edu
UPMC Insurance Services Division Products Earn High Ratings from NCQA Plans Are Among the Highest-Rated in Pennsylvania and the Nation
FOR IMMEDIATE RELEASE
PITTSBURGH, PA (Sept. 15, 2025) – UPMC Health Plan announced today that the National Committee for Quality Assurance (NCQA) has awarded 4.5- and 5-Star ratings to select UPMC Insurance Services Division products. This makes these plans among the highest NCQA-rated plans in both Pennsylvania and the nation in 2025.
“Earning these high-quality ratings across our plans reflects our unwavering commitment to clinical quality improvement and the betterment of health care outcomes for the patients and communities we passionately serve,” said Carrie Whitcher, UPMC Health Plan’s Chief Quality Officer. “This commitment to quality ensures all of our members have the optimal care they need and a commensurate member experience.”
NCQA Health Plan Accreditation evaluates how well a health plan manages all parts of its delivery system—physicians, hospitals, other providers, and administrative services—to continuously improve the quality of care and services provided to its members.
Nine UPMC Insurance Services Division entities received NCQA Health Plan Ratings of 4 Stars or higher. Highlights include the following:
- UPMC Commercial HMO products issued by UPMC Health Coverage Inc. and UPMC Health Plan Inc. and administered by UPMC Benefits Management Services Inc. are the top-rated Commercial HMO plans in Pennsylvania with a rating of 5 out of 5 Stars in NCQA’s Commercial Health Plan Ratings 2025. They are among the top 1.5 percent nationally.
- UPMC Benefit Management Services administers the top-rated Commercial EPO/PPO plan in Pennsylvania, receiving 4.5 Stars in NCQA’s Commercial Health Plan Ratings 2025. It is among the top 6 percent nationally.
- UPMC for You Inc. is among the top 5 percent of Medicaid plans in the nation, maintaining 4.5 Stars in NCQA’s Medicaid Health Plan Ratings 2025. There are no 5-Star Medicaid health plans nationally.
NCQA Health Equity Accreditation
UPMC Health Plan also earned NCQA’s Health Equity Accreditation for the UPMC for You Medicaid product and the UPMC Health Coverage and UPMC Health Options Marketplace products. In addition, the Health Plan renewed NCQA’s Health Equity Accreditation Plus for the UPMC for You Medicaid product.
Why This Matters
NCQA’s Health Equity Accreditation provides a framework for embedding equity into organizational operations. It emphasizes:
- Building an internal culture that supports external equity work.
- Collecting data to drive culturally and linguistically appropriate services.
- Identifying strategies to reduce health disparities and improve outcomes.
Health Equity Accreditation Plus goes further by:
- Using community-level social risk data to shape interventions.
- Creating effective partnerships with community-based organizations.
- Enhancing patient engagement.
- Improving processes for addressing social needs.
Together, these accreditations reflect UPMC Health Plan’s sustained, organization-wide, community-driven commitment to health equity—not just as an initiative, but as a core operating principle.
How Plans Are Rated
NCQA accredits and certifies a wide range of health care organizations, and it manages the evolution of Healthcare Effectiveness Data and Information Set (HEDIS®), the performance measurement tool used by more than 90 percent of the nation’s health plans. Health plans are rated in three categories: private/commercial plans in which people enroll through work or on their own; plans that serve Medicare beneficiaries in the Medicare Advantage program (not supplemental plans); and plans that serve Medicaid beneficiaries. NCQA ratings are based on a scale of 5 Stars and include three categories of quality performance: measures of clinical quality from HEDIS; measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®); and results from NCQA’s review of a health plan’s health quality processes (NCQA Accreditation). NCQA rates health plans that choose to report measures publicly.
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About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. In recognition for its leadership in diversity, equity and inclusion, NCQA has won the Excellence in Diversity Award from the Chesapeake Human Resources Association. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more-informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, and on LinkedIn at linkedin.com/company/ncqa.
About UPMC Insurance Services
The UPMC Insurance Services Division serves more than 4.2 million members and is owned and operated by UPMC, a world-renowned health care provider and insurer in Pittsburgh, Pennsylvania. The UPMC Insurance Services Division provides commercial products through UPMC Health Plan for both groups and individuals. Its commercial products also include workers' compensation and employee assistance from nationally known Workpartners®. Government products include Medicare Advantage plans (UPMC for Life); special needs plans for those who are eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); a Medical Assistance plan (UPMC for You); and Children's Health Insurance Program plans (UPMC for Kids). Community Care Behavioral Health Organization—one of the nation's largest nonprofit managed care behavioral health organizations—is also part of the Insurance Services Division. Community Care offers a full range of services to commercial and Medical Assistance members. For more information, visit upmchealthplan.com.
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