How the Plan Works
UPMC HealthyU is a unique health insurance plan that rewards you for making healthy choices. As a member, you can earn reward dollars in a health incentive account (HIA) by completing the activities that are recommended for you. These activities are designed to help you understand and improve your health. Here are the plan options for FEHB members:
Both plan options include an HIA in which you can earn up to $250 for Self Only coverage and up to $500 for Self Plus One or Self and Family coverage.
UPMC Health Plan will automatically apply any HIA reward dollars you earn toward eligible out-of-pocket expenses. Please note that, with the HDHP Option PPO, you must meet your deductible before you can use your HIA reward dollars.
Depending on the plan you select, you will pay 15 or 20 percent coinsurance.
The deductible, coinsurance, and copayments apply to your out-of-pocket maximum. The out-of-pocket maximum is the most you'll have to pay in a plan year. Once you meet your maximum, UPMC HealthyU will pay 100 percent of your eligible medical expenses, including prescription and medical copayments.
In addition to allowing you to earn reward dollars, our plans also offer:
- Coverage for preventive care at no cost to you.
- Access to a broad network of care providers and pharmacies including the top-ranked* doctors and hospitals of UPMC.
- Award-winning customer service from UPMC Health Plan’s Health Care Concierge team.**
- All the resources of MyHealth, the acclaimed health and wellness program developed by UPMC.
- Online tools and resources on our secure member website, MyHealth OnLine. Log in to learn about your health plan benefits, get information about your doctors, and track your personal health information. You can even review your prescriptions and receive important reminders for preventive screenings.
- On-the-go access to your member ID card, the status of claims, and more if you download the UPMC Health Plan app.
- Self-guided programs and expert health coaches to help you manage a chronic condition or make lifestyle changes.
- Discounts and savings at gyms and spas, and on sporting goods and health food.
- Preventive Services Guide
UPMC HealthyU is a unique health insurance plan that allows you to earn reward dollars for completing healthy activities. Here are some of the healthy activities that may be incentivized:
- MyHealth Questionnaire: This confidential assessment takes just minutes to complete and will ask you key questions about your health and wellness. Afterward, you’ll receive a wellness score and access to activities that can help you improve your fitness, learn about or manage a condition, or progress toward your health goals.
- Biometric screening: This test can be done at your doctor’s office. It measures your total cholesterol and glucose levels, blood pressure, height, weight, and body mass index.
- Condition or lifestyle management coaching: A health coach can help you manage a chronic condition so you can live your healthiest life. Chronic conditions include heart disease, diabetes, asthma, chronic obstructive pulmonary disease (COPD), and depression. Lifestyle programs include smoking cessation, stress management, physical activity, weight management, and nutrition.
The complete list of activities can be found in the Healthy Activities Guide.
The COVID-19 vaccine is worth a one-time credit of 25 reward dollars for eligible subscribers and their spouses. Here’s how you can receive the credit:
- Complete the FEHB Self-Report Form on our secure member website, MyHealth OnLine.
- Provide a copy of the Centers for Disease Control and Prevention's COVID-19 vaccination card showing the date you received the vaccination.
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You can earn up to $250 for Self Only coverage or $500 for Self Plus One or Self and Family coverage.
Yes. Any unused reward dollars—up to two times your annual deductible—will automatically roll over to the next year.
With the Standard option, your reward dollars can be applied toward your deductible, coinsurance, and prescription drug copayments, regardless of whether your deductible has been met. With the HDHP option, you must meet your deductible before you can use your reward dollars on coinsurance and prescription drug copayments.
No, but if you don't, you'll miss out on savings that can be applied toward your out-of-pocket medical expenses.
It depends on which plan option you choose. If you enroll in the Standard Option HMO, the reward dollars in your health incentive account will automatically be applied toward your deductible if it has not been met. If you enroll in the HDHP option, your reward dollars will only apply after your deductible has been met.
Yes. Any reward dollars you earn will automatically roll over to the plan option you select within UPMC Health Plan.
No. Preventive care is covered at 100 percent even if your deductible has not been met, so they are at no additional cost. Learn about our preventive health services.
*Visit upmchealthplan.com/best for award information.
**UPMC Health Plan earned one of 10 coveted 2022 Grand Stevie® Awards for its exemplary customer service. Grand Stevie trophies are awarded to companies that submit an exceptional body of work for the Stevie Awards competition. More than 2,300 nominations from companies in 51 nations were considered in this year’s competition.
The Health Plan also earned four 2022 Gold Stevie Awards for its sales and customer service excellence.
We are committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all members. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us at 1-855-395-8762 (TTY: 711), and we will work with you and your doctor to find a wellness program with the same reward that is right for you in light of your health status.