How the Plan Works
UPMC HealthyU consists of two plan options that provides a complete spectrum of coverage including doctor and hospital visits, prescription drugs, and more. When you choose a participating provider, preventive care is always covered at 100 percent even if you haven't met the deductible. These plan options are:
Both plan options include a health incentive account (HIA) that enables you to earn up to $250 for Self Only coverage and up to $500 for Self Plus One and Self and Family coverage. Please note that your deductible must be met in the HDHP option. UPMC Health Plan automatically applies any HIA dollars you have accumulated toward the plan cost-sharing for deductible, coinsurance, and pharmacy copays with the Standard Option HMO and coinsurance and pharmacy copays after the deductible has been met in the HDHP option..
Depending on the option you select, you will pay 15 or 20 percent coinsurance. If you have earned HIA funds, they will help with this.
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 one plan year. At that point HealthyU pays 100 percent of your eligible medical expenses, including prescription and medical copayments.
UPMC HealthyU is a unique health insurance plan that allows you to earn reward dollars for completing healthy activities. Here are some of the most important healthy activities that may be incentivized:
- MyHealth Questionnaire – This confidential assessment takes 20 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 health screening can be done at your doctor’s office and measures your total cholesterol and glucose levels, as well as your blood pressure, height, weight, and body mass index (BMI).
- Condition or lifestyle management coaching – A health coach will help you manage a chronic condition, so you can live your healthiest life possible. Chronic conditions include heart disease, diabetes, asthma, 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 Activities Guide.
In addition to earning reward dollars that can be used for your out-of-pocket medical expenses, HealthyU also offers:
- 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-only website: MyHealth OnLine. Log in to learn more about your health plan benefits, get personalized 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, status of claims, and more if you download the UPMC Health Plan mobile app.
- Self-guided programs and expert health coaches to help you manage a chronic condition or make lifestyle changes.
- Discounts and savings at gyms, spas, and sporting goods and health food.
- 2021 Preventive Services Guide
- Healthy Activities Guide
*Visit upmchealthplan.com/best for award information.
**UPMC Health Plan has earned one of 10 coveted 2021 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.
In 2021, the Health Plan also earned five Gold Stevie Awards for its sales and customer service excellence, including Best Back-Office Customer Service Team and Sales Support Team of the Year.
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, 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.