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Plan Options and Rates

What's New for 2022

Changes to the Service Area

The Eastern Pennsylvania service area and its corresponding enrollment codes have been eliminated from our service area. The Eastern Pennsylvania counties that are eliminated from the UPMC Health Plan service area are: Berks, Clinton, Cumberland, Dauphin, Juniata, Lackawanna, Lancaster, Lehigh, Luzerne, Lycoming, Mifflin, Northampton, Northumberland, Perry, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, and Wayne. The following plan options and enrollment codes for the eliminated Eastern Pennsylvania service area are:

Standard Option

  • YT4 (Self Only)
  • YT6 (Self Plus One)
  • YT5 (Self and Family)

High Deductible Health Plan (HDHP) Option

  • YS4 (Self Only)
  • YS6 (Self Plus One)
  • YS5 (Self and Family)

Changes to both the Standard Option HMO and HDHP Option PPO

Through UPMC Health Plan's HealthyU incentive program, members are eligible to receive a $25 health incentive reward for obtaining their COVID-19 vaccination. You must provide a Centers for Disease Control and Prevention COVID-19 Vaccination Card as proof of attestation for receiving the vaccination. The annual maximum Health Incentive reward dollars per year remains $250 for Self-Only coverage and $500 for Self and Family and Self Plus One coverage.

Changes to the Standard Option HMO only

  • Your share of the premium will increase for Self-Only/Self Plus One/Self and Family.
  • Iatrogenic infertility has been added to the list of covered infertility treatments (see page 37 for complete benefit description). Your cost-sharing is 20% of our allowance after the calendar year deductible up to a $25,000 per member maximum lifetime benefit. Coverage of member’s preserved specimen is only available while the member is enrolled in UPMC Health Plan. You are responsible for the cost once the member’s enrollment terminates or reaches the $25,000 maximum lifetime benefit. PriorAuthorization is required.
  • The list of gender reassignment procedures has been updated to include only the following:
    • Male to female – Orchiectomy, penectomy, penile inversion vaginoplasty, and labiaplasty
    • Female to male – Mastectomy, oophorectomy, salpingoophorectomy, hysterectomy, vaginectomy, metoidioplasty, phalloplasty, and scrotoplasty

    Your cost sharing will continue to be 20 percent of our allowance after the calendar year deductible.

    Changes to the HDHP Option PPO only

    • Your share of the premium will increase for Self-Only/Self Plus One/Self and Family.
    • Iatrogenic infertility has been added to the list of covered infertility treatments (see page 94 for complete benefit description). Your cost-sharing is 15 percent of our allowance after the calendar year deductible up to a $25,000 per member maximum lifetime benefit. Coverage of member’s preserved specimen is only available while the member is enrolled in UPMC Health Plan. You are responsible for the cost once your enrollment terminates or reaches the $25,000 maximum lifetime benefit. Prior authorization is required.

    The list of gender reassignment procedures has been updated to include only the following:

    • Male to female – Orchiectomy, penectomy, penile inversion vaginoplasty, and labiaplasty
    • Female to male – Mastectomy, oophorectomy, salpingoophorectomy, hysterectomy, vaginectomy, metoidioplasty, phalloplasty, and scrotoplasty

      The member's cost-sharing will continue to be for in-network services 15 percent of covered charges after the calendar year deductible and for out-of-network services 40 percent of covered charges after the calendar-year deductible.

Standard Option HMO

Our Standard Option HMO plan offers a high-value plan for a low monthly premium. You can use the reward dollars earned in your health incentive account (HIA) to pay for coinsurance, pharmacy copayments, and deductible.

Learn more about Standard Option HMO

High-Deductible Health Plan Option PPO

Our High-Deductible Health Plan (HDHP) Option PPO comes with a health savings account (HSA) that you can use for qualified health care expenses.

Learn more about HDHP Option PPO

2021 Plan Information

Read the summary of benefits and coverage documents for the 2021 benefit year.

View 2021 plan information

Pennsylvania Service Area Rates

View the Pennsylvania service area rates for our FEHB plans.

View our PA service area rates
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It is important to know that when you enroll in this plan, services are provided through UPMC Health Plan's participating providers as described in UPMC Health Plan's federal brochure — but the continued participation of any one doctor, hospital, or other provider cannot be guaranteed.

Continue to UPMC Health Plan online provider search
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