What's New for 2022
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)
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.
- 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.
- 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.