How to use health insurance

Do you have questions about how to use your UPMC Health Plan Individual or Family plan? You are in the right place! The information on this page can help you understand how to use your health insurance plan. It can guide you on everything from how to access care to ways to make the most of your coverage. Remember that the information on this page applies only to members of UPMC Health Plan Individual and Family plans. If you are a member of another plan type, please refer to guidance specific to your plan.

Why health insurance is important

Health insurance protects you from big costs if you get sick or hurt. 

It also makes getting checkups and screenings easier.

You can choose a primary doctor who will get to know you and help you manage your health. 

They can catch any health issues before they become serious.

Where you can use your health insurance

There are four network options for UPMC Health Plan Individual and Family plans. All provide full in-network access to UPMC doctors and hospitals, as well as community providers. View the network options that are available in your county:

  • UPMC Partner Network: For residents of Allegheny, Bedford, Blair, Butler, Clinton, Erie, Greene, Lawrence, Lycoming, Mercer, McKean, Potter, Somerset, Tioga, Washington, and Venango counties
  • UPMC Select Network: For residents of Allegheny, Beaver, Butler, Fayette, Washington, and Westmoreland counties
  • UPMC Standard Network: For residents of Crawford and Clearfield counties
  • UPMC Premium Network: For residents of Allegheny, Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Clarion, Clinton, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lackawanna, Lawrence, Lebanon, Luzerne, Lycoming, McKean, Mercer, Perry, Potter, Somerset, Sullivan, Tioga, Venango, Warren, Washington, Westmoreland, and Wyoming counties 

Provider 
Doctor, hospital, urgent care center, or other health care facility.

Network
Also called "provider network." It includes doctors, hospitals, and other providers who contract with your plan. They provide services at a negotiated rate of payment.

Our network options include all the world-renowned hospitals of UPMC and many community hospitals in the areas you call home. Our flexible plans adapt to your needs so you can choose the network that works best for you. You can even save money by narrowing down your hospital network to the locations to which you’re most likely to go. Why pay for what you don't need?

What is a healthcare provider?

A healthcare provider is a doctor, hospital, urgent care center, or other care facility.

What are provider networks?

Provider networks are made up of doctors, hospitals, and other care providers who contract with your plan. They provide services at a negotiated rate of payment.

Our network options include all UPMC provider and many community doctors and hospitals. And you can save money by narrowing your hospital network to the locations you’re most likely use. Why pay for what you don't need?

How to use your health insurance benefits

UPMC Health Plan offers benefits well beyond network access and high-quality care, and we want you to make the most of your coverage.

Your 2027 plan will put all the resources you need to manage your health within easy reach:

Access to the care you need to get or stay healthy

Help to take care of your mental and physical health

Support when you need it

  • Telehealth services—including 24/7 video visits, behavioral health support, and health coaching—covered at 100 percent by most plans5
  • The UPMC Health Plan app for easy access to your health insurance information
  • Our exceptional Health Care Concierge team, which can help you navigate your benefits with a quick chat or phone call

1Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

2Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.

3Go to upmchealthplan.com/best for award information. For network access details, visit upmchp.us/networkaccess.

424/7 video visits are available to UPMC Health Plan members who are located in Pennsylvania at the time of the visit. The service is available to members of your household who are 18 years old or older. If further counseling is needed, the counselor may refer you or your household members to relevant community resources.

524/7 video visits are available only to UPMC Health Plan members who are in Pennsylvania at the time of their virtual visit. Members may select a UPMC provider, subject to provider availability and discretion. Members or the member’s parent or legal guardian must accurately verify their physical location and that they are in Pennsylvania at the time of the visit. Limitations may apply for members of administrative services only (ASO) plans who have opted out of coverage. A parent or legal guardian must be present during the video portion of the visit for children younger than 18. Providers employed or contracted by UPMC retain discretion regarding the treatment of patients ages 0-2. 24/7 video visits for children ages 0-2 are unavailable from 11 p.m. to 7 a.m. in Pennsylvania.