Please use the chart below to determine your next steps.
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 may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.
2Tier 5 preventive 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.
4UPMC Health Plan commercial members and their dependents who reside or are traveling in Ohio will continue to access care through the SuperMed PPO Network and, while traveling outside of the state of Ohio, can also utilize the Cigna PPO Network.
5UPMC AnywhereCare Virtual Counseling is 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 and older. If further counseling is needed, the counselor may refer you or your household members to relevant community resources.
6Only the virtual visit with the provider will be covered at 100 percent. Prescription drug and other costs related to the visit or recommended by the provider will not be included in the virtual visit coverage and will be your responsibility. If you are enrolled in the UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $3,000/$0, or UPMC Advantage Catastrophic $9,100/$0 plans, UPMC AnywhereCare virtual visits will be covered at 100 percent after you meet your deductible. This information is not a complete description of benefits.
Contact the plan for more information. Limitations, copayments, and restrictions may apply.