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Using Health Insurance

Why you need health insurance


  • It protects you from big surprise costs if you get sick or hurt.

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

  • It makes getting checkups and screenings easier.

  • You can catch problems before they become serious.

Where you can use it

Our UPMC Advantage individual and family plans include four network options so you can choose the network that works best for you. You will have full in-network access to all UPMC doctors and hospitals in your community, as well as other providers. Click below to view the network options available in your county:

  • UPMC Partner Network (for residents of Allegheny, Bedford, Blair, Clinton, Erie, Lawrence, Lycoming, Mercer, Somerset, Tioga, 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 (Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clinton, Cumberland, Columbia, Dauphin, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mercer, Northampton, Northumberland, Perry, Potter, Schuylkill, Snyder, Somerset, Sullivan, Tioga, Union, Venango, Warren, Washington, Westmoreland, Wyoming, and York counties)

Provider

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

Network

Also called "provider network." The network 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?

How you can use it

When you buy health insurance, you want to get the most out of it. UPMC Health Plan offers benefits well beyond network access and high quality care.

As a member, you'll have access to:

  • $0 preventive care that can help you and your family stay healthy. Screenings, immunizations/vaccines, and health exams for adults and children are covered at 100 percent.1
  • No-cost preventive medications.2
  • RxWell, a free app that you can use to cope with mental health and wellness—and build a stronger you.
  • Top-ranked doctors and hospitals, plus a national extended network when you need it.3
  • Urgent care anytime, anywhere—covered at 100 percent—through UPMC AnywhereCare4, 5 and UPMC Children's AnywhereCare.6
  • Six free counseling sessions through LifeSolutions®.7 You can use these sessions over-the-phone or virtually with the UPMC AnywhereCare app, to discuss your family, relationship, or work concerns. You can also have free consultations related to financial wellness, legal issues, and more.
  • Our exceptional Health Care Concierge team. This team can help you understand your insurance and make the most of your benefits.
  • Free health coaching to support you in making lifestyle changes or managing a health condition.
  • The UPMC Health Plan mobile app, which puts your insurance, care, and wellness information in the palm of your hand. You can easily see as snapshot of your health care spending, find in-network providers, complete your wellness questionnaire, live chat with a Health Care Concierge, and more.

1. Preventive 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.

2. Tier 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.

3. Go to upmchealthplan.com/BEST for award information.

4. UPMC Health Plan members located in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider or a provider from Online Care Network II PC (OCN), subject to availability and discretion of the provider. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.

5. Only 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 or Gold HSA $3,100/$0 plan or the Catastrophic $8,700/$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.

6. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit.

7. UPMC 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.

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