Health Insurance Coverage for Individuals and Families
High-quality plans to address your health care needs
We have a variety of plans that are designed to fit the needs of individuals and families. But don't worry about having too many choices! Getting health insurance is all about worrying less.
No matter which plan you choose, you and your family will have access to high-quality health care, generous discounts on vision care and materials, and dental/vision coverage for kids.
Shop Individual and Family Plans
How UPMC Health Plan Serves Individuals and Families
Your 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
- $0 preventive care covers many health services for adults and children at 100 percent1
- No-cost preventive medications2
- Access to top-ranked doctors and hospitals and an extended network3,4
Help to take care of your mental and physical health
- Six free counseling sessions through LifeSolutions®5
- Free health coaching to help you make healthy changes in your life
- The RxWell® app to support your total well-being
Support when you need it
- Virtual urgent care 24/7 for treatment that fits your schedule and is covered at 100 percent by most plans6
- 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
How to shop UPMC Health Plans:
- Shop online. Use our shopping tool to find plan options that fit your needs and budget. Just tell us a little bit about yourself, and we'll show you plans that match.
- Shop by phone. If you have a question about a plan, need more information, or want our help walking through a purchase, we can help! We can be reached at 1-877-563-0292 (TTY: 711):
- Nov. 1, 2024, to Jan. 15, 2025: Monday to Friday from 8 a.m. to 7 p.m. and Saturday 8 a.m. to 1 p.m.
- Jan. 16 to Oct. 31, 2025: Monday through Friday from 8 a.m. to 5 p.m.
- Hours may vary
Browse Networks
For residents of Allegheny, Bedford, Blair, Butler, Clinton, Erie, Greene, Lawrence, Lycoming, McKean, Mercer, Potter, Somerset, Tioga, Venango, and Washington counties
The UPMC Partner Network is our most affordable network option. The network includes all UPMC providers as well as some non-UPMC providers. In a true emergency, you can seek care from any emergency department, even if the hospital is not in the Partner Network. The emergency care you receive will be covered at the in-network benefit level.
Partner Network Overview (PDF)
Find Partner Network Providers
For residents of Allegheny, Beaver, Butler, Fayette, Washington, and Westmoreland counties
The UPMC Select Network includes all UPMC providers as well as a select group of non-UPMC providers. Like the Partner Network, the Select Network is designed to encourage you to seek care from UPMC providers. However, the Select Network covers more non-UPMC providers than the Partner Network. You can seek care from any emergency department in a true emergency situation, even if the hospital is not in the Select Network. The emergency care you receive will be covered at the in-network benefit level.
For residents of Clearfield and Crawford counties
The UPMC Standard Network gives you access to many high-quality providers. This includes all UPMC doctors and hospitals, a certain group of non-UPMC providers, and most community hospitals.
You must select a primary care provider and get a referral to see most specialists. In an emergency, you can visit any emergency department. Your emergency care will be covered at the highest benefit level, even if the hospital does not participate with UPMC Health Plan.
Standard Network Overview (PDF)
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
The UPMC Premium Network—our highest-priced and broadest network and it is available throughout our service area. This network allows you to use in- and out-of-network providers. The Premium Network also offers the most flexibility in terms of cost sharing. You may pay less if you choose in-network providers than if you choose out-of-network providers. You can seek care from any emergency department in a true emergency situation, even if the hospital is not in the Premium Network. The emergency care you receive will be covered at the in-network benefit level.
Premium Network Overview (PDF)
Find Premium Network Providers
Check Marketplace Formulary
Sample Individual and Family Plan Policies
Below are sample policy documents outlining the terms of coverage relative to various products offered by UPMC Health Plan Inc. and its affiliates, including UPMC Health Options Inc. and UPMC Health Coverage Inc. Please note that if you enroll in any product offered by UPMC Health Plan Inc. or its affiliates, you will receive policy documents outlining the terms of coverage specific to the product in which you enroll.
Sample 2025 Individual and Family Plan Policies
UPMC Advantage HMO Policy
UPMC Advantage & First Care PPO Policy
UPMC Advantage PPO HSA Policy
UPMC Advantage EPO HSA Policy
UPMC Advantage UPMC VirtualCare & First Care EPO Policy
UPMC Advantage HMO HSA Policy
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.
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 $2,500/10%, or UPMC Advantage Catastrophic $9,200/$0 plan, 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.
Contact the plan for more information. Limitations, copayments, and restrictions may apply.