Member Resources

On this page you can find electronic copies of many UPMC for You resources, including documents, forms, and more. If you require an alternative format or would like printed copies instead, please call a Health Care Concierge team at 1-800-286-4242 (TTY: 711). Help is available Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 8 a.m. to 8 p.m.

Member Handbook

• Member Handbook (PDF)
• Manual para Miembros (PDF)

Provider Directory

• UPMC for You Provider Directory (PDF)
• Searchable directory

Formulary

• UPMC for You Formulary
  • Programa de medicamentos con receta de UPMC for You
• Pennsylvania Department of Human Services Preferred Drug List (PDL)
• Searchable Formulary

Important Documents

• Authorization to Release Substance Use Health Information Form (PDF)
• Authorization to Release Physical or Behavioral Health Information Form (PDF)
• Consent for Provider Act for Member Grievance Form
• Consent for Provider to File Fair Hearing on Behalf of Member Form
• UPMC for You Dental Advantage BLE form
• Flu Shot Reimbursement Form (PDF)
• Member Authorization to Use/Disclose PHI (PDF)
• Alternate Address Request Form (PDF)
• Member Rights and Responsibilities (PDF)
• Notice of Privacy Practices (PDF)
• Out-of-Network Care Claim Form (PDF)
  • Formulario de Reclamo de Atención Fuera de Red (PDF)
• Personal Representative Designation Form (PDF)
  • Formulario de Designación de Representante Personal (PDF)
  • Personal Representative Designation Form (PDF) - 繁體中文/Mandarin (Chinese)
  • Personal Representative Designation Form (PDF) - ខ្ខ្មែរ/Mon-Khmer (Cambodian)
  • Personal Representative Designation Form (PDF) - Русский/Russian
  • Personal Representative Designation Form (PDF) - नेपाली/Nepali
• Prescription Reimbursement Claim Form (PDF)

Domestic Violence Links

• Pennsylvania Department of Human Services
• National Domestic Violence Hotline – 1-800-799-7233

Food and Nutrition Services

• Women, Infants, and Children (WIC)

Managed Care Organizations (BH-MCOs) by County

• Behavioral Health-MCOs

Pennsylvania Head Start Programs

• Head Start

Medical Assistance Transportation Program

• Medical Assistance Transportation Program (MATP)

Safety Net Health Plans Link

• Association for Community Affiliated Plans (ACAP)

National Museum of Dentistry

• Healthy Smiles for Autism (PDF)

Advance Directives

Advance directives can help participants let others know what medical treatments they do or do not want. The resources below can assist with the development of advance directives.

• Living Will (upmc.com)
• Pennsylvania Hospice and Palliative Care Network Next Step in Care

Newsletter

• Caring for You newsletter, Volume 2, 2026
• Caring for You newsletter, Volume 1, 2026
• Caring for You newsletter, Volume 3, 2025
• Caring for You newsletter, Volume 2, 2025
• Caring for You newsletter, Volume 1, 2025

Prior Authorization Metrics for Medical Items and Services (Excluding Drugs)

To comply with the CMS Interoperability and Prior Authorization final rule, UPMC for You is required to annually report aggregated prior authorization metrics on our website. This includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (approvals, denials, etc.) during the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. If you have questions about the data below, please contact Member Services.

These are the medical items and services for which we require prior authorization (excluding drugs)

Beginning Jan. 1, 2026, the CMS Interoperability and Prior Authorization final rule requires UPMC for You to send prior authorization decisions within:

• 72 hours for expedited requests (urgent)
• 7 calendar days for standard requests (nonurgent).

Standard/Expedited Quantities/Review Time data

This managed care plan may not cover all your health care expenses.

If you have questions about your benefits, call the UPMC for You Health Care Concierge team at 1-800-286-4242 (TTY 711). Representatives are available Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m.; Wednesday from 8 a.m. to 8 p.m.