Erie Member Guide

35 1 UPMC nurses who answer calls are licensed to assist members located in Pennsylvania, West Virginia, Virginia, New York, and Ohio. Members must be located in one of those states when calling the UPMC My Health 24/7 Nurse Line. The UPMC My Health 24/7 Nurse Line is not a substitute for medical care. If an emergency arises, call 911 or go to the nearest emergency department. Nurses cannot answer plan or benefit questions. Please call the Member Services phone number on the back of your member ID card for nonclinical inquiries. 2 UPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II PC (OCN), subject to availability and provider discretion. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC. 3 The Travel Concierge Program is applicable only in the states of Arizona, Florida, Georgia, North Carolina, South Carolina, and Tennessee. HMO members will be charged in-network cost sharing for covered services received from any provider that accepts Medicare. All members are charged the applicable cost sharing for emergency and urgent care as listed in the Evidence of Coverage. 4 The routine vision allowance does not apply to glasses after cataract surgery. It is excluded from the yearly deductible, if applicable, and does not count toward your annual maximum out-of-pocket. 5 Members must use a participating dental provider. Go to upmchealthplan.com/find to find participating dental providers. You are responsible for any costs not covered under preventive dental or the comprehensive dental allowance (if covered by your plan). Dental care copays and the dental allowance are excluded from the yearly deductible, if applicable, and do not count toward the annual maximum out-of-pocket. 6 Members must use a participating hearing provider. Go to upmchealthplan.com/find to find participating hearing providers. Routine hearing copays and the hearing aid allowance are excluded from the yearly deductible, if applicable, and do not count toward your annual maximum out-of-pocket. . 7 The over-the-counter allowance cannot be used to pay for your Part B or Part D prescription drug costs. 8 UPMC for Life does not install bathroom safety devices or reimburse for costs associated with the installation of bathroom safety devices. UPMC for Life is not liable for improper installation, repairs, or other modifications. Members are responsible for any and all costs associated with installation. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries.