Enrollment
Have access to the tools you need to enroll your clients in one of your UPMC for Life plans, including how the enrollment process works.
Enrollment application process
Learn how the enrollment application process works and all the ways that your clients can easily enroll and make sure to complete the pre-enrollment checklist.
2027 Enrollment applications
- Allegheny County
- Bedford, Blair, and Somerset counties
- Butler, Clarion, and Westmoreland counties
- Central PA
- HMO/PPO plans – Western PA
- Huntingdon County
- Indiana County
- Northeastern PA
- Northwestern PA
- Ohio
- PPO Salute
- Southwestern PA
- UPMC for Life Complete Care (HMO D-SNP)
2027 Enrollment kits
- Allegheny MA PA Kit
- Butler Clarion Westmoreland MA Kit
- Southwestern PA MA Kit
- Northwestern PA MA Kit
- Indiana MA Kit
- Bedford Blair Somerset MA Kit
- Huntingdon MA Kit
- Central PA MA Kit
- Northeastern PA MA Kit
- Veterans MA Kit
- Veterans Southeastern PA MA Kit – Southeast PA
- OH MA Kit – Harrison and Jefferson counties
- HMO Ded Rx HMO Rx Enh PPO High Ded Rx PPO Rx Enh WPA MA Kit
- UPMC for Life Complete Care SNP Kit – Northeastern PA
- UPMC for Life Complete Care SNP Kit – Southeastern PA
- UPMC for Life Complete Care SNP Kit – Southwestern and South Central PA
- UPMC for Life Complete Care SNP Kit – Northwestern and North Central PA
- UPMC for Life Complete Care SNP Kit – Bedford, Blair, Cambria, Huntingdon, and Somerset counties
2026 Enrollment applications
- Allegheny, Erie, and NWPA
- Berks County
- Carbon County/South Central/North Central
- Cumberland/Dauphin/Lancaster/Lycoming
- HMO/PPO plans – Central PA
- HMO/PPO plans – Western PA
- Johnstown/Altoona
- Northeastern PA
- Ohio
- PPO Salute
- PPO Salute – Southeastern PA
- Southwestern PA
- UPMC for Life Complete Care (HMO SNP) application
- Westmoreland County
- York County
Agent of record (AOR) change form
Your client must fill out the form linked below to transfer agent of record.