Preventive Services to Help You Stay Well
At UPMC Health Plan, we believe the disease or condition that’s easiest to treat is the one you never get. That’s why we cover so many preventive services for children and adults at 100 percent—which means you pay nothing.
These services fall into three categories:
- Health exams
Common adult screenings include well-visits, breast cancer screenings, cervical cancer screenings, and colorectal cancer screenings. Common adult immunizations include the tetanus, diphtheria, and pertussis (Tdap) vaccine as well as those for the flu and shingles.2 If you have children covered under your plan, they are also covered at 100 percent for a variety of developmentally appropriate screenings and immunizations.
During a routine preventive exam, your doctor may find something that requires follow-up care. What then? If your routine preventive service leads to the need for follow-up care, or if you need to be treated for an injury or illness, those additional services will likely be covered—but not at 100 percent.3
For a list of preventive services that your plan covers at no cost to you, log in to MyHealth OnLine, click on Your Insurance, and go to Plans and Coverage. Once here, choose a type of coverage (medical, vision, or dental) to view your Schedule of Benefits.
View Preventive Guidelines for Adults and Children (PDF)
Getting the flu shot is free and easy
Even if you’re healthy, you can still get the flu and spread the virus to others. That’s why the Centers for Disease Control and Prevention (CDC) urges everyone over 6 months old to get an annual flu shot. (Some children may need two doses to have the best protection, according to the CDC.4)
Getting the vaccine could help prevent millions of people from getting sick and/or having to seek treatment from a doctor for flu-related issues.5
Read more flu facts and get answers to frequently asked questions in our flu resources blog.
Flu shots are available at your doctors' offices, participating urgent care centers, or local pharmacies,6 including Rite Aid, Giant Eagle, Martin's, CVS, Giant, and many independent pharmacies.7 When you show your health care member ID card, your shot will be free.
If you have to pay for your shot, we will reimburse you. All you have to do is fill out and submit the flu shot reimbursement form (PDF) (UPMC for Kids flu shot reimbursement form (PDF)) or use your UPMC Health Plan Login to complete the digital flu shot reimbursement form on MyHealth OnLine.
Want personalized recommendations to help you take charge of your health? Use the U.S. Department of Health and Human Services’ myhealthfinder tool. Enter your information and click on the “Get Started” button to find out which preventive services you should consider having this year.
1This is the medical term for testing to find a disease before it causes symptoms.
2If you have a UPMC for Life plan, the shingles vaccine is covered under your Part D plan benefits. To check whether your plan has Part D prescription drug coverage, see your Summary of Benefits.
3Call the number on your member ID card for additional information and/or help finding an in-network provider.
4Vaccines for Your Children. Centers for Disease Control and Prevention. Reviewed Aug. 2, 2019. Accessed Aug. 31, 2022. cdc.gov/vaccines/parents/diseases/flu.html.
5Source: Centers for Disease Control and Prevention
6Pursuant to the Pennsylvania Immunization Bill (Act 80 of 2022), licensed pharmacists, by state law, may administer the influenza and COVID-19 vaccines (collectively "vaccines") to individuals 5 years old and older. Based upon amendments to the Public Readiness and Emergency Preparedness (PREP) Act, state-licensed pharmacists may administer vaccines to persons 3 years old and older. This provision of the PREP Act will expire on Dec. 31, 2024.
7The listed pharmacies are in-network for members who reside in Pennsylvania as of October 2024. If you are an out-of-state member or need further assistance finding a pharmacy, please call the number on your member ID card.