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, pertussis (Tdap) vaccine and those for the flu and shingles.†† If you have children covered under your plan, they’ll be covered at 100 percent for a variety of screenings and immunizations.
During a routine exam covered at 100 percent, your doctor may find something requiring follow-up care. What then? Here’s a good rule of thumb: (1) If your routine preventive service leads to the need for follow-up care, or (2) if you’re being treated for injury or illness, those services will likely be covered, but not at 100 percent.
For a list of preventive services your plan covers at no cost to you, log in to MyHealth OnLine, click on Your Insurance, and go into Plans and Coverage. Once here, choose the coverage type you'd like to see (Medical, Vision, or Dental) to view your Schedule of Benefits.
View Preventive Guidelines for Adults and Children
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 urge everyone 6 months and older to get an annual flu shot.
The flu vaccine prevents millions of illnesses and flu-related doctor’s visits each year.*
Read more flu facts and get answers to frequently asked questions in our flu resources blog.
Flu shots are available at your doctor’s office, participating urgent care centers, or and local pharmacies,** including Giant Eagle and Rite Aid. 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 or use your UPMC Health Plan Login to complete the digital flu shot reimbursement form on MyHealth OnLine.
*Source: Centers for Disease Control and Prevention
**Pennsylvania pharmacies by state law are generally only permitted to administer the flu vaccine to children ages 9 and older, but may, until Dec. 29, 2021, administer the flu vaccine to children ages 3 and older.
Lung cancer is the leading cause of cancer death for both men and women in the United States. Low-dose computerized tomography (CT) is a new screening† test that can improve lung cancer survival rates by finding signs of the disease at an earlier stage. Finding cancer early makes it easier to cure. Doctors use a low-dose CT scan of the lungs to look for signs of lung cancer.
Older adults who have smoked for a long time should get this test. Read our Q&A about the low-dose CT scan to decide if you should be tested.
Want personalized recommendations to help you take charge of your health? Use the U.S. Department of Health and Human Services’ myhealthfinder tool below. Enter your information and click on the “get started” button to find out which preventive services you should consider this year.
†The medical term for testing to find a disease before it causes symptoms.
††For our UPMC for Life plans, the shingles vaccine is covered under your Part D plan benefits. To check if your plan has Part D prescription drug coverage, see your Summary of Benefits.