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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:

  • Screenings
  • Immunizations
  • Health exams

Common adult screenings include cholesterol, blood pressure, mammograms, and colonoscopies. 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.

Please note that 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.

So...what exactly is covered at 100 percent?

The Affordable Care Act requires that certain preventive services are covered at no cost to you.*

For a listing of what your plan covers at 100 percent, log in to MyHealth OnLine and click on the Plan Documents tab.

*Under some employers’ plans that are “grandfathered” under the ACA, you may have to pay all or part of the cost of routine preventive services. Please refer to your specific Schedule of Benefits.

View Preventive Guidelines for Adults and Children


Get the Flu Shot

According to the Centers for Disease Control and Prevention (CDC), the flu virus causes around 200,000 hospitalizations in the United States each year. Getting the flu shot is the first and most important way to protect yourself and your family during flu season.

Go to your doctor’s office, Giant Eagle, or Rite Aid* to get your flu shot. As a UPMC Health Plan member, your flu shot is free of charge when you show your member ID card.

If you get your flu shot at another location, we will reimburse you if you are required to pay for it up-front. All you have you have to do is fill out and submit the reimbursement form.

*Only applies to pharmacy locations in Pennsylvania. Pharmacies, by state law, are not permitted to administer vaccines to children under the age of 10.

Lung Cancer Testing for People at High Risk

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. Learn more about the screening and see if you should be tested.

*The medical term for testing to find a disease before it causes symptoms.

Myhealthfinder Tool

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 what preventive services you should consider this year.

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