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Welcome to UPMC Health Plan

This page outlines everything you can do to get the most out of your coverage. It’s a good idea to bookmark this page for reference.

Once you get your member ID number:

  • Create your MyHealth OnLine account.
    It's quick and easy to create an account. Once you sign up you can use our secure, members-only website to find an in-network provider, get inspiration to make healthy changes, and learn about your UPMC Health Plan benefits.

    Already have an account?
  • Understand your coverage.
    • View your Schedule of Benefits: This document is a broad list of the medical services covered under your plan, and it details levels of coverage provided for them. Before you seek care from any providers, review your Schedule of Benefits for detailed information about your copayment, coinsurance amounts, and your out-of-pocket limit.

      Find your Schedule of Benefits by logging in to your MyHealth OnLine account and following this path:
      MyHealth OnLine > Your Insurance > Plans and Coverage
      Then, select the appropriate link to view your medical, vision, or dental information.

    • Getting the right care at the right time is important. As a UPMC Health Plan member, you have options when you experience an illness or injury.
  • Understand the costs of your plan.
    • Enrolled for coverage through your employer? You will pay your share of the cost through a payroll deduction.
    • Purchased insurance coverage on your own? Learn how to pay your monthly bill.
    • Your Explanations of Benefits (EOBs) are a history of what you and your covered family members have paid during the plan year toward your out-of-pocket maximum.
 

After your effective date:

  • Take your MyHealth Questionnaire.
    Log in to your MyHealth OnLine account and click on Better Health and Wellness, then go to Resources for Healthier Living. After you click Browse by Resource Type, you will find your MyHealth Questionnaire in the Online Activities Section. Once you complete the questionnaire, you will get a confidential overview of your health, a personalized wellness plan, and easy-to-follow advice to help you feel your best.
  • Submit any necessary forms.
    • Transition of Care (TOC) form: If you joined UPMC Health Plan while receiving ongoing treatment from a nonparticipating provider, you can request to keep receiving care from your current provider for up to 90 days from the date your UPMC Health Plan coverage begins (your effective date). To get started, electronically complete all the fields on this form to email to your provider. You can also print the form, fill out the fields in black ink, and mail or fax it to your provider. Your provider must return the form to UPMC Health Plan within 30 days of your effective date.
    • Personal Representative Designation (PRD) form: Your dependents must complete, sign, and date a Personal Representative Designation form to give UPMC Health Plan permission to share their personal health information with you, a guardian, a family member, or another custodian.
    • View any other forms regarding your coverage and benefits on MyHealth OnLine.
  • Take advantage of our programs and tools to help you live your healthiest life.
  • Choose your primary care provider.
    Make searching for a primary care provider (PCP) a priority. Your PCP’s goal will be to keep you healthy and give you the best possible care. You can designate your PCP on MyHealth OnLine.
  • Get the most from your pharmacy benefits.
    Find a pharmacy near you, get a personal review of your medications, and be sure your medications are covered with our drug search tool.

Have questions? Call our award-winning Member Services team.

We work hard to make sure you can easily get answers to your health care questions or concerns. Call Member Services at the number on your ID card Monday through Friday from 7 a.m. to 7 p.m. and Saturday from 8 a.m. to 3 p.m. TTY users should call 711. Members of the team are dedicated to helping you navigate the world of health care. Learn more about our Member Services team.