Some COVID-19-related benefits will be extended through Dec. 31 with $0 cost share for UPMC for You members
As previously communicated, UPMC Health Plan will retire Appendix A – COVID-19 Special Coverage and Payment Policy for all lines of business on Sept. 30, 2024. However, UPMC Health Plan will extend the $0 cost share until Dec. 31 for the following services for UPMC for You members when the services are clinically indicated and consistent with generally accepted practice guidelines based on an individual assessment by the member’s attending provider:
- COVID-19 diagnostic lab testing
- Over-the-counter (OTC) COVID-19 testing1
- Evaluation for a COVID-19 diagnosis
- Treatment for COVID-19-related diagnosis
COVID-19 vaccines (FDA-authorized agents) are covered with $0 member cost sharing for vaccine administration at all licensed providers and pharmacies. Note: When the government provides COVID-19 vaccines at no cost, providers should bill only for vaccine administration.
If you have any questions, please contact your physician account executive or call Provider Services at 1-866-918-1595.
1For Medicaid: Coverage includes up to 8 FDA-authorized OTC rapid tests every 28 days per covered individual when the tests purchased directly from a retail store or retailer website through 12/31/24. When purchasing through a participating pharmacy, coverage is limited to 2 COVID-19 OTC tests per 7 days for up to 8 tests in a 28-day time period. Members are eligible to purchase rapid at-home OTC COVID-19 tests for $0 through participating pharmacies or submit for reimbursement after purchasing from retailers.