We have a variety of plans to fit all needs. But don't worry about having too many choices! Getting health insurance is all about worrying less.
No matter which plan you choose, you and your family will have access to high-quality health care, generous discounts on vision care and materials, and dental/vision coverage for kids.
Your plan will put all the resources you need to manage your health within easy reach:
Providing access to care to help keep you healthy.
Helping you take care of your mental and physical health.
Supporting you when you need it.
For residents of Allegheny, Bedford, Blair, Clinton, Erie, Lawrence, Lycoming, Mercer, Somerset, Tioga, and Venango counties
The UPMC Partner Network is our most affordable network option. The network includes all UPMC providers as well as some non-UPMC providers. In a true emergency, you can seek care from any emergency department, even if the hospital is not in the Partner Network. The emergency care you receive will be covered at the in-network benefit level.
For residents of Allegheny, Beaver, Butler, Fayette, Washington, and Westmoreland counties
The UPMC Select Network includes all UPMC providers as well as a select group of non-UPMC providers. Like the Partner Network, the Select Network is designed to encourage you to seek care from UPMC providers. However, the Select Network covers more non-UPMC providers than the Partner Network. You can seek care from any emergency department in a true emergency situation, even if the hospital is not in the Select Network. The emergency care you receive will be covered at the in-network benefit level.
For residents of Clearfield and Crawford counties
The UPMC Standard Network gives you access to many high-quality providers. This includes all UPMC doctors and hospitals, a certain group of non-UPMC providers, and most community hospitals.
You must select a primary care provider and get a referral to see most specialists. In an emergency, you can visit any emergency department. Your emergency care will be covered at the highest benefit level, even if the hospital does not participate with UPMC Health Plan.
For residents of Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clinton, Cumberland, Columbia, Dauphin, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mercer, Northampton, Northumberland, Perry, Potter, Schuylkill, Snyder, Somerset, Sullivan, Tioga, Union, Venango, Warren, Washington, Westmoreland, Wyoming, and York counties
The UPMC Premium Network—our highest-priced and broadest network and it is available throughout our service area. This network allows you to use in- and out-of-network providers. The Premium Network also offers the most flexibility in terms of cost sharing. You may pay less if you choose in-network providers than if you choose out-of-network providers. You can seek care from any emergency department in a true emergency situation, even if the hospital is not in the Premium Network. The emergency care you receive will be covered at the in-network benefit level.
Below are sample policy documents outlining the terms of coverage relative to various products offered by UPMC Health Plan Inc. and its affiliates, including UPMC Health Options Inc. and UPMC Health Coverage Inc. Please note that if you enroll in any product offered by UPMC Health Plan Inc. or its affiliates, you will receive policy documents outlining the terms of coverage specific to the product in which you enroll.
Sample 2024 Individual and Family Plan Policies
1 Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.
2 Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.
3 Go to upmchealthplan.com/BEST for award information.
4 UPMC Health Plan commercial members and their dependents who reside or are traveling in Ohio will continue to access care through the SuperMed PPO Network and, while traveling outside of the state of Ohio, can also utilize the Cigna PPO Network.
5 UPMC AnywhereCare Virtual Counseling is available to UPMC Health Plan members who are located in Pennsylvania at the time of the visit. The service is available to members of your household who are 18 years old and older. If further counseling is needed, the counselor may refer you or your household members to relevant community resources.
6 Only the virtual visit with the provider will be covered at 100 percent. Prescription drug and other costs related to the visit or recommended by the provider will not be included in the virtual visit coverage and will be your responsibility. If you are enrolled in the UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $2,500/10%, or UPMC Advantage Catastrophic $9,450/$0 plans, UPMC AnywhereCare virtual visits will be covered at 100 percent after you meet your deductible. This information is not a complete description of benefits.
Contact the plan for more information. Limitations, copayments, and restrictions may apply.
