UPMC for Life members may have changes to out-of-pocket costs related to COVID-19 after the public health emergency ends on May 11, 2023.
Information about what’s changing is listed below. Cost-sharing varies based on plan type. You can find more information on these changes in the below documents.
You can also refer to your Evidence of Coverage or Summary of Benefits by logging into the UPMC Health Plan app or MyHealth OnLine.
COVID-19 vaccines and boosters will continue to be available at no cost to members from in-network providers, even after the public health emergency ends.
Diagnostic testing†
Now through May 11, 2023, we are waiving deductibles, copayments, and other cost-sharing for COVID-19 diagnostic testing when ordered by your medical provider. After May 11, your plan’s standard cost-sharing will apply for this service. See your plan Summary of Benefits for the cost-sharing amounts.
Over-the-counter tests
New! Starting May 12, 2023, if your plan includes the UPMC for Life Flex Spend Card, you can use it to buy over-the-counter COVID-19 tests. OTC tests are also covered at no cost through Medicare through May 11, 2023. Here’s how to get no-cost COVID-19 OTC tests through Original Medicare.
Learn how to get tested
Virtual visits through telehealth and UPMC AnywhereCare
UPMC AnywhereCare*
Most UPMC for Life plans offer a $0 copay for UPMC AnywhereCare visits for the diagnosis of suspected COVID-19 and other nonemergency conditions. See your plan Summary of Benefits for the cost-sharing amounts.
Learn more about UPMC AnywhereCare
Telehealth
We are waiving all member cost sharing, including deductibles or copayments, for virtual health care visits for the diagnosis of suspected COVID-19 until May 11, 2023. After this date, your plan’s normal cost- sharing for telehealth will apply.
See your plan Summary of Benefits for the cost-sharing amounts.
Preventive care services that can be provided by telehealth (like your annual wellness vist) will continue to be covered at no-cost.
In-person visits, including urgent care, emergency room, imaging, diagnostics, radiology, and office visits
After May 11, your plan’s normal cost-sharing for in-person visits will apply. See your plan Summary of Benefits for the cost-sharing amounts.
UPMC for Life plans include coverage for necessary, comprehensive inpatient treatment of COVID-19. Standard provider network and authorization rules apply to non-emergency COVID-19 treatment. These services will continue to be covered subject to standard cost sharing under your plan after the public health emergency ends.
See your plan Summary of Benefits for the cost-sharing amounts.
Coverage for necessary monoclonal antibody treatment is available when medically necessary and administered in accordance with FDA guidelines. Standard provider network rules apply to this treatment. These services are available for Medicare members at no-cost through the end of 2023.
*UPMC for Life members who are in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Providers are not available to treat members who are in Puerto Rico.
Your wait time for UPMC AnywhereCare may be longer than usual due to increased call volume. If there is a wait, you can stay in the virtual waiting room or choose "text me when the provider is available."
If you have questions about your coverage, see your plan documents or contact Member Services at 1-877-539-3080 (TTY: 711) seven days a week from 8 a.m. to 8 p.m. for the most up-to-date information regarding your benefits.
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UPMC for Life Complete Care (HMO SNP) members will not have any changes to their out-of-pocket costs related to COVID-19 after the public health emergency ends on May 11, 2023.
See complete details below. You can also find your plan benefit information on the UPMC Health Plan app or MyHealth OnLine.
COVID-19 vaccines and boosters will continue to be available at no cost to members from in-network providers, even after the public health emergency ends.
Diagnostic testing†
COVID-19 diagnostic testing will continue to be available at no cost when ordered by your medical provider through the end of 2023.
Over-the-counter tests
New! Starting May 12, 2023, you can use your UPMC for Life Shop Healthy Card to buy over-the-counter COVID-19 tests at participating retail stores. OTC tests are also covered at no cost through Medicare through May 11, 2023. Here’s how to get no-cost COVID-19 OTC tests through Original Medicare.
Learn how to get tested
Our nurses offer support and advise on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).
UPMC nurses who answer calls are licensed to assist members in New York, Maryland, Pennsylvania, West Virginia, and Ohio. Members must be located in one of those states when calling the UPMC MyHealth 24/7 Nurse Line. The UPMC MyHealth 24/7 Nurse Line is not a substitute for medical care. If an emergency arises, call 911 or go to the nearest emergency department. Nurses cannot answer plan or benefit questions. Please call the Member Services phone number on the back of your member ID card for nonclinical inquiries.
Virtual health visits for the diagnosis of COVID-19 will continue to be at no cost through the end of 2023. Preventive services that can be provided by telehealth will continue to be covered without member cost sharing.
If you are under the weather, you can reach a health care professional 24/7 without leaving your home through UPMC AnywhereCare*. Your smartphone, computer, or tablet is all you need!
Learn how to download the app, enroll, and use UPMC AnywhereCare
Visit UPMC AnywhereCare
Your plan includes coverage for necessary, comprehensive inpatient treatment of COVID-19. Standard provider network and authorization rules apply to non-emergency COVID-19 treatment. These services will continue to be covered subject to standard cost sharing under your plan.
Coverage for necessary monoclonal antibody treatment is available when medically necessary and administered in accordance with FDA guidelines. These services will continue to be available for Medicare members without cost-sharing through the end of 2023.
*UPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II, P.C. (OCN), subject to availability and discretion of the provider. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.
For detailed cost sharing information, see your Evidence of Coverage or Summary of Benefits.
Your wait time for UPMC AnywhereCare may be longer than usual due to increased call volume. If there is a wait, you can stay in the virtual waiting room or choose "text me when the provider is available."
If you have questions about your coverage, see your plan documents or contact Member Services at 1-877-539-3080 (TTY: 711) seven days a week from 8 a.m. to 8 p.m. for the most up-to-date information regarding your benefits.
†During the current public health emergency, members can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.
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All Pennsylvanians age 6 months and older can get a COVID-19 vaccine.
Vaccine recommendations are based on your age, the vaccine you first received, and time since your last dose. People who are moderately or severely immunocompromised have different recommendations for COVID-19 vaccines.
Details about COVID-19 vaccines and boosters by age
Keep in mind that these guidelines can change over time as we learn more about COVID-19 vaccines and boosters. For the most current information, check the CDC website.
COVID-19 vaccine and booster shots are covered at all licensed providers and pharmacies from Nov. 20, 2020 through Sept. 30, 2024.
From Aug. 30, 2021 through Sept. 30, 2024, UPMC for Kids (CHIP) members can purchase FDA-approved COVID-19 self-tests, through an in-network pharmacy for $0 or request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. COVID-19 self-tests are home tests that can be purchased over-the-counter (OTC). You administer and read these tests on your own. They are also called OTC, rapid, or rapid antigen tests.
Purchasing COVID-19 self-tests at the pharmacy
UPMC for Kids (CHIP) members can purchase FDA-approved COVID-19 self-tests at an in-network pharmacy for $0. If a COVID-19 self-test is purchased at an out-of-network pharmacy, you will have to pay out-of-pocket and request reimbursement using the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form.
UPMC for Kids (CHIP) members can only get two COVID-19 self-tests per week when purchasing at a pharmacy.
No prescription is needed for purchasing COVID-19 self-tests at an in-network or out-of-network pharmacy. Tests that are mailed or dropped off at a lab or office, even if purchased over-the-counter (OTC), are not eligible for $0 purchase or reimbursement. These lab-read tests are eligible for coverage only when obtained with a prescription.
Requesting reimbursement
You can request reimbursement by submitting your COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online or by calling a Health Care Concierge.
To submit online, view the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form and instructions.
To speak with a Health Care Concierge call 1-800-650-8762 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m. and Saturday from 8 a.m. to 12 p.m.
In addition to filling out the form, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to contact you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all members. If your claim is denied, you can submit it again to correct any problems or supply missing information. You can submit for reimbursement up to 365 days from the date of purchase.
UPMC for Kids (CHIP) will only accept requests for reimbursement of COVID-19 self-test purchased on or after Aug. 30, 2021.
UPMC for Kids (CHIP) members can request reimbursement for up to eight COVID-19 self-tests per 28 days, per member. Each individual COVID-19 self-test counts toward the total of eight per 28 days, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as two COVID-19 self-tests with six eligible COVID-19 self-tests remaining for the 28 days.
Any FDA-approved COVID-19 self-tests purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (for example, Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-19 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.
Members should exercise caution in buying from websites that are unfamiliar to them—especially those that only sell COVID-19 self-tests, require participants to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.
Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness.
Our reimbursement process is normally completed within 60 days, however processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all UPMC for Kids (CHIP) participants are able to receive reimbursement are able to receive reimbursement for their purchases.
Now through September 30, 2024, we are waiving all deductibles, coinsurance, and copays for in-network, inpatient COVID-19 treatment for members.
Monoclonal antibody treatment for COVID-19 is covered at no cost until September 30, 2024.a,b
Now through September 30, 2024, we are waiving copayments for COVID-19 diagnostic testing when ordered by your child’s medical provider.
Learn how to get tested
Our nurses offer support and advise on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).
Resources for UPMC for Kids members
If you have experienced a financial hardship and are unable to pay your premiums because of a decrease or loss of income, please contact the Department of Human Services (DHS). You can use COMPASS, the myCOMPASS PA mobile app, or call the DHS Customer Service Center at 1-877-395-8930 (1-215-560-7226 in Philadelphia) to report any changes in your family's circumstances.
UPMC for Kids
Visit UPMC for Kids to learn more about member benefits.
UPMC for Kids members Health Care Concierge services
If you have questions, our UPMC for Kids Health Care Concierge team will help you and your child every step of the way. Call 1-800-650-8762 (TTY: 711) Monday through Friday from 8 a.m. to 6 p.m. and Saturday from 8 a.m. to 12 p.m.
Health management programs
If your child needs day-to-day help with a health condition, UPMC for Kids is here for you, thanks to our care management programs. A nurse can help you and your child to better understand your child’s condition. Call 1-866-778-6073 (TTY: 711) Monday through Thursday from 7:30 a.m. to 8 p.m., Friday 7:30 a.m. to 6 p.m., and Saturday from 8 a.m. to 3 p.m.
Additional resources
The United Way of Pennsylvania
The United Way of Pennsylvania helps you connect with resources in your community, such as food/meals, housing, clothing, community services, financial assistance, and more.
Visit pa211.org, dial 211, or text your ZIP code to 898-211.
Pennsylvania Statewide Support and Referral Helpline for COVID-19
The Department of Human Services has partnered with the Center for Community Resources (CCR) to create and staff the Pennsylvania Statewide Support and Referral Helpline for COVID-19. The Support and Referral Helpline is a 24-7 listening and referral service provided to all of Pennsylvania during the COVID-19 crisis. Call 1-855-284-2494 (TTY: 724-631-5600) to speak with a caseworker who’s there to counsel Pennsylvanians struggling with anxiety and other challenging emotions due to the COVID-19 emergency. You can also visit the Center for Community Resources.
Pennsylvania Department of Human Services
For emergency cash and food assistance visit COMPASS.
Behavioral health resources
It’s normal if you or your child(ren) are experiencing feelings of anxiety or depression right now. Resources are available to support you and your family’s mental well-being. Visit the websites or call the numbers below for more information.
If you have questions about your coverage, see your plan documents or contact Member Services for the most up-to-date information regarding your benefits.
*UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II PC (OCN) at the discretion of the provider. OCN is not an affiliate of UPMC.
aUPMC Health Plan will cover these services from in-network providers with no member cost share until September 30, 2024, subject to permissibility under the current federal and/or state emergency declarations and associated guidance.
bFor more information on monoclonal antibody treatments, visit UPMC.com/AntibodyTreatment or call 1-866-804-5251 from 7 a.m. to 8 p.m., seven days a week.
†Until September 30, 2024, members can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.
All Pennsylvanians age 6 months and older can get a COVID-19 vaccine.
Vaccine recommendations are based on your age, the vaccine you first received, and the time since your last dose. People who are moderately or severely immunocompromised have different recommendations for COVID-19 vaccines.
Details about COVID-19 vaccines and boosters by age
Keep in mind that these guidelines can change over time as we learn more about COVID-19 vaccines and boosters, For the most current information, check the CDC website.
COVID-19 vaccine and booster shots are covered no matter which one you or your child gets or where you or your child gets it in the United States.
UPMC for You (Medicaid) members can purchase FDA-approved COVID-19 self-tests, through an in-network pharmacy for $0 or request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. COVID-19 self-tests are home tests that can be purchased over-the-counter (OTC). You administer and read these tests on your own. They are also called OTC, rapid, or rapid antigen tests.
Purchasing COVID-19 self-tests at the pharmacy
UPMC for You (Medicaid) members can purchase FDA-approved COVID-19 self-tests at an in-network pharmacy for $0. If a COVID-19 self-test is purchased at an out-of-network pharmacy, you will have to pay out-of-pocket and request reimbursement using the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form.
No prescription is needed for purchasing COVID-19 self-tests at an in-network or out-of-network pharmacy. Tests that are mailed or dropped off at a lab or office, even if purchased OTC, are not eligible for $0 purchase or reimbursement. These lab-read tests are eligible for coverage only when obtained with a prescription.
Requesting reimbursement
You can request reimbursement by submitting your COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online or by calling a Health Care Concierge.
To submit online, view the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form and instructions.
To speak with a Health Care Concierge call 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.
In addition to filling out the form, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to contact you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all members. If your claim is denied, you can submit it again to correct any problems or supply missing information. We must receive this form within six months of the date on your receipt.
UPMC for You (Medicaid) will only accept requests for reimbursement of COVID-19 self-test purchased on or after Aug. 30, 2021.
UPMC for You (Medicaid) members can purchase at the pharmacy or request reimbursement for up to eight COVID-19 self-tests per 28 days, per member. Note that each individual COVID-19 self-test counts toward the total of eight per 28 days, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as two COVID-19 self-tests with six eligible COVID-19 self-tests remaining for the 28 days.
Any FDA approved COVID-19 self-tests purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (for example, Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-19 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.
Members should exercise caution buying from websites that are unfamiliar to them, especially those that only sell COVID-19 self-tests, require members to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.
Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness.
Our reimbursement process is normally completed within 60 days, however processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all UPMC for You (Medicaid) members are able to receive reimbursement for their purchases.
Now through September 30, 2024, we are waiving all deductibles, coinsurance, and copays for in-network, inpatient COVID-19 treatment for members.
Monoclonal antibody treatment for COVID-19 is covered at no cost until September 30, 2024.a,b
Now through September 30, 2024, we are waiving deductibles, copayments, and other cost-sharing for COVID-19 diagnostic testing when ordered by your medical provider.
Learn how to get tested
Our nurses offer support and advise on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).
We are waiving all member copayments for virtual health care visits for the diagnosis of suspected COVID-19. Preventive services that can be provided by telehealth will continue to be covered without member cost sharing.
If you or your child is feeling ill, you can reach a health care professional 24/7 without leaving your home through UPMC AnywhereCare* and Children’s AnywhereCare. Your smartphone, computer, or tablet is all you need!
With Children’s AnywhereCare, your child (ages 0-17) can now have a video visit with a provider from UPMC Children’s Hospital of Pittsburgh.**
Learn how to download the app, enroll, and use UPMC AnywhereCare.
Visit UPMC AnywhereCare.
*UPMC for You members located in Pennsylvania at the time of service will have a virtual visit with a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service will receive care from a provider employed or contracted by Online Care Network II P.C. (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. UPMC AnywhereCare virtual visits are not covered services when UPMC for You members are traveling outside of Pennsylvania. Providers are not available to treat members who are in Puerto Rico.
Your wait time for UPMC AnywhereCare may be longer than usual due to increased call volume. If there is a wait, you can stay in the virtual waiting room or choose "text me when the provider is available."
If you have questions about your coverage, see your plan documents or contact Member Services for the most up-to-date information regarding your benefits.
**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II P.C. (OCN), also known as Amwell Medical Group, at the discretion of the provider. OCN is not an affiliate of UPMC. Providers are not available to treat members who are in Puerto Rico.
aUPMC Health Plan will cover these services from in-network providers with no member cost share until September 30, 2024, subject to permissibility under the current federal and/or state emergency declarations and associated guidance.
bFor more information on monoclonal antibody treatments, visit UPMC.com/AntibodyTreatment or call 1-866-804-5251 from 7 a.m. to 8 p.m., seven days a week.
†Until September 30, 2024, members can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.
The federal government put the Public Health Emergency (PHE) in place in response to the COVID-19 pandemic. As the PHE ended on May 12, 2023, cost-sharing waivers that were applied during the PHE have changed. The following services are subject to normal coverage rules as described in your plan documents, including applicable cost-sharing and provider network requirements:
- COVID-19 diagnostic and antibody testing
- Prescription antiviral treatment
- Telemedicine, office, urgent care, and emergency room visits to diagnose COVID-19
UPMC Health Plan will continue to cover COVID-19 vaccines at no cost from in-network providers. COVID-19 vaccines are safe and effective, so schedule your shot today!
If you purchased eligible OTC tests prior to May 12, 2023 you may still request reimbursement for up to 365 days from the date of purchase through our online Testing Reimbursement form, or by requesting a Testing Reimbursement Form from a Health Care Concierge.
- Call us at the phone number on your member ID card. TTY users should call 711
- Chat with us by logging in to the UPMC Health Plan app or MyHealth OnLine
- Help is available Monday through Friday from 7 a.m. to 7 p.m. and Saturday from 8 a.m. to 3 p.m.
Over-the-counter COVID-19 tests will no longer be reimbursable under your medical benefit.
Commercial members can request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail through 5/11/23. Self-tests are home tests that can be purchased over-the-counter (OTC), are self-administered, and self-read. They are also called OTC, rapid, or rapid antigen tests.
Sign in using your UPMC Health Plan login to complete the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online
View COVID-19 Over-the-Counter (OTC) Testing Reimbursement form and instructions (PDF)
Call a Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.
UPMC Community HealthChoices (UPMC CHC) participants who also have Medicare should check with their Medicare plan about coverage and in-network providers for all needs related to COVID-19. Medicare is the primary payer. UPMC CHC is the secondary payer.
UPMC Community HealthChoices (CHC) participants can purchase FDA-approved COVID-19 self-tests, through an in-network pharmacy for $0 or request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. COVID-19 self-tests are home tests that can be purchased over-the-counter (OTC). You administer and read these tests on your own. They are also called OTC, rapid, or rapid antigen tests.
Purchasing COVID-19 self-tests at the pharmacy
UPMC Community HealthChoices (CHC) participants can purchase FDA-approved COVID-19 self-tests at an in-network pharmacy for $0. If a COVID-19 self-test is purchased at an out-of-network pharmacy, you will have to pay out-of-pocket and request reimbursement using the reimbursement form COVID-19 Over-the-Counter (OTC) Testing Reimbursement form.
No prescription is needed for purchasing COVID-19 self-tests at an in-network or out-of-network pharmacy. Tests that are mailed or dropped off at a lab or office, even if purchased OTC, are not eligible for $0 purchase or reimbursement. These lab-read tests are eligible for coverage only when obtained with a prescription.
Requesting reimbursement
You can request reimbursement by submitting your COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online or by calling a Health Care Concierge
To submit online, view the reimbursement form and instructions.
To speak with a Health Care Concierge call 1-844-833-0523 (TTY: 711) seven days a week, 24 hours a day.
In addition to filling the form out, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to contact you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all participants. If your claim is denied, you can submit it again to correct any problems or supply missing information. You can submit for reimbursement up to 365 days from the date of purchase.
UPMC Community HealthChoices (CHC) only accept requests for reimbursement of COVID-19 self-test purchased on or after Aug. 30, 2021.
UPMC Community HealthChoices (CHC) participants can purchase at the pharmacy or request reimbursement for up to eight COVID-19 self-tests per 28 days, per member. Note that each individual COVID-19 self-test counts toward the total of eight per 28 days, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as two COVID-19 self-tests with six eligible COVID-19 self-tests remaining for the 28 days.
Any FDA-authorized COVID-19 self-test purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (for example, Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-19 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.
Participants should exercise caution buying from websites that are unfamiliar to them, especially those that only sell COVID-19 self-tests, require participants to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.
Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness.
Our reimbursement process is normally completed within 60 days but due to the unique nature of this new coverage requirement, processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all UPMC Community HealthChoices (CHC) participants are able to receive reimbursement for their purchases.
Now through September 30, 2024, we are waiving all deductibles, coinsurance, and copays for in-network, inpatient COVID-19 treatment for participants.
Monoclonal antibody treatment for COVID-19 is covered at no cost until September 30, 2024.a,b
Now through September 30, 2024, we are waiving deductibles, copayments, and other cost-sharing for COVID-19 diagnostic testing when ordered by your medical provider.
Learn how to get tested
Our nurses offer support and advise on a wide range of health issues, including COVID-19. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).
Learn how to download the app, enroll, and use UPMC AnywhereCare
Visit UPMC AnywhereCare
*UPMC Community HealthChoices participants who are in Pennsylvania at the time of a virtual visit through UPMC AnywhereCare may select a UPMC-employed provider, subject to availability and discretion of the provider. Participants located outside of Pennsylvania at the time of service will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. UPMC AnywhereCare virtual visits are not covered services when UPMC Community HealthChoices participants are traveling outside of Pennsylvania. Providers are not available to treat participants who are in Puerto Rico.
Your wait time for UPMC AnywhereCare may be longer than usual due to increased call volume. If there is a wait, you can stay in the virtual waiting room or choose "text me when the provider is available."
If you have questions about your coverage, see your plan documents or contact the Health Care Concierge for the most up-to-date information regarding your benefits.
aUPMC Health Plan will cover these services from in-network providers with no member cost share until September 30, 2024, subject to permissibility under the current federal and/or state emergency declarations and associated guidance.
bFor more information on monoclonal antibody treatments, visit UPMC.com/AntibodyTreatment or call 1-866-804-5251 from 7 a.m. to 8 p.m., seven days a week.
†Until September 30, 2024, participants can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.