Network and Access

Don’s Story

Don’s employer gave him the option to choose UPMC Health Plan. The network and access to life-saving care made Don glad he did. "I’m very fortunate that I did choose UPMC Health Plan because it allowed me to resolve my situation without worrying."

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Pharmacy Network

Retail

UPMC Health Plan members have access to a broad retail pharmacy network that includes national chain pharmacies, regional chain pharmacies and hundreds of independent pharmacies.

Mail Order

Long-term maintenance medications are typically available through the Express Scripts mail-order pharmacy.

Specialty medications will generally be dispensed from Accredo Specialty Pharmacy or Chartwell Specialty Pharmacy and may be limited to a one-month supply.

 

Extended Network

UPMC Health Plan provides access to high-quality care for your employees and their covered dependents who are traveling or living outside our service area. The extended network is composed of the Cigna Healthcare® PPO Network¹ for members who are outside the UPMC Health Plan service area and not in Ohio, and the SuperMed PPO Network for members in Ohio.² The Cigna Healthcare PPO Network has nearly 1.5 million health care providers and 6,400 hospitals.³

Global Emergency Assistance with Assist America

Members traveling more than 100 miles from home have access to emergency medical assistance through Assist America.* This service can connect members and their covered family members to doctors, hospitals, and other emergency services—free of charge.

UPMC AnywhereCare

With UPMC AnywhereCare,** members and their covered dependents, including children,^† can access high-quality care 24/7 using their computer or mobile device. Eligible users can also chat with licensed pharmacists about their medications, get personalized health guidance from a health navigator, schedule an appointment with a health coach, or connect with talk therapy or psychiatry resources.

 

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¹The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration. Cigna Healthcare is an independent company and is not affiliated with UPMC Health Plan and its affiliates. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with UPMC Health Plan. All Cigna Healthcare products are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Intellectual Property Inc. Access to the Cigna Healthcare PPO Network outside of the UPMC Health Plan service area is applicable for members in Bucks, Chester, Delaware, Franklin, Fulton, Juniata, Mifflin, Montgomery, Montour, and Philadelphia counties in Pennsylvania; all other states except Ohio; Garrett and Allegany counties in Maryland; and Chautauqua, Cattaraugus, and Allegany counties in New York.

²UPMC Health Plan commercial members and their dependents who reside in Ohio do not have access to the Cigna Healthcare PPO Network and will continue to access care through the SuperMed PPO Network. Ohio residents/members, while traveling outside of the state of Ohio, can utilize the Cigna Healthcare PPO Network.

³ Cigna Healthcare analysis of actual providers contracted as part of the Cigna Healthcare PPO for Shared Administration as of July 2024. Data is subject to change.

*Assist America is available when members experience a medical emergency while traveling more than 100 miles from their residence, including to another country, for less than 90 days. Assist America is not medical insurance.

**UPMC Health Plan 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 P.C. (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Limitations may apply for members of ASO plans that have opted out of coverage. Providers are not available to treat members who are in Puerto Rico.

^†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. During the COVID-19 emergency declaration, UPMC for You members located outside of Pennsylvania will receive service from OCN. After the COVID-19 emergency declaration, 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.