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Using Health Insurance

Why you need health insurance


  • It protects you from big costs if you get sick or hurt.

  • You can choose a primary doctor who gets to know you and will help you manage your health.

  • It makes getting checkups and screenings easier.

  • You can catch problems before they become serious.

Where you can use it

Our UPMC Advantage individual and family plans include four network options so you can choose the network that works best for you. You will have full in-network access to all UPMC doctors and hospitals in your community, as well as other providers. Click below to view the network options available in your county:

  • UPMC Partner Network (for residents of Allegheny, Bedford, Blair, Clinton, Erie, Lawrence, Lycoming, Mercer, Somerset, Tioga, and Venango counties)
  • UPMC Select Network (for residents of Allegheny, Beaver, Butler, Fayette, Washington, and Westmoreland counties)
  • UPMC Standard Network (for residents of Crawford and Clearfield counties)
  • UPMC Premium Network (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)

Provider

Doctor, hospital, urgent care center, or other health care facility.

Network

Also called "provider network." The network includes doctors, hospitals, and other providers who contract with your plan. They provide services at a negotiated rate of payment.

Our network options include all the world-renowned hospitals of UPMC and many community hospitals in the areas you call home. Our flexible plans adapt to your needs so you can choose the network that works best for you. You can even save money by narrowing down your hospital network to the locations to which you’re most likely to go. Why pay for what you don't need?

How you can use it

When you buy health insurance, you want to get the most out of it. UPMC Health Plan offers benefits well beyond network access and high quality care.

Your 2023 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.

  • Six free counseling sessions through LifeSolutions®6
  • Free health coaching to help you make healthy changes in your life
  • The RxWell app to support your total well-being

Supporting you when you need it.

1Preventive 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 may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

2Tier 5 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.

3Go to upmchealthplan.com/BEST for award information.

4UPMC 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.

5UPMC 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.

6Only 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 $3,000/$0 plan or the UPMC Advantage Catastrophic $9,100/$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.