For residents of Allegheny, Bedford, Blair, Clinton, Erie, Lawrence, Lycoming, Mercer, Tioga, and Venango counties
Partner Network Overview (PDF)
Find Partner Network Providers
Check Partner Network Drug Formulary
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
Select Network Overview (PDF)
Find Select Network Providers
Check Select Network Drug Formulary
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 Crawford and Clearfield 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.
Standard Network Overview (PDF)
Find Standard Network Providers
Check Standard Network Drug Formulary
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
Premium Network Overview (PDF)
Find Premium Network Providers
Check Premium Network Drug Formulary
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.
Sample Individual and Family Plan Policies
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 2021 Individual and Family Plan Policies
UPMC Advantage HMO Policy
UPMC Advantage HMO HSA Policy
UPMC Advantage EPO Policy
UPMC Advantage PPO Policy
UPMC Advantage EPO HSA Policy
UPMC Advantage PPO HSA Policy
UPMC Advantage EPO Catastrophic Policy
UPMC Advantage PPO Catastrophic Policy
UPMC Advantage HMO Catastrophic Policy
Tower UPMC Advantage PPO Policy
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 may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.
2. Tier 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.
3. Go to upmchealthplan.com/BEST for award information.
4. 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 or Gold HSA $2,900/$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.