UPMC for Life Coverage Criteria

UPMC for Life uses clinical criteria to make coverage decisions. You can click the link below to access the InterQual criteria used to make medical necessity coverage determinations. You must create an account if you currently do not have one. Just select "Create One Healthcare ID."

UPMC Health Plan Self-Registration Transparency for UPMC for Life Medicare Advantage credentialed providers

Our coverage policies can also help you better understand your plan’s health coverage requirements:

Policies and Procedures Manual

Contact us

UPMC for Life Members
Call us toll-free: 1-877-539-3080 (TTY: 711)

Oct. 1 – March 31: 
Seven days a week from 8 a.m. to 8 p.m. 
 
April 1 – Sept. 30: 
Monday through Friday from 8 a.m. to 8 p.m. 

UPMC for Life Prospective Members
Call us toll-free: 1-866-400-5077 (TTY: 711)
Oct. 1 – March 31: 
Seven days a week from 8 a.m. to 8 p.m. 
 
April 1 – Sept. 30: 
Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m.

Medicare resources

Additional Documents and Forms
Medicare Complaint Form
Eligible for Medicare and Medicaid
Request a Provider Directory or Plan Materials
Medication Therapy Management
Language Assistance
UPMC for Life Coverage Criteria
This information is not a complete description of benefits. Call 1-866-400-5077 (TTY: 711) for more information. Out-of-network/Noncontracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 711).

UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.

SilverSneakers is a registered trademark of Tivity Health Inc. SilverSneakers GO is a trademark of Tivity Health Inc. © 2024 Tivity Health Inc. All rights reserved.

UPMC for Life Members
Call us toll-free: 1-877-539-3080
TTY: 711

Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.

April 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m.

UPMC for Life Prospective Members
Call us toll-free: 1-866-400-5077
TTY: 711

Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.

April 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m.

Y0069_241177

Last Updated: 9/10/2024

Y0069_241177 

Last Updated: 9/10/2024