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What is my allowance amount?
Select your plan below to see your allowance for 2024. Not all UPMC for Life plans offer the Flex Spend Card benefit.
| Plan name | Counties | Yearly allowance amount |
|---|
| HMO Rx (HMO) |
Adams, Allegheny, Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford,
Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene,
Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh,
Lycoming, McKean, Mercer, Mifflin, Montour, Northampton,
Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren,
Washington, Wayne, Westmoreland, Wyoming,
York, Harrison (OH), Jefferson (OH)
|
$1,000 |
| Plan name | Counties | Yearly allowance amount |
|---|
| HMO Premier Rx (HMO) |
Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Butler, Cameron, Clarion, Crawford,
Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Greene, Lancaster, Lawrence,
Lycoming, McKean, Mercer, Somerset, Tioga, Venango, Warren,
Washington, Westmoreland, York
|
$500 |
| Plan name | Counties | Yearly allowance amount |
|---|
| HMO Rx Choice (HMO) |
Adams, Allegheny, Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford,
Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene,
Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh,
Lycoming, McKean, Mercer, Mifflin, Montour, Northampton,
Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren,
Washington, Wayne, Westmoreland, Wyoming,
York, Harrison (OH), Jefferson (OH)
|
$500 |
| Plan name | Counties | Yearly allowance amount |
|---|
| HMO Deductible Rx (HMO) |
Adams, Allegheny, Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford,
Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene,
Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh,
Lycoming, McKean, Mercer, Mifflin, Montour, Northampton,
Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren,
Washington, Wayne, Westmoreland, Wyoming,
York, Harrison (OH), Jefferson (OH)
|
$500 |
| Plan name | Counties | Yearly allowance amount |
|---|
| PPO Premier Rx (PPO) |
Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria,
Cameron, Carbon, Clarion, Clearfield,
Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon,
Indiana, Jefferson, Lawrence, McKean,
Mercer, Somerset, Venango, Warren, Washington, Westmoreland
|
$300 |
| PPO Premier Rx (PPO) |
Adams, Centre, Clinton,
Cumberland, Dauphin, Fulton, Juniata,
Lancaster, Lebanon, Lycoming, Mifflin,
Montour, Perry, Potter, Snyder,
Sullivan, Tioga, Union, York
|
$500 |
| Plan name | Counties | Yearly allowance amount |
|---|
| PPO Rx Choice (PPO) |
Allegheny
|
$750 |
| PPO Rx Choice (PPO) |
Armstrong, Beaver, Bedford, Blair, Butler, Cambria,
Cameron, Carbon, Clarion, Clearfield,
Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon,
Indiana, Jefferson, Lawrence, McKean,
Mercer, Somerset, Venango, Warren, Washington, Westmoreland
|
$300 |
| PPO Rx Choice (PPO) |
Adams, Centre, Clinton, Cumberland, Dauphin, Fulton, Juniata,
Lancaster, Lebanon, Lycoming, Mifflin, Montour, Perry, Potter,
Snyder, Sullivan, Tioga, Union, and York counties
|
$500 |
| Plan name | Counties | Yearly allowance amount |
|---|
| PPO Salute (PPO) |
Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford,
Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene,
Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh,
Lycoming, McKean, Mercer, Mifflin, Montour, Northampton,
Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren,
Washington, Wayne, Westmoreland, Wyoming, York
|
$600 |
| Plan name | Counties | Yearly allowance amount |
|---|
| HMO No Rx (HMO) |
Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford,
Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene,
Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh,
Lycoming, McKean, Mercer, Mifflin, Montour, Northampton,
Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren,
Washington, Wayne, Westmoreland, Wyoming,
York, Harrison (OH), Jefferson (OH)
|
$250 |
How can I check my balance?
How to use your UPMC for Life Flex Spend Card
Your health care dollars, your choice. You can use your card to buy OTC products and pay for medical service costs and out-of-pocket dental, vision, and hearing services.
Medical service costs Use your card anytime you are asked to pay out-of-pocket for your care, like for a doctor’s office visit, urgent care visit, physical therapy, x-ray, or lab service. You can use $50 of your allowance per transaction.
Over-the-counter (OTC) products. Use your card to buy covered OTC products at participating retail stores and through our mail order catalog.
Dental, vision, and hearing services. Use your plan benefits first and then use your Flex Spend Card second to help pay for any out-of-pocket costs.
You cannot use your Flex Spend Card to pay for prescription drug copays or your monthly plan premiums.
Using your UPMC for Life Flex Spend Card for medical service costs
You can use your Flex Spend Card anytime you are asked to pay out-of-pocket for your care, like for a doctor’s office visit copay. You can use $50 of your allowance per transaction for things like the following:
- Primary care provider visits
- Specialist visits
- Urgent care visits
- Inpatient hospital stays
- Lab services
- X-rays
- Physical therapy.
You can use your card for both in-network and out-of-network medical service costs, but remember your cost share may be greater for care received outside of the network. Search for participating providers.
If you receive a bill for covered medical services, you can use your card to pay $50, per transaction, of the cost.
- Bills received from a UPMC provider:
- By phone: You can call the phone number on your bill to pay with your Flex Spend Card and another form of payment, if needed.
- Online: Follow the instructions on your bill to pay online or go to the MyUPMC app and select Pay Your Bills. You can pay with your Flex Spend Card and another form of payment, if needed.
- Bills received from a non-UPMC provider:
- If you receive a bill from a non-UPMC provider, you may want to pay your bill in full using another form of payment and then use our reimbursement process to be reimbursed the $50 per transaction allowance from your Flex Spend Card. See How to submit a claim for reimbursement.
If you need to pay out-of-pocket for medical service costs for any reason, you can submit a claim for reimbursement. Make sure to submit a reimbursement claim for no more than $50 per transaction.
Using your UPMC for Life Flex Spend Card for dental, vision, and hearing services
Use your plan benefits first for any dental, vision, and hearing services and then use your Flex Spend Card second to help pay for any out-of-pocket costs. You can use this card at providers that accepts MasterCard, but make sure to use an in-network provider to take advantage of your plan benefits. Search for participating providers.
Here are some examples of dental, vision, and hearing services you can use your card for:
- Dental services – Teeth whitening, dental implants, dentures, denture repairs and realignments, tooth extractions, root canals, bridges, crowns, and periodontal work
- Vision services – Contact lenses, eyeglasses, progressive and transition lenses, and prescription sunglasses
- Hearing services - Hearing aids, hearing aid batteries, and hearing aid repairs
If you go to an out-of-network provider to receive dental, vision, and hearing services, you may need to pay out-of-pocket for your care and submit a claim for reimbursement. If you are on a PPO plan that provides out-of-network coverage and has a benefit allowance, make sure to only submit a reimbursement claim for the amount that exceeds your benefit allowance.
Find participating retail stores
If you want to shop for OTC products in-person, you can use your card at any of our participating retail stores, including Giant Eagle, Kroger, Rite Aid, Walgreens, and Walmart.
Use the Merchant Locator Tool to see the full list of participating retail stores and find specific retail store locations near you:
- Log in to MyHealth OnLine.
- Under Your Insurance on the homepage, click UPMC for Life Flex Spend Card. Then click UPMC for Life Flex Spend Card Portal.
- Once on the portal, use the Merchant Locator tool, under Tools and Support, to search our complete list of OTC retailers.
At checkout, simply swipe your UPMC for Life Flex Spend Card to pay for covered products. After swiping your card, if you still owe a remaining amount on your purchase, you can use another form of payment to complete your transaction. You can buy 50 products per transaction at participating retail stores. If you have to pay out-of-pocket for covered products or services, you can submit a claim for reimbursement.
What OTC products are covered at retail stores?
To make in-store shopping even easier, download the UPMC Health Plan app. With the app, you scan products while you shop to see if they’re covered. To get started, log in to the UPMC Health Plan app, then tap Scan Items on the insurance tab.
Here are the types of OTC products you can buy with your card at retail locations:
- Cold and allergy
- Allergy prevention, relief, antihistamines
- Chest rubs
- Cough and cold remedies
- Decongestants
- Humidifiers and vaporizers
- Nasal strips and sprays
- Throat remedies
- Digestive health
- Antacids, indigestion, and flatulence remedies
- Diarrhea remedies
- General gastrointestinal remedies
- Laxatives
- Nausea remedies
- Motion sickness remedies
- Ear and eye care
- Ear preparations
- Eye preparations
- Contact lens care
- First aid
- Bandages, wraps, tapes, dressings, and kits
- Antibiotics and antiseptics
- Slings and supports
- Skin remedies and protectants
- Hand sanitizers
- Protective gloves and face masks
- Thermometers
- Insect bite relief
- Foot and leg care
- Antifungal products
- Wart, corn, and callus treatments
- Foot care and hygiene aids
- Therapeutic compression hosiery
- Oral care
- Dental cleansing
- Denture care
- Oral care aids (nonpowered and powered)
- Halitosis treatments
- Ulcer treatments
- Other health and wellness
- Pain relievers
- Sleep aids
- Smoking deterrents
- Diagnostic monitors
- Personal care
- Incontinence supplies
- Disposable and nondisposable underwear
- Pads
- Sun protection
- Sunscreen
- After-sun care
- Lip balm with SPF
- Vitamins and dietary supplements
How to get OTC products by mail
OTC products can be delivered by mail to your home. Here are your mail order options:
- Online. There are two easy ways to access the UPMC for Life OTC website and order products.
- Log in to MyHealth OnLine. Under Your Insurance on the homepage, click UPMC for Life Flex Spend Card. Then click Visit the UPMC for Life OTC Website.
- Log in to the UPMC Health Plan app. Tap UPMC for Life Flex Spend Card on the insurance tab, then click Over-the-Counter store.
- By mail. See a copy of our catalog and complete an order form. Mail completed order forms to OTC Servicing Center, PO Box 526266, Miami, FL 33152-9819.
- By phone. A team of experts is standing by at 1-800-688-2515 (TTY: 711) Monday through Friday from 8 a.m. to 11 p.m.
Here are some examples of products you can buy through mail order. See our mail-order catalog for a complete list.
- Allergy
- Antacids and acid reducers
- Anticandidal (yeast)
- Anti-diarrheal, laxatives, and digestive health
- Anti-fungal
- Bathroom safety and fall prevention
- Cold and flu
- Cold sore and medicated lip products
- Dental and denture care
- Diabetes care
- Diagnostics
- Eye and ear care
- First aid
- Foot care
- Hemorrhoidal preparations
- Home aids
- Incontinence supplies
- Motion sickness
- Nutritional supplements
- Pain relief aids
- Pain relievers and fever reducers
- Pediculicide (lice treatment)
- Skin and sun care
- Sleep aids
- Smoking cessation
- Supports and braces
- Vitamins and minerals
- Wart remover
How to submit a claim for reimbursement
- Online:
- Log in to MyHealth OnLine.
- Under Your Insurance on the homepage, click UPMC for Life Flex Spend Card. Then click UPMC for Life Flex Spend Card Portal.
- Once on the portal, click Reimburse Myself.
- By fax: Fax a completed reimbursement form and proper documentation to 1-844-361-4700.
- By mail: Mail a completed reimbursement form and proper documentation to UPMC Health Plan, PO Box 2784, Fargo, ND 58108.
- Mobile:
- Log in to the UPMC Health Plan app.
- Tap UPMC for Life Flex Spend Card on the insurance tab, then click Submit Reimbursement.
Submitted claims can take up to 72 hours to process. We will reimburse you by mailing you a check. Please allow 10-14 business days to receive your mailed check. Or you can follow these steps to set up direct deposit through the UPMC for Life Flex Spend Card Portal. After your claim is processed, please allow 24-48 hours to receive your direct deposit reimbursement.
Proper documentation for expenses includes a third-party receipt containing the following information:
- Date service was received, or purchase made
- Description of service or item purchased
- Dollar amount (after insurance, If applicable)
Unacceptable forms of documentation include the following:
- Provider statements that only indicate the amount paid, balance forward or previous balance
- Credit card receipts that only reflect a payment
- Copies of checks
- Bills for prepaid expenses where services have not yet occurred