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UPMC Community HealthChoices

Participant Advisory Committee Application

UPMC Community HealthChoices (UPMC CHC) is looking for participants, family caregivers, direct care workers, and providers to join our Participant Advisory Committee (PAC). The PAC will share their thoughts about our programs, benefits, and services. Recommendations provided by the PAC will assist UPMC CHC to enhance services designed to meet the unique needs of participants.

We want to make sure the PAC reflects our community. Participants, family caregivers, direct care workers, and providers of all ages, races, genders, and disability groups should apply.

We ask that our members serve for a minimum of one year. The PAC meets four times a year. The application process includes a short meet and greet with the Community Engagement Team. Please note there is limited space. We look forward to receiving your application and welcoming your voice to the committee to help us better understand the needs of our participants!

If you are interested in serving on the committee, please fill out this form.


* Indicates required fields

1. What makes joining the PAC interesting to you?*

2. What experience or knowledge would you bring to the PAC?*

3. What topics or challenges would you like to see addressed as a PAC member?*

4. What is your relationship to UPMC CHC?*














Representative Name and Signature (if signing for committee member)



If you have any questions or require a language or disability-related accommodation to complete this form, please contact the UPMC Community HealthChoices Health Care Concierge team at 1-844-833-0523 (TTY: 711).

UPMC Community HealthChoices complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex, gender, gender identity or expression, or sexual orientation.

UPMC Community HealthChoices does not exclude people or treat them differently because of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex, gender, gender identity or expression, or sexual orientation.

UPMC Community HealthChoices provides free aids and services to people with disabilities to communicate effectively with us, such as:

  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

UPMC Community HealthChoices provides free language services to people whose primary language is not English, such as:

  • Qualified interpreters
  • Information written in other languages

If you need these services, contact UPMC Community HealthChoices at 1-844-220-4785. (TTY: 711)

If you believe that UPMC Community HealthChoices has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, physical or mental disability, health status, pre-existing condition, anticipated need for health care, income status, MA category status, program participation, grievance status, creed, religious affiliation, ancestry, marital status, sex, gender, gender identity or expression, or sexual orientation, you can file a complaint with:

  • UPMC Community HealthChoices
  • Complaints and Grievances
  • PO Box 2939
  • Pittsburgh, PA 15230-2939
  • Phone: 1-844-220-4785 (TTY: 711)
  • Fax (412) 454-7920
  • Email: HealthPlanCompliance@upmc.edu

  • The Bureau of Equal Opportunity
  • Room 223, Health and Welfare Building
  • PO Box 2675
  • Harrisburg, PA 17105-2675
  • Phone: (717) 787-1127, TTY/PA Relay 711
  • Fax: (717) 772-4366
  • Email: RA-PWBEOAO@pa.gov

You can file a complaint in person or by mail, fax, or email. If you need help filing a complaint, UPMC Community HealthChoices and the Bureau of Equal Opportunity are available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

  • U.S. Department of Health and Human Services
  • 200 Independence Avenue S.W.
  • Room 509F, HHH Building
  • Washington, DC 20201
  • 1-800-368-1019, 1-800-537-7697 (TDD)

Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.