UPMC Health Plan Review


UPMC stands out among top health care providers as one of the country’s premier group and individual providers, managing group insurance policies and behavioral health, EAP, and workers’ compensation programs for our communities across the U.S.

If you visit nonparticipating (out-of-network) providers, they may bill for their services and require prior authorization to see certain out-of-network providers.

UPMC for You

If you want a group health plan that will offer great value to your employees, UPMC could be an excellent option. Based in Pittsburgh, PA, offering world-renowned doctors and facilities and being known for innovation and making a difference in communities served, this local integrated health care system boasts excellent value to consider as part of any group health plan solution.

UPMC’s managed care plans can guide you through the healthcare system and access coverage. Working closely with community-based organizations such as Fabric Health, they connect members to healthcare services and coverage assistance assistance. In addition to their UPMC for You offer, their Medicare and Medicaid managed care plans feature local provider networks.

A UPMC for You plan can save money and time by offering discounted or free healthcare services, such as wellness visits and preventive screenings. Plus, you can save with discounts on healthy food purchases, gym membership fees, travel insurance, and pet policies!

UPMC for You members can access online tools and resources to maintain their health. MyHealth OnLine, the member website offered by UPMC, allows users to track personal data and find providers within their network easily. In addition, the UPMC app gives members mobile access to member ID cards and claim status information.

UPMC stands out with excellent customer service. When calling its hotline, you will be connected with someone in the local community – something not available with many health insurance providers. Furthermore, UPMC invests heavily in Southwestern Pennsylvania by investing in its economy.

UPMC offers health insurance plans with two accounts: A high-deductible health savings account (HDHP Option PPO and PPO Plus), as well as a Health Incentive Account (HIA), which allows members to earn reward dollars that can be applied toward out-of-pocket expenses. Additional member benefits from UPMC include discounted tickets to the zoo, expert health coaching, and travel medical cover through Assist America, which offers medical assistance 100 miles or further from home for its members of UPMC for You memberships.

UPMC for Life

UPMC for Life Medicare Advantage plans provide many attractive features that may make them an excellent fit for some Medicare beneficiaries. Their plans typically feature low monthly premiums, no deductibles, lower copays for primary care and prescription drugs, and wellness programs designed to help members improve their health.

Before signing up for UPMC for Life plans, individuals should ensure they have all of the required information. Prices, coverage options, and prescription drug costs may differ among programs; it would be advisable to consult an independent insurance agent to choose an ideal one.

Some UPMC for Life plans come with an annual allowance to purchase over-the-counter health products or pay for dental, vision, and hearing services – an extra dollar can go a long way in cutting healthcare costs while supporting healthier lifestyle choices.

Other plans offer members a telehealth benefit, enabling them to see their PCP via video visit without incurring the standard copay. This is ideal for busy individuals who avoid expensive emergency room visits and save money with reduced copays for in-network specialists and preferred generic medications.

All UPMC for Life members have access to an award-winning Health Care Concierge team, which can assist them with understanding their healthcare benefits and connecting them with resources needed for staying healthy. The team has won multiple accolades, including the 2021 Stevie(r) Gold Customer Service Excellence Award.

UPMC for Life can provide extra motivation for reaching healthcare goals, including helping you shed excess weight, lower stress levels, and quit smoking. They also offer financial benefits like 401(k) retirement savings plans and life insurance policies to keep your goals on track.

UPMC for Life partners with local organizations to offer its members access to social support services that may aid with the social determinants that impede their health, such as childcare, housing, or transportation issues.

UPMC Advantage

UPMC Advantage is a Medicare Advantage plan with many additional features and benefits, such as pediatric care management, access to a 24/7 nurse line, access to UPMC anywhere care, eyeglass or contact lens allowance, and mobile app and web portal access for bill pay/health advice/finding doctor services. Their customer service is outstanding as they specialize in processing claims quickly.

UPMC employs over 14,000 workers, making it one of Pennsylvania’s largest healthcare companies. Its network is well-regarded, boasting many renowned doctors and facilities. Hospitals within UPMC boast excellent ratings for specialty care procedures like transplant surgeries. Furthermore, local networks within UPMC rank highly for quality of care and affordability.

UPMC Advantage is a Medicare Advantage program available in most counties of Pennsylvania and parts of Ohio. It offers HMO, PPO, and PFFS Advantage plans as well as SNPs for those who qualify for both Medicare and Medicaid; some plans provide prescription drug coverage; many programs offer access to an extensive pharmacy network, including pharmacies within UPMC facilities as well as chain stores like Riteaid.

In addition to offering a selection of Medicare Advantage plans, UPMC also provides an inclusive wellness program to assist in maintaining good health. This program features personalized plans and an online wellness coach who can assist with setting health-related goals and helping reach them successfully, even helping with weight loss or quitting smoking!

When it comes to group health insurance for small businesses, UPMC is an excellent option. They provide excellent value in the area while offering numerous group options, discounts, and incentives that help small companies save money on healthcare costs. Furthermore, they have an impressive presence throughout their region, working closely with community organizations while offering integrated FSA, HRA, and HSA accounts for added convenience.

UPMC for Business

As a member of UPMC, you have access to many resources and services designed to make life better – these include group health insurance, Medicare, Special Needs Assistance (MSNA), behavioral health, employee assistance services, and workers’ compensation products and services. In addition, they also provide community care and comprehensive specialty health services – with its primary flagship hospital, UPMC Presbyterian Shadyside, being one of the largest hospitals in Pennsylvania known for world-class surgical and clinical services; Heartland (2007) and Three Rivers (2009) have featured it as well.

UPMC’s diverse business model rewards continuous innovation and breakthrough ideas, as well as rapid research translation into practical products and services that serve both western Pennsylvanians and people worldwide. Furthermore, its focus on compassionate healthcare enables it to foster an atmosphere of prioritizing patients.

UPMC Enterprises Marketing Team is an agile and versatile group supporting several portfolio companies’ internal and external marketing initiatives. Their specialization lies in digital, social media, and public relations – skills essential in the rapidly developing healthcare sector.

UPMC Enterprises stands out with its robust marketing capabilities, business development network, and investor relationships. This allows them to provide expert counsel and services to early-stage startups looking to grow their businesses quickly.

Jeffrey Romoff has an unfavorable approval rating among employees; his ranking among other CEOs at similarly-sized organizations ranks in the bottom 20%. On the other hand, other managers and directors at UPMC tend to receive high marks in performance reviews.

UPMC for Business members enjoy various advantages, such as accessing a consolidated provider directory, instant messaging with a Customer Service Representative, and self-service tools online. In addition, members can access documents detailing their rights and responsibilities and how to file complaints or request Fair Hearings, plus mobile apps that instantly allow instant healthcare information management.