Medical Coverage

Medical Plan Options

Click on each plan below for additional information.

Each plan includes:

Choosing Your Plan
To help you choose the health plan that best meets your family's needs, use the
Medical Plan Comparison & Medical Plan Decision guide.

UPMC provides high-quality, comprehensive medical options allowing you the opportunity to choose coverage that best meets your health requirements and budget. In order to make the right decision for you and your family, you must take the time to understand your benefit choices — keep in mind that you are the manager of your health care needs. Studies have shown that people who do not understand their coverage pay more. Use the following tools to help educate yourself about your benefit options and to be an advocate for your health.

MyHealth

Each medical option includes a basic deductible and a MyHealth deductible. By meeting the My-Health requirements, staff will receive a deductible credit ($500 per individual/$1,000 per family).

Learn more about MyHealth and completing the requirements>

Available Plan Options

As you compare the options offered under the UPMC Benefits Plan, it is important to remember that when you stay in-network*, copays are the same for physician office visits, emergency room visits, and prescription drugs. While it is imperative to learn about the coverage for those items, they are not a decision point when comparing the UPMC medical options. To help you focus on the differences in the programs, review the overview snapshots below. Continue your education by using the buttons and links on this page to learn the terminology and review additional benefit details. Refer to your My HUB benefit enrollment screens for the per-pay cost of each medical option.

Advantage HMO

Lowest deductible, 100% coinsurance in-network, mid-range per-pay contributions, UPMC Advantage Network for maximum benefit

Coverage features:

Low out-of-pocket costs (in-network)
Primary Care Physician (PCP) for preventive/ill visits; no referral needed for specialist office visits
UPMC Advantage Network for highest coverage level of hospital, lab, diagnostic services; UPMC Health Plan Network for PCP/specialist visits; no coverage out-of-network
Highest coinsurance rate (in-network); No lifetime maximum (in-network)

Excellent choice for high health care users or those who prefer to pay more on a per-pay basis for higher coinsurance in the event of a hospital stay or if diagnostic/lab work is needed.

Advantage PPO

Mid-range deductible, 80% coinsurance in-network, lowest per-pay contributions, UPMC Advantage Network for maximum benefit

Coverage features:

Most affordable per-pay contributions
No primary care physician (PCP) or referral needed for physician office visits
UPMC Advantage Network for this plan's highest coverage level of hospital, lab, diagnostic services; UPMC Health Plan Network for PCP/specialist visits; may go out-of-network at a lower coverage level
Lowest coinsurance rate (in-network); $1,000 individual/$2,000 family out-of-pocket maximum (in-network); $2,000,000 lifetime maximum (in-network)

Excellent choice for those who prefer lower per-pay costs for the potential savings should hospital stays or diagnostic/lab work not be needed or for those on a limited budget and a tolerance for risk/reward.

Open Access PPO

Highest deductible, 100% coinsurance in-network, highest per-pay contributions, UPMC Health Plan Network for maximum benefit

Coverage features:

No primary care physician (PCP) or referral needed for physician office visits
Maximum freedom of provider choice with UPMC Health Plan Network for highest coverage level of hospital, lab, diagnostic services, and PCP/specialist visits; may go out-of-network at a lower coverage level
Highest coinsurance rate (in-network); $2,000,000 lifetime maximum (in-network)

Excellent choice for those who require the most network flexibility and are willing to pay a premium on a per-pay basis for that ability.

Special Note for UPMC Mercy Staff
Please be aware that UPMC Mercy, as a Catholic health care organization, is covered by Ethical and Religious Directives for Catholic Health Care Services. All benefit plans have been designed to comply with these directives. Abortions, contraceptives (except for authorized medical reasons), and voluntary sterilization are excluded from coverage under UPMC Mercy’s health insurance plans. Assisted fertilization techniques are excluded from coverage under all of UPMC’s health insurance plans.

Benefits described may not be applicable to all staff. Some business units have unique benefit programs, certain job classifications may affect benefit eligibility, and contract terms determine benefits for physicians and members of collective bargaining units.

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In-Network *
The use of the term “in-network” on these pages refers to services received by providers participating in the network offering the highest level benefit for each plan.