Plan Year

March 1, 2026 - February 28, 2027

We sincerely believe that our employees are our greatest asset. To offer a competitive and affordable employee benefits package, we have partnered with our local NFP team in Somerset, PA. NFP is a leading insurance broker and consultant that provides employee benefits, property and casualty, retirement, and individual private client solutions through licensed subsidiaries and affiliates. By partnering with NFP, we are committing to continuing to improve the employee benefits experience for all of our employees. For more information about NFP, visit nfp.com.

What is Open Enrollment?

Open Enrollment is the one time of year that you are able to enroll in or modify your employee benefits for the upcoming plan year. Elections you make at this time will remain in effect until the next Open Enrollment period, unless you have a Mid-Year Election Change Event that allows for a plan change.

What is a Mid-Year Election Change Event?

A Mid-Year Election Change Event (such as marriage, divorce, birth/adoption of a child, or loss of eligibility under another plan) allows you to make plan changes outside of Open Enrollment. If you experience this type of event during the year, you may modify your benefits within 30 days by notifying HR as soon as possible. Learn more.

Who is eligible for benefits?

Full-time employees working 30 or more hours per week, your spouse, and your legal dependents are eligible to participate in the benefit plans.

Who are my legal dependents?

  • Your legal spouse
  • Your children (up to age 26) including natural, step, legally adopted/placed for adoption, and children for whom you serve as legal guardian
  • Disabled dependent children (any age)

When does my coverage start?

Your coverage becomes effective on the first day of the month following 30 days from your date of hire.

How to Enroll

Current Employees: If you'd like to change your existing coverage or make new elections, complete the appropriate enrollment form(s) below and return to HR. If no changes are needed, your current coverage will automatically renew for the new plan year.

New Employees: To enroll, complete the appropriate enrollment form(s) below and return to HR.

Your Benefit Options

Medical

UPMC Health Plan


Dental

United Concordia


Vision

VBA Vision


Understanding Your Benefits

Covered Health Service: A service could be an office visit, test, prescription, or another medical treatment your health insurance covers. Before seeking care, check to make sure the service is covered.

Claim: The request for payment that's sent to your health insurance company after you receive covered care.

Copay: A fixed fee that you must pay for a covered service as outlined in your plan design, usually at the time you receive the service.

Plan Allowance: The set amount your plan will pay for a health service, even if your provider bills for more.

Deductible: The set amount you pay for a covered health service before your plan will begin to pay. Will be outlined within your plan design.

Coinsurance: The percentage of the cost of your covered health care services, that you must pay after you've met your deductible.

Out-of-Pocket Maximum: The most you'd pay for covered care within the plan period. If you hit this amount, your plan pays 100% after it is reached.

Premium: The monthly amount paid (by your employer, a combination of employer and employee or the employee only if voluntary)


In-Network Provider: A doctor, hospital, or other provider in the plan's network. Network providers accept the plan's payment in full. You pay less when you use an in-network provider. With the exception of care for emergent and urgent conditions, if the plan does not offer out of network coverage, you must seek an in–network provider for all covered services.


Out-of-Network Provider: Provider who does not have a contract with your health insurer to provide services to you at a discount. You will generally pay more to see an out-of-network provider. If you have an EPO or HMO plan, you are not covered for out-of-network services (except for emergency and urgent care services).


Formulary: A list of medications covered by your plan sorted by tier. Lower tiers usually mean lower copays.

Plan Options

  • UPMC EPO MyCare $500 Deductible

Did you know?

  • Preventive services are covered at 100% in-network, and copays and deductibles do not apply.
  • You pay less out of pocket if you receive care from an in-network provider.
  • You do not need a referral to see a specialist.

Download the UPMC Health Plan app

Find care, check benefits and coverage, access member ID cards, view claims, and more.

EPO MCA $500 Benefit Summary

EPO MCA $500 Benefit Summary

EPO MCA $500 SBC

EPO MCA $500 SBC

2026 Benefit Notices

2026 Benefit Notices

Telehealth

As a UPMC Health Plan member, you have access to a variety of telehealth services - right from your computer, tablet, or smartphone.

Sign up for a MyUPMC account to conveniently manage the care you receive from UPMC providers:

  • Schedule a video or office visit
  • Communicate with your doctor's office via secure messaging
  • Manage your appointments
  • Renew your prescriptions
  • View your test results and medical history
  • Pay your bills

To get started, download the MyUPMC mobile app or visit myupmc.upmc.com.

UPMC MyHealth

24/7 Nurse Line

Illnesses and injuries don’t wait for the “right” time. When you need guidance for a non-emergency concern, especially after hours or when your PCP isn’t available, the UPMC MyHealth 24/7 Nurse Line is here for you. You can talk to a UPMC nurse at no cost, anytime. Just have your member ID card ready when you call.

To speak with a registered nurse 24/7, call 1-866-918-1591.

With UPMC AnywhereCare, you and your covered dependents can have virtual visits with health care providers to address these and other nonemergency medical issues:

  • Cold and flu symptoms
  • Rashes
  • Pink eye

You can connect with a provider from your mobile device or computer 24/7, and you never need an appointment. If appropriate, your provider can send a prescription to your preferred pharmacy. UPMC AnywhereCare is free or low-cost to UPMC Health Plan members.

To have a secure virtual visit, download the UPMC AnywhereCare mobile app or visit upmcanywherecare.com.

Express Scripts

UPMC Health Plan and Express Scripts mail-order pharmacy work together to provide home delivery of your prescription medications - and you’ll enjoy free standard shipping!

Home delivery works best for maintenance medications. These are medicines that are taken on a regular, long-term basis and may include drugs to treat asthma, diabetes, high cholesterol, high blood pressure, and other chronic conditions. Express Scripts should not be used for short-term medications, such as drugs to treat a sinus infection.

Getting started: Once you become a UPMC Health Plan member, it’s easy to transfer your prescriptions to Express Scripts. Just visit express-scripts.com/lowercost or call 1-877-787-6279.

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UPMC Express Scripts Form

UPMC Express Scripts Form

Added Benefits from UPMC

Assist America

As a UPMC Health Plan member, you have access to a unique global emergency travel assistance program - Assist America. You can use this service if you experience an emergency while traveling 100 miles from home (including to another country) for less than 90 days. This service can connect you and your covered family members to doctors, hospitals, pharmacies, and more for no extra cost.

Active&Fit Direct

As a member, you have access to the Active&Fit Direct program for one low monthly cost.

  • 8,000+ digital workout videos
  • No long-term contract
  • Ability to enroll a spouse/domestic partner
  • 11,000+ fitness centers and studios nationwide, including:

To get started, log into upmchealthplan.com and see Health and Wellness Discounts.

LifeSolutions

Our Employee Assistance Programs (EAPs) help your workers balance everyday work-life demands and supports your managers as they address the challenges in today's workplace.


LifeSolutions is an employee assistance program (EAP) and much more. We use our expertise in human behavior in the workplace to help companies thrive. We connect employees to the resources they need so they stay focused and productive. We help managers and leaders face challenges in their day-to-day responsibilities. In short, LifeSolutions can contribute to achieving your company's bottom line goals.


We look forward to partnering with you.

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Medicare Services from NFP

Considering Medicare coverage?

NFP is proud to support you when it comes to Medicare and understanding your coverage options. As trusted advisors in the individual markets for over 20 years, our team is comprised of experienced and knowledgeable agents specializing in Medicare coverage. We offer independent and individualized consultations to help you to:

  • Understand your coverage options
  • Determine if you are eligible for subsidies to lower your healthcare costs
  • Establish a timeline for applying for coverage
  • Choose a plan that fits both your lifestyle and your budget
  • Find coverage that allows you to access the doctors and hospitals you want most
  • Enroll in the plan that works best for you

Best of all, there is never a fee for our services.

Dental

Plan Options

  • Basic Dental
  • Platinum Dental
  • Premium Dental

Did you know?

Oral health is more than just healthy teeth. Oral refers to the mouth, which includes the teeth, gums, and supporting tissues. Most oral health conditions are largely preventable and can be treated in their early stages.

Basic Dental Benefit Summary

Basic Dental Benefit Summary

Platinum Dental Benefit Summary

Platinum Dental Benefit Summary

Premium Dental Benefit Summary

Premium Dental Benefit Summary

Vision

Plan Options

  • Basic Vision
  • Platinum Vision
  • Premium Vision

Did you know?

Eyes can give doctors a clear picture of overall wellness. A comprehensive eye exam can detect early signs of serious health problems, such as:

  • Diabetes
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Glaucoma and cataracts

Basic Vision Benefit Summary

Basic Vision Benefit Summary

Platinum Vision Benefit Summary

Platinum Vision Benefit Summary

Premium Vision Benefit Summary

Premium Vision Benefit Summary

Contacts

You have dedicated agents ready to handle any situation in a discreet and confidential manner. Contact us for questions and needs such as:

  • Understanding your benefit coverage
  • Help finding in-network providers
  • Assistance with prescription or pharmacy issues
  • Questions regarding bills you receive from your doctor, specialist, hospital, or lab
  • Claims you believe haven’t been paid properly

ContactImage

Brianna Rainey

Account Executive

brianna.rainey@nfp.com

814-289-4232

ContactImage

Debra Barron

Producer / Sales Consultant

deb.barron@nfp.com

814-289-4227