Plan Year
November 1, 2026 - October 31, 2027
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 Qualifying Life Event that allows for a plan change.
What is a Qualifying Life Event?
A Qualifying Life 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 your date of hire.
How to Enroll
Current Employees: If you would like to change your existing coverage or make new elections, you must complete the applicable enrollment form(s) and submit to your employer. Your current medical, dental, and vision elections will carry forward to the new plan year if you do not make a new election.
New Hires: You must complete applicable enrollment form(s) and submit to your employer.
Your Benefit Options
Medical | UPMC Health Plan
Dental | UPMC / United Concordia
Vision | UPMC Health Plan
Short-Term Disability | Boston Mutual
Accident | Boston Mutual
Critical Illness | Boston Mutual
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.
Medical + Rx
Plan Options
- Option 1 - Base Plan: EPO $6000 Deductible
- Option 2 - Mid-Level Plan: First Care Plan: EPO $2500 Deductible
- Option 3 - Buy-Up Plan: Custom EPO $0 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.
Partner Network: This is UPMC’s own network that includes only UPMC-owned hospitals. Steering members to their own facilities helps to control claim costs. Only in non-emergency situations or for scheduled services, you must use a UPMC provider in order to have coverage by the plan. In emergency situations, you should go to the closest hospital, regardless if it is UPMC-owned. You have 100% coverage in emergency situations - in-network, out-of-network, and anywhere in the world.
First Care: This plan encourages members to obtain care when needed by removing costs associated in these situations:
- $0 copay for first in-person or virtual primary care and specialist visits
- $0 copay for ALL behavioral health visits (either virtual or in-person visits)
- $0 copay for urgent care visits using UPMC Anywhere Care
Prescription copays are the same for all three plans offered:
- Retail: $15 (Generic) / $30 (Brand Name Formulary) / $50 (Non-Formulary)
- Mail Order: $30 (Generic) / $60 (Brand Name Formulary) / $100 (Non-Formulary)
Contribution Rates
Table
Telehealth
As a UPMC Health Plan member, you have access to a variety of telehealth services - right from your computer, tablet, or smartphone.
MyUPMC
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.
MyHealth 24/7 Nurse Line
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. Nurses can offer advice for how to treat a condition at home, or guidance about whether to seek a higher level of care.
You can talk with a UPMC nurse anytime - at no cost. Just have your member ID card ready when you call.
To speak with a registered nurse, call 1-866-918-1591.
24/7 Video Visits
With 24/7 video visits, patients of all ages can receive non-emergency virtual care from anywhere in the U.S. All that’s needed is a computer, tablet, or smartphone. Receive convenient, high-quality virtual health care visits for conditions such as cold and flu symptoms, sinus infections, allergies, pink eye, and more. Visits cost $0 to $67 for UPMC Health Plan members, with most paying $5 to $15 for a visit - much less than a visit to an urgent care facility or emergency room.
Members can access 24/7 video visits through the UPMC Health Plan member site, upmchealthplan.com/members.
Added Benefits from UPMC
Mental Health Resources
As a UPMC Health Plan member, you have access to mental health resources, such as:
- Behavioral Health Coaching and Care Management | Access to behavioral health case manager, including six no-cost, virtual counseling sessions
- Stress Management Text Messaging Program | Get tips, exercises, and resources to help you manage your emotions.
- Behavioral Health Care Providers | Specially trained providers can assist with managing behavioral health issues.
To get started, download the UPMC Health Plan app or visit myupmc.upmc.com.
Employee Assistance Program
Through Workpartners, LifeSolutions® EAP can help you and your household members address your work and personal concerns to become healthier, happier, and more productive. You can speak with a licensed counselor in person, over the phone or virtually about:
- Family, marital, and other relationship issues
- Childcare, elder care, and other personal responsibilities
- Work-related and career challenges
- Stress, anxiety, and depression
- Making healthy lifestyle changes
- Alcohol and/or drug overuse
Learn more at workpartners.com or call the LifeSolutions Confidential National Service Center at 800-647-3327.
Assist America
If you or your covered dependents experience an emergency while traveling more than 100 miles from home for less than 90 days, Assist America can connect you to doctors, hospitals, pharmacies, and more.* Download the Assist America mobile app to contact the 24/7 Emergency Operations Center.
Within the United States: 1-800-872-1414
Outside the United States: 1-609-986-1234
*Assist America is not travel or medical insurance, and its services will not replace your health care coverage while you are away from home.
Health Coaching Programs
Lifestyle coaching and condition management health coaching programs are available at no cost to you, and they can be scheduled at times that are convenient for you. Our health coaches are registered dietitians, nurses, certified diabetes counselors, smoking cessation counselors, licensed social workers, and other health experts who can help you:
- Lose weight
- Eat better and build healthier habits
- Reduce your stress
- Quit using tobacco
- Create a healthy family plan
- Understand and manage your diabetes, heart disease, asthma, or other chronic condition(s)
Baby Steps Maternity Program
Through Baby Steps, you will be connected with a maternity care manager who will provide caring, clinical support throughout your pregnancy. There is no cost for this service. Baby Steps maternity care managers are registered nurses who are experienced in obstetrics. They can:
- Help you form questions for doctor appointments
- Tell you about ways to manage your labor pain
- Talk with you about healthy eating and foods to avoid during pregnancy
- Help you find prenatal exercise and parenting classes
Amplifon Hearing Health Benefit
Amplifon has health care solutions to fit a variety of lifesthearingyles and budgets.
- More than 700 hearing aid products from the leading manufacturers
- Access to nearly 6,000 clinic locations nationwide
- No-interest financing (for those who qualify)
- A 60-day, risk-free trial with no restocking fee
- One year of free follow-up care
- Battery support
- Three-year warranty covering loss, damage, and repairs
For more information, call 1-877-846-7077 or visit amplifonusa.com/lp/upmchp.
Health and Wellness Programs
Active&Fit Direct
With the Active&Fit Direct program, work out the way you want with one monthly membership.
- Access to 11,000+ standard fitness centers
- Access to 5,500+ premium exercise studios
- Access to 8,000+ digital workout videos
- Ability to enroll a spouse/domestic partner
- Ability to change fitness centers at any time
- No long-term contracts
Health Coaching
Free for members, health coaching can help you make lifestyle changes to lose weight, quit smoking, or manage a chronic condition like diabetes.
Rx Information
Prescription copays are the same for all three plans offered:
- Retail: $15 (Generic) / $30 (Brand Name Formulary) / $50 (Non-Formulary)
- Mail Order: $30 (Generic) / $60 (Brand Name Formulary) / $100 (Non-Formulary)
Cost-Saving Tips
- Ask About Generics: Generic medications are often just as effective as brand-name drugs and typically cost much less. Ask your doctor if a generic alternative is available.
- Use Home Delivery or Mail Order: Many pharmacy plans offer lower costs for a 90-day supply through mail order or home delivery services.
- Check for Discounts and Coupons: Manufacturer coupons, pharmacy savings programs, and prescription discount services may help reduce your out-of-pocket costs.
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
- Option 1 - United Concordia
- This dental plan requires a Primary Care Dentist be chosen and used for all services rendered. It is comprehensive coverage, but the network of dentists is limited.
- Option 2 - UPMC Health Plan
- This is a dental insurance policy that gives you the freedom to use Network or Out-of-Network dentists, with a $1500 annual maximum.
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.
Contribution Rates
Table
Vision
Plan Details
- UPMC Exam Only Plus (included with all UPMC medical plans)
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
Short-Term Disability
Short-Term Disability (STD) insurance replaces a portion of your income for a limited time when a non-work-related illness, injury, or medical condition temporarily prevents you from working. It provides cash benefits directly to you, helping cover living expenses while you recover.
- Available Purchase Amounts: $100 - $1,400 per week in $25 increments
- Coverage starts on the 1st day for injury and 8th day for sickness
- Benefit payment period is up to 13 weeks
- Non-occupational
Accident
Accident Insurance pays cash benefits directly to you for injuries from unexpected accidents, covering costs like copays, deductibles, prescriptions, emergency care, physical therapy, and even lost wages. It offers fixed payouts for specific events (like broken bones, concussions, or other injuries) and helps manage the financial strain of accidents that happen on or off the job.
- Includes hospital care, emergency care, tests, burns, concussion, eye injury, gunshot wounds, dental work, etc. needed as a result of covered accident
- Coverage must have been in force for 1 month after our certificate date
Critical Illness
Critical Illness Insurance provides a lump-sum cash payment if you're diagnosed with a specific serious illness (like cancer, heart attack, or stroke). It supplements your health insurance by covering non-medical costs like lost wages, mortgage payments, or travel, allowing you to focus on recovery rather than finances.
- Includes cancer, heart bypass surgery, coma, Alzheimer's, transplants, etc.
- Spouse coverage available
- Children covered at no additional charge
Contacts
You have dedicated agents to support you throughout the year. Contact us for help with:
- Understanding and making the most of your benefits
- Questions about eligibility or enrollment
- Resolving claims or billing issues
Brianna Rainey
Account Manager
brianna.rainey@nfp.com
Michelle Ruff
Producer / Sales Consultant
michelle.ruff@nfp.com
412-600-2341