Plan Year

February 1, 2025 - January 31, 2026

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 would like to make changes to your existing coverage, please submit your completed Benefit Election Form / HSA Election Form to HR by January 29, 2026. If no changes are needed, your current benefits will automatically renew for the new plan year.

New Employees:

Please submit your completed Benefit Election Form / HSA Election Form to HR by January 29, 2026.

Your Benefit Options

Medical

UPMC Health Plan

Dental

UPMC Health Plan

Vision

UPMC Health Plan

2026 Plan Rates

2026 Plan Rates

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.

UPMC Health Plan

Plan Options

  • EPO MCA 2000
  • HSA EPO 2200

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 2000 Benefit Grid

EPO MCA 2000 Benefit Grid

EPO MCA 2000 SBC

EPO MCA 2000 SBC

HSA EPO 2200 Benefit Grid

HSA EPO 2200 Benefit Grid

HSA EPO 2200 SBC

HSA EPO 2200 SBC

Virtual Visits

As a UPMC Health Plan member, you have access to virtual visits with a provider - right from your computer, tablet, or smartphone.

Using telehealth, you can receive:

  • A rapid response to your health needs
  • Advice on appropriate care
  • Access to providers

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

Answer a few questions, then have a virtual visit with a provider over live video. UPMC AnywhereCare provides access to treatment for a variety of nonemergency conditions:

  • Cold and flu symptoms
  • Sinus and allergy symptoms
  • Bronchitis
  • Sore throats
  • Pink eye
  • Rashes

If you need a prescription, the provider will send it to your preferred pharmacy. The copayment is generally less than the cost of an urgent care visit and much less than an emergency department visit.

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.

Life Solutions EAP

Services Offered

Life Solutions EAP

Services Offered

Health Savings Account

What is a Health Savings Account? A Health Savings Account (HSA) is a tax-advantaged savings account that you can use to pay for qualified medical expenses, such as copays and medications - now or later in life. Contributions to HSAs aren’t subject to federal income tax if used for medical expenses, and earnings in the account grow tax-free. You must be enrolled in a high-deductible health plan (HDHP) to qualify for an HSA.

Do HSA funds expire? HSA funds don't expire; they will stay in your account and can be used for medical expenses even after you retire.

Who is covered? An HSA covers qualified out-of-pocket expenses for you, your spouse, and your tax dependents, even if they are not covered under an HDHP.

How much can I contribute to an HSA? For 2026, the HSA annual contribution limits are $4,400 for individuals and $8,750 for families, with an additional $1,000 catch-up contribution allowed for individuals age 55 and over.

If you enroll in an HSA, UPMC Health Plan will send you a debit card. The amount that you elect to contribute each pay will be loaded onto the card. Contributions can be changed at any time, as long as you do not contribute over the IRS annual limit. Please notify HR if you would like to make changes to your contributions.

Additional Resources

MyCare Advantage Network

for the Gold EPO MCA 2000 plan

MyCare Advantage Network

for the Gold EPO MCA 2000 plan

Premium Network Listing

for the HSA EPO 2200 plan

Premium Network Listing

for the HSA EPO 2200 plan

2026 Preventive Services Guide

2026 Preventive Services Guide

2026 RX Formulary

2026 RX Formulary

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 100/0/0/$0
  • Premium 100/80/50 $0 / $1,500/ No Ortho

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 100/0/0/$0 Benefit Summary

Basic 100/0/0/$0 Benefit Summary

Premium 100/80/50 $0/$1,500/No Ortho

Premium 100/80/50 $0/$1,500/No Ortho

Vision

Plan Options

  • Exam Only Plus $0 Copay
  • Elite Plus $0 Copay

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

Exam Only Plus $0 Copay Benefit Summary

Exam Only Plus $0 Copay Benefit Summary

Elite Plus $0 Copay

Elite Plus $0 Copay

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

Erica Jones

Account Executive

erica.jones@nfp.com

724-940-9466

ContactImage

Michelle Ruff

Producer / Sales Consultant

michelle.ruff@nfp.com

412-600-2341