UPMC Health Plan Latest Updates

July 2023 Updates:

UPMC notified clients of August Dental & Vision premium & administration fee billing delays.

  • Impacted groups will receive updated invoices that should be paid in full by the stated deadline.
  • For groups using Autopay, the combined amount of all outstanding invoices will be pulled on the scheduled Autopay date.
  • UPMC is continuing to monitor any outstanding Dental and Vision billing that may become past due as a result of this error.

June 2023 Updates:

UPMC announced upcoming changes to SaveOnSP Program:

  • Medications included in the SaveOnSP program to change effective July 1.
  • Click here for a list of medication changes.
  • Impacted members mailed letters as outlined below:
    • 60 days before the effective date of change for drugs that are being added to the program.
    • 30 days before the effective date of the change for drugs that are being removed from the program.
  • Please note the following clarifications as confirmed by UPMC:
    • All fully insured non-HSA plans include SaveOnSP regardless of deductible.
    • The excluded groups from SaveOnSP are ASO groups (they have to opt-in on their own), SelfAssure level funded groups, Grandmothered 2-50 groups, and any HSA plan.

CAA RxDC Update from UPMC:

  • Confirmation that UPMC submitted the required 2022 RxDC reports to the department by the deadline of June 1.
    • Please note that UPMC did not & will not be able to submit this information on behalf of clients who did not complete the UPMC CAA RxDC survey.
  • UPMC will work to refine the data collection process for the calendar year 2023 data, due on June 1, 2024.

May 2023 Updates:

UPMC to offer a new Zero-Dollar Select Generic Medications Tier Prescription Drug Initiative:

  • Available for both fully insured and ASO groups, effective 1/1/24:
    • ASO groups are strongly encouraged to participate in this initiative, and must notify UPMC by June 2 if they want to opt-out.
    • If you have an ASO group with questions, please reach out to your NFP BNGA team ASAP.
  • Certain medications will move to a new tier with no member cost share (deductible may still apply) called the Select Generic Medications Tier.
    • To include generic blood pressure, high cholesterol, depression, diabetes, and other medications.
  • Click here to view a full list of generic drugs that will move to the Select Generic Medications Tier.
  • If you have any questions, please reach out to your NFP BNGA team.

April 2023 Updates:

Effective April 1, 2023 UPMC has officially transitioned receipt and review of bills to online only via Employer OnLine:

  • Online payment is not required but is encouraged, fast and secure
  • Groups will need to make sure they have access to EOL – please reach out to your NFP BNGA team if you need help with this.

UPMC is waiving the $28 enrollment fee for standard gyms only April thru June:

  • Code included in flyer – view here.
  • Great resource to share with UPMC clients!

UPMC announces approach to end of Public Health Emergency:

  • End of COVID-19 PHE is May 11, 2023.
  • Members’ cost sharing will change for the below outlined benefits and services:
    • COVID-19 diagnostic and antibody testing
    • At-home, over-the-counter COVID-19 testing
    • Prescription antiviral treatment
    • Evaluation services used to diagnose COVID-19; including telemedicine, office, urgent care, and emergency room visits
  • Covid vaccines will continue to be covered at $0 at in network pharmacies/facilities.

March 2023 Updates:

UPMC announces change in refill of prescription eye drops:

  • Pennsylvania State Bill No. 1201 (Act 162 of 2022) permits the early refill of prescription eye drops in certain circumstances
  • UPMC allows for early refills of all medications once members have used 75% of their medication
  • This new bill allows early refills of prescription eye drops once members have used 70% of their medication
  • Change is effective for fully insured groups July 1, 2023

Final reminder: UPMC is shifting all clients to paperless billing effective April 1, 2023:

  • Groups will need to access Payments & Billing via Employer OnLine
  • Groups will be required to appoint an Online Account Administrator & this individual with register for access to EOL
  • Please direct any questions to your NFP BNGA team

February 2023 Updates:

UPMC called renewed attention to the SaveON SP Copay Program:

  • This program is for all fully insured groups regardless of group size as of 1/1/23 or at the time of their 2023 renewal
  • UPMC has communicated that a small subset of membership is impacted depending on use of specialty medication – please contact your NFP BNGA team for more information

UPMC clients are shifting to paperless billing:

  • Change is effective 4/1 – groups will need to access Payments & Billing via Employer OnLine
  • Groups will be required to appoint an Online Account Administrator & this individual with register for access to EOL
  • Please direct any questions to your NFP BNGA team

UPMC announces compensation increases in the 51+ Market:

  • Effective 4/1
  • More information to follow regarding how this change effects your General Agency compensation schedules

January 2023 Updates:

December 2022 Updates:

November 2022 Updates:

  • UPMC released their 2023 ACA Benefit Plan Summary brochures:

October 2022 Updates:

  • UPMC VirtualCare updates:
    • Innovative, lower-cost group health plan for employers with 2-50 employees in Allegheny & Erie counties – to be offered with the UPMC Partner Network in 2023.
    • Access to convenient, affordable care from virtually enabled in-network providers.
    • $0 copay for virtual visits
    • Virtual specialist visits for half the copay of in-person
    • Video linked here
    • Flyer linked here
  • UPMC Essential Pharmacy Network:
    • Offered to Individuals on and off the Exchange, as well as to small market (2-50) employer groups (excluding MUW) – available upon group’s 2023 renewal date.
    • Provides most members access to at least 2 participating pharmacies within 5 miles of their home.
    • Network includes more than 19,000 participating pharmacies nationwide & over 1,200 pharmacies in PA.
    • Producer training webinar available here
  • UPMC encouraging clients to go paperless:

September 2022 Updates:

  • UPMC hosted a VirtualCare & Essential Pharmacy Network Webinar on 9/27:
  • Employer groups are able to schedule On-Site Flue Vaccination Clinics through UPMC:
  • Telehealth Awareness Week (9/18 – 9/24) highlighted approved access to quality care on telehealth platforms, such as UPMC AnywhereCare.
    • Additional digital health UPMC services available to covered members:
      • Exclusive digital health tools and resources, such as MyHealth OnLine and the UPMC Health Plan app.
      • RxWell, a cutting-edge app for depression, stress, anxiety, and other health and well-being concerns.
      • MyUPMC, which allows members to have a virtual visit with a UPMC physician, view test results, schedule appointments, renew their medications, and pay bills they’ve received from UPMC providers.

August 2022 Updates:

  • Vision Advantage plan changes:
    • All Vision Advantage plans are phasing into Vision Care products at upcoming client renewals – please keep in mind as you review renewals with your UPMC clients. They must indicate new Vision plan selection or coverage will terminate effective the last day of month prior to renewal.

July 2022 Updates:

Active&Fit Direct is offering a “Summer Special” through the end of August:

  • Waived $25 enrollment fee
  • Provides UPMC Health Plan members over the age of 18, & spouses, the opportunity to join A&FD for $25 / month
  • Members can use any of their 11,600+ Standard Fitness Centers & over 7,600 digital on demand workouts
  • Get started here (UPMC log in required).

June 2022 Updates:

Click the links below to access UPMC commonly used forms:

Click the links below to access UPMC User Guides for Employer OnLine:

UPMC to comply with Transparency in Coverage Final Rule – Machine Readable Files (MRFs) will be available online effective July 1, 2022


May 2022 Updates:

UPMC Health Plan, Express Scripts Inc., and SaveOnSP are pleased to provide the SaveOnSP specialty cost-share assistance service for Health Plan members:

  • Begins on July 1, 2022
  • Targets specific high-cost specialty medications & leverage funds from manufacturer patient assistance programs to lower cost sharing for members who enroll
  • Members will be able to work with UPMC Health Plan’s preferred specialty pharmacies (Chartwell and Accredo) to apply manufacturer assistance to eligible pharmacy claims.
  • Visit here to check the SaveOnSP drug list.

Please contact your UPMC account manager with any questions.

UPMC Enrollment Form Step-by-Step


April 2022 Updates:

UPMC Update: Enrollment Contact Form – Moving to Producer OnLine

Important: Vision plan transition for ACA renewals


Recently Archived Updates:

Review Adjusted Best Practices surrounding UPMC’s MSP Attestation Submission

UPMC Health Plan Virtual Concierge on Amazon Alexa & Google Home

UPMC Health Plan Extends Members’ Out-Of-Pocket Cost Waivers for In-Network Telehealth Visits, Inpatient COVID-19 Treatment and Monoclonal Treatment (extension in effect through July 20, 2021

UPMC Partner Network Now Available for Groups with 51+ Employees (Beginning with 7/1/2021 Effective Dates)

UPMC Client Communication – UPMC COBRA Subsidies under America Rescue Plan

All Pennsylvanians age 16 and older are now eligible to receive the COVID-19 vaccine. UPMC encourages you to schedule your vaccine today at a UPMC COVID-19 Vaccine Clinic in your region and provides online opportunities for those 18+ to schedule a COVID-19 Vaccine at UPMC. To schedule for a 16 or 17 year old, contact (844)-UPMCVAC (844-876-2822).

UPMC Health Plan has not mailed hard copy 1095B Forms to members covered under fully insured small group plans for the 2020 tax year.  Members have access to their 1095B via their MyHealth Online Member Portal (in the Forms and Guides section) to download for their records.

UPMC Initiates Authentication Process for Producer OnlineRead Two Step Authentication FAQs

UPMC introduces RxWell as a partner for their UPMC Prescription for Wellness portfolio

The American Rescue Plan Act of 2021 Signed Into Law

COVID-19 Vaccines at UPMC – Vaccine Information & Updates

UPMC Client Communications – Introducing the UPMC Small Group Help Line

The UPMC Account Management Department has been restructured for groups 1-99.

  • New segments have been developed based on group size (1-5, 6-50, 51-99) with a dedicated UPMC Account Manager in each segment.
  • Client letters are being mailed by the carrier to introduce the changes.
  • For details on how your UPMC Clients’ Account Managers may have changed, contact your NFP-BNGA team.

UPMC COVID-19 Vaccine Information – issued directly to UPMC Employer Group Clients

UPMC has resurfaced their initiative to change how claims are adjudicated for clients that fall under 20 employees (with Medicare deemed Primary).  The following resources have been shared by UPMC.

UPMC Clients with 20 or fewer participants on their UPMC coverage are being contacted by UPMC via email or mail to notify them of their current Medicare Primary status and how it can impact Medicare eligible members.  In the communication, clients are provided guidance to attest (via online link) the Medicare Primary status if they have 20+ employees.  The attestation is the way to appeal for adjustment to Medicare Secondary Payer status in the system.  Be on the lookout for more on this topic from our NFP-BNGA Group & Medicare Team.

UPMC COVID-19 Employer FAQs including Vaccine Details