UPMC Health Plan

UPMC Advantage Silver $3,500/$40 - Premium Network

Plan Overview

Medical Deductible
  • Individual: $3,500
  • Family: $7,000
  • Per Person: $3,500
Prescription Drug Deductible
  • Individual: $0
  • Family: $0
  • Per Person: $0
Medical Out-of-Pocket Maximum
  • Individual: $8,700
  • Family: $17,400
  • Per Person: $8,700
Drug Out-of-Pocket Maximum
  • Individual: Included in Medical
  • Family: Included in Medical
  • Per Person: Included in Medical

Office Visit

Primary Doctor
  • Standard: $40 Copay
  • Standard: $75 Copay

Prescription Drug Information

Preferred Brand Drugs
  • Standard: $50 Copay
Non Preferred Brand Drugs
  • Standard: $100 Copay
Generic Drugs
  • Standard: $10 Copay
Specialty Drugs
  • Standard: 50% Coinsurance

Inpatient Coverage

Hospital Services
  • Standard: 30% Coinsurance after deductible
Inpatient Services
  • Standard: 30% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room
  • Standard: $1000 Copay after deductible
Rates shown are determined based on age, geographic region, and tobacco use and are dependent on information provided by or on behalf of the consumer. If changes are made to the determining factors, rates will change accordingly. UPMC Health Plan is not responsible for typographical errors, errors of fact, or any other error resulting from information provided by or on behalf of consumer. UPMC Health Plan is not responsible for the calculation of any financial assistance, including advance payments of the premium tax credit, provided through the Federally Facilitated Marketplace. This managed care plan may not cover all of your health care expenses and all benefits are subject to the terms and conditions set forth in your policy. Read your contract/policy carefully to determine which health care services are covered.

Nondiscrimination statement

UPMC Health Plan1 complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

1UPMC Health Plan is the marketing name used to refer to the following companies, which are licensed to issue individual and group health insurance products or which provide third party administration services for group health plans: UPMC Health Network Inc., UPMC Health Options Inc., UPMC Health Coverage Inc., UPMC Health Plan Inc., UPMC Health Benefits Inc., UPMC for You Inc., and/or UPMC Benefit Management Services Inc.

Translation Services"
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