On July 1, 2015, UPMC Health Plan changed its process for covering children attending school or residing outside the western Pennsylvania service area.
All dependent members up to age 26* (regardless of student status) will be covered at the highest level of benefits for eligible services when they use providers that participate in our national network through Private Healthcare Systems (PHCS) or Medical Mutual of Ohio (MMO), or obtain services at a student health center. This applies for all commercial group products sold by UPMC Health Plan (EPO, PPO, HMO, etc.). There are no member specific notification requirements needed from the employer or the employee.
Note that certain services require a prior authorization, and those requirements will remain in force.
As always, true emergencies are covered at the highest level of benefits for all UPMC Health Plan members.
Members can search our online provider directory at
www.upmchealthplan.com/find . Enter the city or zip code where care is needed, then select "Coverage Through Your Employer" under "Coverage Type". Scroll down to see the buttons "Care in Ohio" or "Care Outside of Western Pa. and Ohio". If they do not have Internet access, they can call Member Services at the telephone number on the back of their member ID card.
*or the maximum age specified for dependent children in the employer's group coverage documents.
