2025 Product Training for Review 8-8-24 FINAL.pdf

2025 UPMC for Life Product Training

Updated 8/8/24

Training agenda

UPMC for Life Medicare Advantage

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Plan lineupBenefits featuresIndividual plan changes

Prescription drug coverage

Extra benefits and services

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UPMC for Life Complete Care

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Plan documents and marketing

33

UPMC for Life

Medicare Advantage

Who we are

We are proud to call Pennsylvania home. From our local doctors and hospitals you know and trust, to our Health Care Concierge team, it’s all right here.

217k

96%

Thank you for joining us!

22

members strong

of our members stay with us every year

years of service

Second-largest

Owned by UPMC, a world-class academic medical center

Owned by UPMCa world-class academic medical center

Award-winning

Health Care Concierge

provider-led plan in the nation

55

Industry changes impacting

Medicare Advantage plans for 2025

It’s important for you to be aware of the changes that are impacting the Medicare industry today. These factors play a critical role in our benefits changes for the upcoming year.

Inflation Reduction

Post-COVID

CMSPayment

Act

Demand

CMS reimbursement and star ratings—In 2025 CMS will change how Medicare Advantage plans are paid and calculate the star ratings reimbursement

High utilization—Demand for services post-COVID has increased beyond what was predicted. This issue has been worsened by staffing shortages and hospital budget pressure for volume.

Inflation Reduction Act (IRA)—Restructures the amount Medicare Advantage plans contribute toward Part D drug costs and lowers

member out-of-pocket costs

differently.

overall. See more about this change on page 72.

66

NEW plan! PPO Essential Care Rx

This plan is meant to attract healthy age-ins. It provides members basic care and coverage with a $0 premium and $100 monthly Part B giveback.

Here’s an overview of the plan and target audience:

Competitive advantage and plan

features:

••

Strategy: attract healthy age-ins who do not anticipate needing

$0 monthly premium$100 monthly Part B premium

medical care or taking many

reduction—members get $100

prescriptionsTarget audience: new to Medicare, retiring now, age 64-67, coming off a commercial employer group plan with a high deductible and

back in their Social Security check

each monthExtra benefits: Flex Spend Card, , dental, vision, and

SilverSneakershearing

significant cost sharing

Basic coverage: high medical and Rx deductibles; higher cost sharing for core benefits; narrow Rx formulary; minimal allowances for

extra benefits

77

UPMC for Life provides financial stability

and support to our members

UPMC for Life continues to provide access to the highest-quality care and coverage at

an affordable cost. Here’s what you can expect from our plans this year.

Financial protection

Great extra benefits

Plans start as low as $0 per month with affordable copays for the benefits you use most.We’re working hard to keep your costs stable

We’re working hard to offer you access to the highest quality care, coverage, and customer service.Benefits that support your whole health and help you maintain your

year after year. Your plan limits your out-of-pocket costs and

helps to give you financial protection.

independence.

•Award-winning service from our Health Care Concierge team anytime you need help. UPMC Health Plan was a Grand Stevie® winner for overall best customer

Easy-to-get care

High-quality care from UPMC and access to other community doctors and hospitals across PA.Over 60,000 participating pharmacies, including

service at the 18th annual Stevie

mail order.Emergency and urgent care anywhere in the U.S.Travel Concierge Program for worry-free trips

Awards in 2024! For details, visit upmchp.us/awards.

••

(for HMO members).

88

Medicare service area

99

Sales and marketing regions

The 2025 plans are organized into the following regions for sales and marketing purposes.

Region name

Counties

Allegheny PASouthwestern PA (SWPA)

AlleghenyArmstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington,

Westmoreland

Northwestern PA (NWPA)

Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean,

Mercer, Venango, WarrenBedford, Blair, Cambria, Huntingdon, SomersetAdams, Cumberland, Dauphin, Fulton, Lancaster, Lebanon, Perry, YorkCentre, Clinton, Juniata, Lycoming, Mifflin, Montour, Potter, Snyder, Sullivan,

Johnstown/Altoona (JA)South Central PA (SCPA)North Central PA (NCPA)

Tioga, UnionBerks, Bradford, Carbon, Lehigh, Luzerne, Monroe, Northampton,

Northeastern PA (NEPA)

Susquehanna, Wayne, WyomingBucks, Chester, Delaware, Montgomery, Philadelphia

Southeastern PA (SEPA)

Ohio (OH)

Harrison, Jefferson

1010

Product strategy

The UPMC for Life products fall into four categories. Each plan has a specific target audience and key benefits to best serve our members.

Military veteran plans—These plans are designed to target veterans and have separate sales and marketing plans to support their growth and

member retention.

$0/low-cost plans—Best for those who do not use many health care services or those new to Medicare. They offer lower-cost care with great extra benefits. We expect to gain new members in these plans this year.

Mid-premium plans—Offer richer coverage and extra benefits with a premium. They are best for members who need care or take many medications. We may see current members switch to these plans.

Legacy plans—We would like to retain current members in these plans but do not expect to see sales of new members in them.

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Segmentation

This year, additional plans will be segmented. Here’s a quick reminder of what segmentation is and how it works.

What is segmentation?Segmentation allows a plan to create multiple each region needing to have separate contract and

Are members being terminated?The current plans will be terminated. New plans will be No members are being terminated. All affected members will be seamlessly cross-walked to their new plan. The plans will still be named the same, so members should not realize this has happened at all. Members do not need to do anything for this change.Members will get a new member ID card in November that shows their new segment ID number.

••

segments (also known as regions) in one plan without

created with new contracts and PBP numbers.

PBP numbers.Premiums and benefits can change in each region/segment based on product strategy.Which plans are being segmented?PPO Rx Choice (H5533-015) and HMO Rx Choice (H3907-057) will continue to be segmented.New segmentation for 2025: PPO Salute (H5533-016), HMO Premier Rx (H3907-059), PPO Essential Care Rx (H5533-017), and HMO Rx (H3907-058)These plans are being segmented so that we can offer more competitive benefits in some segments.

••

Example: PPO Rx Choice

Contract #

PBP #

Segment

H5533H5533H5533H5533H5533

015015015015015

001002003004005

Here’s how segmentation works:The plan will have a new contract and PBP number. The contract and PBP are the same for each segment.Each region will have a new segment ID number. The segment ID will be different for each region.Segment ID is a separate field in MC400.

••

1212

Plan lineup for 2025

Use this brief overview to reference the 2025 plans as you go through this document.

Plan name

Contract-PBP

Strategy

Premium

Regions

HMO No Rx

H3907-002

Veterans plan

$0

Allegheny, SWPA, NWPA, JA, SCPA, NCPA, NEPA, OHAllegheny, SWPA, NWPA,

H5533-016-001

Veterans plan

$0

JA, SCPA, NCPA, NEPA

PPO Salute (no Rx)

H5533-016-002

Veterans plan

$0

Service area expansion for

SEPAAllegheny, SWPA, JA

H3907-059-001

$0/low-cost plan

$0

H3907-059-002

$0/low-cost plan

$0

NWPA

HMO Premier Rx

H3907-059-003

$0/low-cost plan

$0

SCPA, NCPA

H5533-017-001

$0/low-cost plan

$0

Allegheny, SWPA, NWPA, SCPA, NCPA, NEPA

PPO Essential

Care Rx

H5533-017-002

$0/low-cost plan

$0

JA

1313

Plan lineup for 2025 (continued)

Plan name

Contract-PBP

Strategy

Premium

Regions

H5533-013H5533-011H5533-015-001H5533-015-002H5533-015-003H5533-015-004H5533-015-005H3907-057-001

$0/low-cost plan$0/low-cost planMid-premium planMid-premium planMid-premium planMid-premium planMid-premium planMid-premium plan

$0$0$19$20$19$19$21$34

Allegheny, SWPA, NWPA, JA

PPO Premier Rx

SCPA, NCPAAlleghenySWPANWPASCPA, NCPA

PPO Rx Choice

JAAllegheny

H3907-057-002

Mid-premium plan

$35

SWPA, OH

HMO Rx Choice

H3907-057-003H3907-057-004H3907-057-005H3907-058-001

Mid-premium planMid-premium planMid-premium planMid-premium plan

$34$35$35$90

NWPASCPA, NCPA, NEPA

JAAllegheny, SWPA, NWPA,

SCPA, NCPA, NEPA, OH

HMO Rx

H3907-058-002

Mid-premium plan

$97

JA

1414

Plan lineup for 2025 (continued)

Plan name

Contract-PBP

Region

Premium

Regions

HMO Deductible Rx

H3907-037

Legacy plan

$22

Allegheny, SWPA, NWPA, JA, SCPA, NCPA, NEPA, OHAllegheny, SWPA, NWPA, JA

PPO High Deductible Rx

H5533-003

Legacy plan

$33

H5533-008

Legacy plan

$58

SCPA, NEPA

PPO Rx Enhanced

H5533-005

Legacy plan

$140

Allegheny, SWPA, NWPA, JA

HMO Rx Enhanced

H3907-006

Legacy plan

$295

Allegheny, SWPA, NWPA, JA, SCPA, NCPA, NEPA, OH

1515

Benefit features

Here are some key benefits and features of our plans for 2025.

Plan stability–Our plans remain strong and consistent by providing financial protection and support for members.

KEY TAKEAWAYS

Veterans plansHMO No Rx–$110 monthly Part B giveback, lower specialist, labs, and x-ray copays.PPO Salute–service area expanded to SEPA counties.

▪▪

1.

Financial stability for members

2.

Veterans plans–HMO No Rx $110

Part B giveback and PPO Salute service area expansion to SEPA

NEW PLAN! PPO Essential Care Rx–Our newest plan has a $0 premium and $100 monthly Part B giveback. It's ideal for those who don’t anticipate needing much medical care.Prescription coverage changes–Due to the Inflation Reduction Act (IRA), once the member reaches the $2,000 out-of-pocket limit for covered drugs, the member will move into the catastrophic coverage stage. In this stage, members will pay $0 for all covered drugs. Learn more about these changes on page 72.UPMC for Life Flex Spend Card–All members who have the Flex Spend Card can now use their card to pay for premier fitness locations, a fitness kit, and home safety products. Learn more on

3.

PPO Essential Care Rx–New $0 plan with $100 Part B giveback

4.

Prescriptions–Changes to the initial coverage stage and member cost sharing

5.

Flex Spend Card–can now be used on fitness and home safety

page 21.

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UPMC for Life Flex Spend Card

The Flex Spend Card will have two allowances for 2025, and members can now use their card for more benefits. Here are some important changes you need to know!

NEW! The Flex Spend Card will have TWO allowances:

The first allowance can be used for dental, vision, and hearing

services.

The second allowance can be used for medical service costs,

premier fitness locations, fitness kits, over-the-counter (OTC) products, and home safety products.Example: HMO Rx Choice plan:$250 can be used for medical service costs, OTC products, fitness, and home safety products

$250 can be usedfor dental, vision, and hearing services

••

See allowance amounts for each plan on the next page.See more information about the new benefits added to the

Flex Spend Card on page 21.

Reminders about how the Flex Spend Card works:

••••

This allowance is in addition to the dental and vision allowances members already get with their plan.This is a yearly allowance, not a quarterly allowance, and it will not roll over from year to year.Members cannot use unspent allowance dollars from one purse to pay for items included in the other purse.If the member changes plans in the middle of the year, they will still get the full Flex Spend Card allowance on

their new plan.

1717

Flex Spend Card–allowance amounts

Members can choose how to spend these additional dollars on their health care!

Category

Plan Name

Contract-PBP-Segment

Medical, OTC, Fitness, Home Safety Products

Dental, Vision, Hearing

HMO No Rx

H3907-002H5533-016-001H5533-016-002H3907-059-001, 002, 003H5533-017-001, 002

$250$300$250$250$150

$250$300$250$250$150

Veterans

plans

PPO Salute

HMO Premier RxPPO Essential Care Rx

$0plans

H5533-013

$150

$150

PPO Premier Rx

PPO Premier Rx

H5533-011H5533-015-001H5533-015-002, 003, 005H5533-015-004H3907-057-001, 002, 003, 004, 005H3907-058-001, 002

$250$375$150$250$250$500$250

$250$375$150$250$250$500$250No Flex Spend Card

PPO Rx Choice

Mid-premium

plans

HMO Rx ChoiceHMO RxHMO Deductible RxPPO High Deductible RxPPO Rx EnhancedPPO Rx EnhancedHMO Rx Enhanced

H3907-037H5533-003H5533-008H5533-005H3907-006

Legacyplans

No Flex Spend CardNo Flex Spend CardNo Flex Spend Card

1818

Flex Spend Card–dental, vision, hearing

Members can use their UPMC for Life Flex Spend Card to pay for dental, vision, and hearing services at any provider that accepts MasterCard.

Dental services

Vision services

Members can use their dental benefit allowance

Members can use their vision benefits

first at any participating dental provider and then use this card second to help pay for any additional

allowance first and then use this card second to help pay for any additional out-of-pocket costs. Members can also use this card to pay for the cost of a vision services at nonparticipating providers, but they would

out-of-pocket costs.Example HMO Rx Choice plan:

oThis plan has a $5,000 maximum comprehensive dental allowance with 50% coinsurance. It also has a $250 Flex Spend Card allowance for dental services.oIf you receive a covered dental service that totals $400, you are responsible for 50% of the cost, which in this case would be $200. You can use your Flex Spend Card to pay for your out-of-pocket cost of $200. Your plan would cover the other 50%, or $200.You would then have a remaining dental allowance of $4,800, and a remaining balance of $50 on your Flex Spend Card that you can use for something else.

not receive a free vision exam or be able to

use their vision allowance benefit.

Hearing aids

Members can use this card to pay the discounted cost for hearing aids through an

Amplifon hearing provider.

Members can also use this card to pay for the cost of hearing aids at nonparticipating providers, but they would not receive a free hearing exam, free hearing aid fitting, or discount on the cost of hearing aids.

Members can also use this card to pay for dental services at nonparticipating providers, but they would not be able to use their dental benefit

allowance first.

1919

Flex Spend Card–medical service costs

Here’s how members can use their card for medical care services.

Parts A and B medical service costs

Members can use their UPMC for Life Flex Spend Card for out-of-pocket costs at the doctor’s office and medical facilities when they receive covered Part A and Part B health care services. This card can be

used at any provider that accepts MasterCard.

oo

Members can use their card to pay for out-of-pocket costs like copays, coinsurance, and deductibles. The card can be used for BOTH in- and out-of-network medical services.The card CANNOT be used to pay for Part B or Part D prescription copays, coinsurance, or deductibles.

Members can use only $50 of their allowance per transaction to pay for medical service costs.

Example: If the member receives a diagnostic/advanced imaging service like a CT scan with a $225

copay, the member can use theFlex Spend Card to pay for $50 of this copay. After using the card, the

member would still have to pay $175 ($225 - $50 = $175) out-of-pocket. Members should pay at the front desk when using their Flex Spend Card, not at a kiosk.If a member submits a claim for reimbursement, they will only be reimbursed $50 of the amount.If the member receives a bill for medical services:

•••

Bill received from a UPMC provider: The member can call the phone number on their bill to pay with their Flex Spend Card and another form of payment, if needed. The member can also follow the instructions on their bill to pay online or go to the MyUPMC app and select Pay Your Bills. Members can pay with their card and another form of payment, if needed.Bill received from a non-UPMC provider: The member may want to pay their bill in full using another form of payment and then use our reimbursement process to be reimbursed the $50 per transaction

allowance from their Flex Spend Card.

2020

Flex Spend Card–fitness, home safety

Members can now use their UPMC for Life Flex Spend Card to pay for premier fitness center membership, a fitness kit, and home safety products.

NEW! Fitness benefits:

Premier fitness locations: Members can use their card to pay for fitness membership, classes, and other activities at premier fitness locations outside the current SilverSneakersincludes 10-15 specific boutique fitness centers. Locations will be posted at upmchp.us/member-flex. Depending on the location, the member may need to pay out-of-pocket and submit a claim for reimbursement. To be reimbursed, the member must use a participating premier fitness location and have applicable allowance dollars available on their card.

network. This

Fitness kit: One fitness kit can be ordered annually through NationsBenefits. Kit options and ordering

information will be posted at upmchp.us/member-flex. The member’s allowance will be decreased by

the $60 cost of the fitness kit (includes shipping).

Home safety products:

Members can use their card to order home safety products through the MedCare catalog. More information about ordering will be available at upmchp.us/member-flex. There is no specific limit on the Plans with a Flex Spend Card will no longer have a separate home safety benefit, and their allowance will be decreased by the cost of each home safety product ordered.Plans that do not have the Flex Spend Card will continue to have six home safety products per year at no cost. Members will order products through MedCare.

number of products that can be ordered.

••

2121

Flex Spend Card–OTC products

Members can buy OTC products using their UPMC for Life Flex Spend Card at participating retail stores and through mail order. Here’s how.

Retail storesMembers can purchase OTC products at participating retail stores and through

our mail-order catalog.Some participating retail stores include Giant Eagle, Rite Aid, Walgreens, and Walmart. Members can use the Merchant Locator tool in the UPMC Health Plan member site to search for additional participating locations.

Mail-order products are purchased through Convey. Here’s how to order:

1.

Online using the UPMC for Life OTC website:Log in tothe UPMC Health Plan member site

atupmchealthplan.com/members.

oTo have a catalog mailed, members can call 1-833-293-6483 (TTY: 711). Catalogs are sent through the Converge fulfillment website.Call Convey at1-800-688-2515 (TTY: 711)Mon.–Fri. from8 a.m.to 11 p.m.

Log in to the UPMC Health Plan app.

2.

3.

See page 24 for additional resources and information.

2222

Preventive incentive rewards

Members get rewarded for getting the preventive care they need. Their rewards dollars get loaded on to their Flex Spend Card.

Preventive care rewards

Earning reward dollars

Members can earn reward dollars for completing certain

If the member’s plan includes the Flex

preventive screenings by Dec. 31 each year. We'll let members know which preventive screenings they are eligible for in 2025.

Spend Card, they should have already received their card in the mail with instructions on how to use it. After the member completes eligible preventive care screenings, reward dollars will be automatically added to this card. If the

Using reward dollars

UPMC for Life members can use preventive care reward dollars to buy healthy foods at participating stores. They can choose from

member’s plan does not include this

healthy foods like fruits/vegetables, meats/seafood, healthy

benefit, we will mail a card to the member preloaded with their reward dollars after they complete their first

grains, and pantry staples. Reward dollars will not be accepted on

retailer websites or apps.Preventive care reward dollars can only be used on healthy foods.

screening.We will add reward dollars to the member's card as they complete additional preventive care screening(s).They can check their card balance on the UPMC Health Plan member site or through the UPMC Health Plan app.

If shopping for both OTC products and healthy foods using the Flex Spend Card, swipe the Flex Spend Card at checkout. Preventive care reward dollars will go toward healthy foods, and the remaining OTC oRewards dollars are always deducted first.

amount will be deducted from the Flex Spend benefit allowance.

2323

Flex Spend Card resources

Here are some helpful resources that can help our members get information they need to use their Flex Spend Card.

Flex Spend Card tutorial videoMembers can learn all about their Flex

Members should check their card balance every time before they use it. Three ways to check real-time 24/7:

Call our automated system: 1-833-293-6483 (TTY: 711)

Spend Card and watch videos about how

••

Member site: upmchealthplan.com/members →UPMC Health Plan app

Spending

to access resources at upmchp.us/member-flex.

Accounts.

Insurance Tab.

Find participating retail stores

Getting OTC products by mail:

••

Public website: upmchp.us/member-flexUPMC Health Plan member site: upmchealthplan.com/members View Account Summary Spend Card Resources Spend Card Portal. Go to Tools and Support and click Merchant Locator Tool.

Here are two easy ways to access the UPMC for Life OTC

online store:

→ UPMC for Life Flex

Spending → Flex

→→ Visit the

Member site: upmchealthplan.com/members View Account Summary Over-the-counter (OTC) Resources UPMC for Life OTC Website.Use the UPMC Health Plan app Over-the-Counter Store.order form. Mail to: OTC Servicing Center, PO Box 526266,

Accounts

Spending Accounts

→ Insurance Tab

View Flex Spending

Scanning products at retail stores

Choose products from our OTC catalog and complete an

Members can scan products while they shop to see if they’re covered. Log in to the UPMC Insurance Tab

Miami, FL 33152-9819.Call 1-800-688-2515 (TTY: 711) Monday through Friday from

Health Plan app

Scan

Items.

8 a.m. to11 p.m.

2424

Individual

Plan Changes

25

Plans for military veterans

UPMC for Life has two plan options that

GOAL:

are recommended for those who have

honorably served our country: HMO No Rx PPO Salute

Engage with veterans in our

oo

community and

The next few pages explain these plan options and why they are a good fit for veterans and retired military.

help them get high-quality, affordable Medicare coverage.

Veterans are also welcome to enroll in any of our other plan options.

If you have any questions about the veteran plan options, please contact Chris Preffer: preffercr@upmc.edu.

2626

HMO No Rx

Here’s the product value story and target audience for this plan.

Value story

Who should buy this plan?

You don’t need to pay more; in fact, we’ll pay you! Why pay more for a plan with drug coverage when you don’t need it? You have a

$0 monthly premium and get $110 back in your monthly Social

Veteran

Security check.No prescription coverage. If you already have creditable coverage for drugs through the VA or as a PACE/PACENET recipient, you do

Less than 20 years of service and does not have Tricare

not need a Part D plan.Extra benefits. More benefits than with Original Medicare alone!Dental, vision, hearing, free gym memberships, personal counseling, caregiver support, and more.The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and dental, vision,

Gets Part D

prescription coverage through VA

oo

PACE/PACENET

Gets Part D prescription coverage

and hearing services.

through

Doctor access.

PACE/PACENET

Access to UPMC and additional community providers

across PA and out of state.Emergency and urgent care anywhere in the U.S.Use the UPMC for Life Travel Concierge program forworry-

oo

free trips.

2727

HMO No Rx–H3907-002

Service Area: Adams, Allegheny, Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Lycoming, McKean, Mercer, Mifflin, Montour, Northampton, Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York, Harrison (OH), and Jefferson (OH) counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$0 per month$39 per month

$0 per month–NO CHANGE$110 per month–that’s $71 MORE

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$0$5,000$300 per stay$225 per servicePCP: $0/ Specialist: $45$90 per visit$45 per visit$0 copay for LifeScan Diabetes Test Strips$3,000/50% coinsurance

$0–NO CHANGE$5,000–NO CHANGE$300 per stay–NO CHANGE$225 per service–NO CHANGEPCP: $0–NO CHANGESpecialist: $25–that’s $20 LESS$125 per visit–$35 increase$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$3,000/50% coinsurance–NO CHANGE$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$200 per year$690-$1,890 copay per aid, per year

$250 per year$0 for one home safety visit per year;Home safety products not covered

2828

PPO Salute

Here’s the product value story and target audience for this plan.

Value story

Who should buy this plan?

This plan was designed by retired military for retired military veterans. It’s best for veterans with over 20 years of service who have CHAMPVA or

TRICARE For Life (TFL).$0 monthly premium and money back in your monthly Social Does not offer Part D prescription drug coverage–TRICARE For Life and VA benefits offer credible prescription drug coverage.You keep your CHAMPVA or TRICARE For Life plan.Rich extra benefits. Unlike Original Medicare, this plan offers important extra benefits so you do not have to pay premium for additional Dental, vision, hearing, free gym memberships, personal counseling, caregiver support, and more.The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and dental, vision, and hearing services.

Retired military veterans20 years of service and retired from U.S. Armed ForcesEligible for CHAMPVA Tricare For LifeVeterans with VA benefits can sign up for this plan. especially if they use the VA

ooo

Security check.

coverage.

oo

for care.

Doctor access.This PPO plan gives you access to in- and out-of-network providers. You can use any doctor who accepts Medicare in the 24/7 worldwide emergency medical assistance when you travel 100 miles or more away from home.

U.S. and agrees to see you.

2929

PPO Salute–H5533-016-001

Service Area: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northampton, Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, and York counties

Member Pays (after TRICARE and UPMC for Life pay)

Plan Highlights

UPMC for Life PPO Salute Pays

TRICARE For Life Pays

Plan PremiumPart B Premium ReductionMaximum Out-of-Pocket

$0 per month$65 per month–$10 decrease

$6,750 IN/$10,100 IN/OON–$1,250 IN increase and $550 IN/OON increaseDays 1-60: Your Part A

Days 1-60: 100% after you meet your Part A deductible for each benefit periodDays 61-150: All but your Part A copay per day for each benefit period

Days 1-60: $0 per dayDays 61-150: $0 per day151+ Days:Your TRICARE cost share

deductibleDays61-150:YourPart A coinsuranceper day151+ Days:TRICARE is the primary payer

Inpatient Hospital

151+ Days: Nothing

For more information on TRICARE for Life cost sharing, visit tricare.mil/tfl.

Outpatient Surgery

80% of the cost per day IN/OON

20% of the cost per day

$0 per service

3030

PPO Salute–H5533-016-001

Service Area: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northampton, Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, and York counties

Member Pays (after TRICARE and UPMC for Life pay)

Plan Highlights

UPMC for Life PPO Salute Pays

TRICARE For Life Pays

PCP/Specialist (in-office and telehealth)Lab ServicesEmergency CareUrgent CareAmbulanceDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$0 per visit; OON telehealth not

80% of the cost per visit IN/OON

20% of the cost per visit

covered$0 per day per facility$0 per service$0 per service$0 per day

$0 copay per day per facility IN/OON80% of the cost per day IN/OON80% of the cost per day IN/OON80% of the cost per day IN/OONTreat no transport: $0 copayUPMC for Life extra benefit: $5,000/50% coinsurance IN/OON–NO CHANGEUPMC for Life extra benefit: $300 per year IN/OON–NO CHANGEUPMC for Life extra benefit: $690-$1,890 copay per aid, per year–NO CHANGEUPMC for Life extra benefit: $300 per year–medical services, OTC, fitness, home safety products;$0 for one home safety visit per year–NO CHANGE;

Nothing20% of the cost per day20% of the cost per day20% of the cost per day

$300 per year–dental, vision, and hearing services

See Flex Spend Card for home safety products$0 copay for 12 one-way trips per year to the doctor’s office, health care facilities, and pharmacies–decrease 12 trips

Transportation

3131

PPO Salute–H5533-016-002

Service Area: Bucks, Chester, Delaware, Montgomery, and Philadelphia counties

Member Pays (after TRICARE and UPMC for Life pay)

Plan Highlights

UPMC for Life PPO Salute Pays

TRICARE For Life Pays

Plan PremiumPart B Premium ReductionMaximum Out-of-Pocket

$0 per month$45 per month$6,750 IN/$10,100 IN/OONDays 1-60: Your Part A

Days 1-60: 100% after you meet your Part A deductible for each benefit periodDays 61-150: All but your Part A copay per day for each benefit period

Days 1-60: $0 per dayDays 61-150: $0 per day151+ Days:Your TRICARE cost-share

deductibleDays61-150:YourPart Acoinsuranceper day151+ Days:TRICARE is the primary payer

Inpatient Hospital

151+ Days: Nothing

For more information on TRICARE for Life cost-sharing, visit tricare.mil/tfl.

Outpatient Surgery

80% of the cost per day IN/OON

20% of the cost per day

$0 per service

PCP/Specialist(in-office and telehealth)

$0 per visit; OON telehealth not

80% of the cost per visit IN/OON

20% of the cost per visit

covered

3232

PPO Salute–H5533-016-002

Service Area: Bucks, Chester, Delaware, Montgomery, and Philadelphia counties

Member Pays (after TRICARE and UPMC for Life pay)

Plan Highlights

UPMC for Life PPO Salute Pays

TRICARE For Life Pays

Lab ServicesEmergency CareUrgent CareAmbulanceDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome SafetyTransportation

$0 copay per day per facility IN/OON80% of the cost per day IN/OON80% of the cost per day IN/OON80% of the cost per day IN/OONTreat no transport: $0 copayUPMC for Life extra benefit: $5,000/50% coinsurance IN/OONUPMC for Life extra benefit: $300 per year IN/OONUPMC for Life extra benefit: $690-$1,890 copay per aid, per yearUPMC for Life extra benefit: $250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services

Nothing20% of the cost per day20% of the cost per day20% of the cost per day

$0 per day per facility$0 per service$0 per service$0 per day

$0 for one home safety visit per year;See Flex Spend Card for home safety products

Not covered

3333

$0 premium plans

These plans work well for members who

GOAL:

do not use many medical services or are

new to Medicare: HMO Premier RxPPO Essential Care RxPPO Premier Rx

ooo

Give members access

to high-quality care

and more value at a price they can afford.

Members get medical and Rx coverage, plus important extra benefits for $0 premium per month

Our new PPO Essential Care Rx plan provides basic coverage and extra benefits at great value

3434

HMO Premier Rx

Here’s the product value story and target audience for these plans.

Value story

Who should buy this plan?

If you don’t go to the doctor often, our HMO Premier Rx plan may be a good fit for you. The Medicare Part B premium is expensive for many, and having to pay for a Medicare Advantage plan on top of it can add up. Our $0 plan provides medical coverage, drug coverage, and additional

Medicare Advantage

switcherMedicare Supp switcher

benefits not covered by Medicare.Prescription coverage. $0 copays for Tier 1 and 2 prescriptions at preferred retail and

•••••

Pick up Part D coverage now to avoid paying a Part D penalty later.

Age-insOriginal Medicare (FFS)Cost consciousGood health–not expecting to use many medical

oExtra benefits.Dental, vision, hearing, free gym memberships, personal counseling, travel coverage, and more. The UPMC for Life Flex Spend Card gives you additional dollars

mail-order pharmacies.

oo

services

each year to pay for medical service costs, OTC products, fitness,

Take few prescriptions

home safety products, and dental, vision, and hearing services.Access to UPMC and additional community providers across PA

Doctor access. and out of state.Emergency and urgent care anywhere in the U.S. Use the UPMC for Life Travel Concierge program for worry-free

ooo

trips.

3535

HMO Premier Rx–H3907-059-001

Service Area: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Huntingdon, Indiana, Lycoming, Somerset, Tioga, Washington, and Westmoreland counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$0 per monthNot applicable

$0 per month–NO CHANGE$7 per month–Part B giveback NEW!

DeductibleMaximum Out-of-Pocket

$0$5,500$165 per day, days 1-5$0 per day, days 6 and beyond$325 per servicePCP: $0/ Specialist: $30

$0–NO CHANGE$6,000–$500 increase$165 per day, days 1-7–change from days 1-5$0 per day, days 8 and beyond$325 per service–NO CHANGE

Inpatient Hospital

Outpatient SurgeryPCP/Specialist(in-office and telehealth)Emergency Care

PCP: $0–NO CHANGESpecialist: $35–$5 increase$125 per visit–$35 increase$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$4,500/50% coinsurance–$500 increase$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE

$90 per visit$45 per visit$0 copay for LifeScan Diabetes Test Strips$4,000/50% coinsurance

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$200 per year$690-$1,890 copay per aid, per year

$250 per year–medical services, OTC, fitness, home safety products;

$500 per year$0 for one home safety visit per year;$0 for six home safety products per year

$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

3636

HMO Premier Rx–H3907-059-002

Service Area: Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, McKean, Mercer, Venango, and Warren counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$0 per month$2 per month

$0 per month–NO CHANGE$8 per month–$6 increase

DeductibleMaximum Out-of-Pocket

$0$4,900

$0–NO CHANGE$5,000–$100 increase

$100 per day, days 1-5, $0 per day, day 6and beyond–change to per

Inpatient HospitalOutpatient SurgeryPCP/Specialist(in-office and telehealth)Emergency Care

$270 per stay$270 per servicePCP: $0/ Specialist: $20$90 per visit$45 per visit$0 copay for LifeScan Diabetes Test Strips$4,000/50% coinsurance

dayASC: $275 per service; Facility: $300 per service–$5-$30 increase

PCP: $0–NO CHANGESpecialist: $35–$15 increase$125 per visit–$35 increase$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$4,500/50% coinsurance–$500 increase

Urgent CareDiabetes Test StripsDental Allowance

Vision Allowance

$200 per year

$200 per year–NO CHANGE

Hearing AidsFlex Spend CardHome Safety

$690-$1,890 copay per aid, per year

$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$500 per year$0 for one home safety visit per year;$0 for six home safety products per year

3737

HMO Premier Rx–H3907-059-003

Service Area: Cumberland, Dauphin, and Lancaster countiesService Area Reduction: Berks and York counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$0 per monthNot applicable

$0 per month–NO CHANGE$7 per month–Part B giveback NEW!

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist(in-office and telehealth)

$0$6,700$170 per day, days 1-5

$0–NO CHANGE$6,700–NO CHANGE$170 per day, days 1-7–change from days 1-5

$0 per day, days 6 and beyond

$0 per day, days 8and beyond

$325 per servicePCP: $0/ Specialist: $30

$325 per service–NO CHANGEPCP: $0–NO CHANGESpecialist: $35–$5 increase

Emergency CareUrgent Care

$90 per visit$45 per visit

$125 per visit–$35 increase$55 per visit–$10 increase

Diabetes Test StripsDental AllowanceVision AllowanceHearing Aids

$0 copay for LifeScan Diabetes Test Strips$4,000/50% coinsurance

$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$4,500/50% coinsurance–$500 increase$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$200 per year$690-$1,890 copay per aid, per year

Flex Spend Card

$500 per year

$0 for one home safety visit per year;$0 for six home safety products per year

Home Safety

3838

NEW plan–PPO Essential Care Rx

Here’s the product value story and target audience for these plans.

Value story

Who should buy this plan?

This is the plan for you if you want basic coverage with extra benefits that support your health and wellness.

This plan has a rich $100 monthly Part B premium

••••

Age-insOriginal Medicare (FFS)Cost consciousGood health–not expecting to use many medical servicesTake few prescriptionsWant access to all doctors, or doctor is out-of-network

giveback. That’s $1,200 back in your pocket each year.This plan has a high medical deductible before coverage begins and higher copays for care.You can see any doctor who accepts Medicare in the U.S.

oo

and agrees to see you.Prescription coverage.Pick up Part D coverage now to avoid paying a Part D

••

oo

penalty later.$0 copays for Tier 1 and 2 prescriptions at preferred retail

and mail-order pharmacies.

Extra benefits.Dental, vision, hearing, free gym memberships, personal

oo

counseling, worldwide travel assistance, and more.

The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and dental, vision,

and hearing services.

3939

PPO Essential Care Rx–H5533-017-001

Service Area: Adams, Allegheny, Armstrong, Beaver, Berks, Bradford, Butler, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Lycoming, McKean, Mercer, Mifflin, Montour, Northampton, Perry, Potter, Snyder, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, and York counties

Plan Highlights

2025

Plan PremiumPart B Premium Reduction

$0 per month$100 per month$500 IN/OON$8,000 IN/$11,500 IN/OON$380 IN per day, days 1-5, $0 per day, days 6 and beyond after deductible;40% of the cost OON after deductible$380 IN/40% of the cost OON per service after deductiblePCP: $0 IN (deductible does not apply)/$0 OON (OON telehealth not covered) after deductible;

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist

(in-office and telehealth)

Specialist: $45 IN (deductible does not apply)/40% OON (OON telehealth not covered) after deductible

Emergency CareUrgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$110 IN/OON per visit (deductible does not apply)$45 IN/OON per visit (deductible does not apply)$0 copay for LifeScan Diabetes Test Strips (deductible does not apply)

$2,600/50% coinsurance IN/OON$200 per year IN/OON$690-$1,890 copay per aid, per year$150 per year–medical services, OTC, fitness, home safety products;$150 per year–dental, vision, and hearing services$0 for one home safety visit per year;See Flex Spend Card for home safety products

4040

PPO Essential Care Rx–H5533-017-002

Service Area: Bedford, Blair, Cambria, Huntingdon, and Somerset counties

Plan Highlights

2025

Plan PremiumPart B Premium Reduction

$0 per month$100 per month$500 IN/OON$8,000 IN/$11,500 IN/OON$380 IN per day, days 1-5, $0 per day, days 6 and beyond after deductible;40% of the cost OON after deductible$380 IN/40% of the cost OON per service after deductiblePCP: $0 IN (deductible does not apply)/$0 OON (OON telehealth not covered) after deductible; Specialist: $45 IN (deductible does not apply)/40% OON (OON telehealth not covered) after deductible

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$110 IN/OON per visit (deductible does not apply)$45 IN/OON per visit (deductible does not apply)$0 copay for LifeScan Diabetes Test Strips (deductible does not apply)

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$2,600/50% coinsurance IN/OON$200 per year IN/OON$690-$1,890 copay per aid, per year$150 per year–medical services, OTC, fitness, home safety products;$150 per year–dental, vision, and hearing services$0 for one home safety visit per year;See Flex Spend Card for home safety products

4141

PPO Premier Rx

Here’s the product value story and target audience for these plans.

Value story

Who should buy this plan?

If you want access to more doctors with a $0 premium and low costs for care, check out our PPO Premier Rx plan.

You can see any doctor who accepts Medicare in the U.S. and

Medicare Advantage

agrees to see you.Your out-of-pocket costs are reasonable even when you use doctors and hospitals out-of-network.The PPO Premier Rx plan in central PA gives you $54 back in your monthly Social Security check, and many services have the same cost sharing in- or out-of-network.

switcherMedicare Supp switcher

oo

•••••

Age-insOriginal Medicare (FFS)Cost consciousGood health–not expecting to use many medical servicesTake few prescriptions

Prescription coverage.Pick up Part D coverage now to avoid paying a Part D

oo

penalty later.$0 copays for Tier 1 and 2 prescriptions at preferred retail

Want access to all doctors, or

and mail-order pharmacies.

doctor is out-of-network

Extra benefits.

Dental, vision, hearing, free gym memberships, personal

counseling, worldwide travel assistance, and more.The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and dental, vision,

and hearing services.

4242

PPO Premier Rx–H5533-013

Service Area: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Carbon, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Somerset, Venango, Warren, Washington, and Westmoreland counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$0 per month$2 per month

$0 per month–NO CHANGE$5 per month–$3 increase$0–NO CHANGE$6,500 IN/$10,000 IN/OON–NO CHANGE$165 IN/$300 OON per day, days 1-7–change fromdays 1-5$0 per day, days 8 and beyond$325 IN/$400 OON per service–$30 IN/$25 OONincreasePCP: $0 IN/OON (OON telehealth not covered)–NO CHANGE;Specialist: $30 IN/$45 OON (OON telehealth not covered)–$5

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist(in-office and telehealth)Emergency Care

$0$6,500 IN/$10,000 IN/OON$165 IN/$300 OON per day, days 1-5$0 per day, days 6 and beyond$295 IN/$375 OON per servicePCP: $0 IN/OON (OON telehealth not covered); Specialist: $35 IN/$45 OON (OON telehealth not covered)

decrease IN$125 IN/OON per visit–$35 increase$55 IN/OON per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$4,700/50% coinsurance IN/OON–$700 increase

$90 IN/OON per visit$45 IN/OON per visit$0 copay for LifeScan Diabetes Test Strips$4,000/50% coinsurance IN/OON

Urgent CareDiabetes Test StripsDental Allowance

Vision Allowance

$225 per year IN/OON

$250 per year IN/OON–$25 increase

Hearing AidsFlex Spend CardHome Safety

$690-$1,890 copay per aid, per year

$690-$1,890 copay per aid, per year–NO CHANGE$150 per year–medical services, OTC, fitness, home safety products;$150 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$300 per year$0 for one home safety visit per year;$0 for six home safety products per year

4343

PPO Premier Rx–H5533-011

Service Area: Adams, Centre, Clinton, Cumberland, Dauphin, Fulton, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Perry, Potter, Snyder, Sullivan, and Union countiesService Area Reduction: Tioga and York counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$0 per month$53 per month

$0 per month–NO CHANGE$54 per month–$1 increase$0–NO CHANGE$6,700 IN/$10,000 IN/OON–$800 increase IN/$1,050 increase IN/OON$170 IN/$250 OON per day, days 1-7–change to per day IN

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$0 $5,900 IN/$8,950 IN/OON$350 IN per stay/$250 per day (days 1-5)

OON; $0 per day, days 6 and beyond

$0 per day, days 8 and beyond

$265 IN/$300 OON per servicePCP: $0 IN/OON; Specialist: $25 IN/OON$90 IN/OON per visit

$325 IN/$400 OON per service–$60 increase IN/$100 increase OONPCP: $0 IN/OON (OON telehealth not covered)–NO CHANGE; Specialist: $30 IN/OON (OON telehealth not covered)–$5 increase$125 IN/OON per visit–$35 increase

Urgent Care

$45 IN/OON per visit

$55 IN/OON per visit–$10 increase

Diabetes Test StripsDental AllowanceVision AllowanceHearing Aids

$0 copay for LifeScan Diabetes Test Strips$4,500/50% coinsurance IN/OON$225 per year IN/OON$690-$1,890 copay per aid, per year

$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/50% coinsurance IN/OON–$500 increase$250 per year IN/OON–$25 increase$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE; See Flex Spend Card for home safety products

Flex Spend Card

$500 per year

$0 for one home safety visit per year;$0 for six home safety products per year

Home Safety

4444

Mid-premium plans

Here are our most competitive plan

GOAL:

options:

ooo

PPO Rx ChoiceHMO Rx ChoiceHMO Rx

Members get access to high-quality care

and benefits and

These plans have our BEST copays for medical care, enhanced extra benefits, and competitive copays for Part D

services to help them get the care they

need.

prescriptions.

The PPO Rx Choice plan in Allegheny County is priced to sell! It’s our most competitive plan this year!

4545

PPO Rx Choice plans

Here’s the product value story and target audience for these plans.

Value story

Who should buy this plan?

If you want access to more doctors with an affordable premium and low costs for care, check out our PPO Rx Choice plan.

You can see any doctor who accepts Medicare in the U.S. and

Medicare Advantage

agrees to see you.Your out-of-pocket costs are reasonable even when you use doctors and hospitals out-of-network.The Allegheny PPO Rx Choice plan offers a low premium with low costs for the services you use most. Specialist copays are only $20 in-network.

switcherMedicare Supp switcher

oo

••••

Age-insOriginal Medicare (FFS)Mid-premium, looking for low cost sharingGood health–not expecting to use many medical services

Prescription coverage.You get our richest prescription drug benefits.$0 copays for Tier 1 and 2 prescriptions at preferred pharmacies and low copays for diabetes medications,

oo

Take few prescriptions

Extra benefits.Dental, vision, hearing, free gym memberships, personal

Want access to all doctors, or doctor is out-of-network

oo

counseling, worldwide travel assistance, and more.

The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and dental, vision,

and hearing services.

4646

PPO Rx Choice–H5533-015-001

Service Area: Allegheny County

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$19 per month$2 per month

$19 per month–NO CHANGE$7 per month–$5 increase$0–NO CHANGE$5,500 IN/$9,000 IN/OON–$550 decrease IN/OON$250 IN/$325 OON per stay–$25 increase IN$200 IN/$300 OON per service–$25 increase IN and OONPCP: $0 IN/OON (OON telehealth not covered)–NO CHANGE;Specialist: $20 IN/$30 OON (OON telehealth not covered)–$10

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist(in-office and telehealth)Emergency Care

$0$5,500 IN/$9,550 IN/OON$225 IN/$325 OON per stay$175 IN/$275 OON per servicePCP: $0 IN/OON;Specialist: $10 IN/$20 OON$90 IN/OON per visit$45 IN/OON per visit$0 copay for LifeScan Diabetes Test Strips$6,000/50% coinsurance IN/OON$300 IN/OON per year$690-$1,890 copay per aid, per year

increase IN and OON$125 IN/OON per visit–$35 increase$55 IN/OON per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$6,000/50% coinsurance IN/OON–NO CHANGE$300 per year IN/OON–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$375 per year–medical services, OTC, fitness, home safety products;$375 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$750 per year$0 for one home safety visit per year;$0 for six home safety products per year

4747

PPO Rx Choice–H5533-015-002

Service Area: Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington,

and Westmoreland counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$23 per month$1 per month

$20 per month–$3 decrease$0 per month–Part B premium reduction removed

DeductibleMaximum Out-of-PocketInpatient Hospital

$0$5,500 IN/$8,950 IN/OON$295 IN/$400 OON per stay

$0–NO CHANGE$5,500 IN/$9,550 IN/OON–$600 increase IN/OON$350 IN/$400 OON per stay–$55 increase IN

Outpatient Surgery

$225 IN/$350 OON per service

$275 IN/$375 OON per service–$50 increase IN/$25 increase OON

PCP: $0 IN/OON (OON telehealth not covered); Specialist: $20 IN/$40 OON (OON telehealth not covered)

PCP: $0 IN/OON (OON telehealth not covered)–NO CHANGE; Specialist: $30 IN/$40 OON (OON telehealth not covered)–$10

PCP/Specialist (in-office and telehealth)Emergency Care

increase IN$125 IN/OON per visit–$35 increase$55 IN/OON–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/50% coinsurance IN/OON–NO CHANGE$300 per year IN/OON–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$150 per year–medical services, OTC, fitness, home safety products;$150 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$90 IN/OON per visit$45 IN/OON per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance IN/OON$300 per year IN/OON$690-$1,890 copay per aid, per year

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$300 per year$0 for one home safety visit per year;$0 for six home safety products per year

4848

PPO Rx Choice–H5533-015-003

Service Area: Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean,

Mercer, Venango, and Warren counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$23 per month$1 per month

$19 per month–$4 decrease$0 per month–Part B premium reduction removed

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$0$5,500 IN/$8,950 IN/OON$295 IN/$400 OON per stay$225 IN/$350 OON per servicePCP: $0 IN/OON (OON telehealth not covered); Specialist: $20 IN/$40 OON (OON telehealth not covered)

$0–NO CHANGE$5,500 IN/$9,550 IN/OON–$600 increase IN/OON$350 IN/$400 OON per stay–$55 increase IN

ASC: $225 IN/$350 OON per service–NO CHANGE

Facility: $250 IN/$350 OON per service–$25 increase INPCP: $0 IN/OON (OON telehealth not covered)–NO CHANGE; Specialist: $30 IN/$40 OON (OON telehealth not covered)–$10

increase IN$125 IN/OON per visit–$35 increase$55 IN/OON–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/50% coinsurance IN/OON–NO CHANGE$300 per year IN/OON–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$150 per year–medical services, OTC, fitness, home safety products;$150 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$90 IN/OON per visit$45 IN/OON per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance IN/OON$300 per year IN/OON$690-$1,890 copay per aid, per year

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$300 per year$0 for one home safety visit per year;$0 for six home safety products per year

4949

PPO Rx Choice–H5533-015-004

Service Area: Adams, Carbon, Centre, Clinton, Cumberland, Dauphin, Fulton, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Perry, Potter, Snyder, Sullivan, Tioga,

Union, and York counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$23 per month$2 per month

$19 per month–$4 decrease$0 per month–Part B premium reduction removed

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$0$4,900 IN/$8,950 IN/OON$300 IN/$400 OON per stay$200 IN/$300 OONPCP: $0 IN/OON (OON telehealth not covered); Specialist: $25 IN/OON (OON telehealth not covered)$90 IN/OON per visit$45 IN/OON per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance IN/OON$300 per year IN/OON$690-$1,890 copay per aid, per year

$0–NO CHANGE$6,000 IN/$9,550 IN/OON–$1,100 increase IN/$600 increase IN/OON$325 IN/$400 OON per stay–$25 increase IN$250 IN/$350 OON–$50 increase IN and OONPCP: $0 IN/OON (OON telehealth not covered)–NO CHANGE; Specialist: $30 IN/OON (OON telehealth not covered)–$5 increase$125 IN/OON per visit–$35 increase

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$55 IN/OON–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/50% coinsurance IN/OON–NO CHANGE$300 per year IN/OON–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$500 per year$0 for one home safety visit per year;$0 for six home safetyproducts per year

$250 per year–dental, vision, and hearing services

5050

PPO Rx Choice–H5533-015-005

Service Area: Bedford, Blair, Cambria, Huntingdon, and Somerset counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$23 per month$1 per month

$21 per month–$2 decrease$4 per month–$3 increase$0–NO CHANGE$6,000 IN/$9,000 IN/OON–$500 increase IN/$50 increase IN/OON$185 IN/$300 OON per day, days 1-5$0 per day, days 6 and beyond–change to per day$300 IN/40% of the cost OON per service–$75 increase IN/change to PCP: $0 IN/OON (OON telehealth not covered)–NO CHANGE; Specialist: $35 IN/$45 OON (OON telehealth not covered)–$15

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$0$5,500 IN/$8,950 IN/OON$295 IN/$400 OON per stay$225 IN/$350 OON per servicePCP: $0 IN/OON (OON telehealth not covered); Specialist: $20 IN/$40 OON (OON telehealth not covered)

coinsurance OON

increase IN/$5 increase OON$125 IN/OON per visit–$35 increase$55 IN/OON–$10 increase

$90 IN/OON per visit$45 IN/OON per visit

Urgent Care

Diabetes Test Strips

$0 copay for LifeScan Diabetes Test Strips

$0 copay for LifeScan Diabetes Test Strips–NO CHANGE

Dental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$5,000/50% coinsurance IN/OON$300 per year IN/OON$690-$1,890 copay per aid, per year

$5,000/50% coinsurance IN/OON–NO CHANGE$300 per year IN/OON–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$150 per year–medical services, OTC, fitness, home safety products;$150 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$300 per year$0 for one home safety visit per year;$0 for six home safety products per year

5151

HMO Rx Choice

Here’s the product value story and target audience for these plans.

Value story

Who should buy this plan?

Our HMO Rx Choice is a well-rounded plan for medical copays, prescription drug costs, added benefits, and more. It is a great plan for someone in good health or who uses a lot of medical services.You get our richest prescription drug benefits.$0 copays for Tier 1 and 2 prescriptions at preferred pharmacies and low copays for diabetes medicationsDental, vision, hearing, free gym memberships, home safety, personal counseling, travel coverage, and more.

•••••

Medicare Advantage switcherMedicare Supp switcher

Prescription coverage.

ooExtra benefits.

Age-insOriginal Medicare (FFS)Mid-premium, looking for low

cost sharing

Good health–not expecting to use many medical servicesTake few prescriptionsMembers who have higher use of medical care may want

The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and dental, vision, and hearing services.

••

Doctor access. Access to UPMC and additional community providers across PA Emergency and urgent care anywhere in the U.S. Use the UPMC for Life Travel Concierge program for worry-free

ooo

and out of state.

to move to the HMO Rx plan

trips.

5252

HMO Rx Choice–H3907-057-001

Service Area: Allegheny County

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$36 per monthNot applicable

$34 per month–$2decreaseNot applicable–NO CHANGE

Deductible

$0

$0–NO CHANGE

Maximum Out-of-PocketInpatient Hospital

$4,500$395 per stay

$5,000–$500 increase$395 per stay–NO CHANGE

Outpatient Surgery

$250 per service

$250 per service–NO CHANGE

PCP/Specialist(in-office and telehealth)Emergency Care

PCP: $0/ Specialist: $35$90 per visit$45 per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance

PCP: $0/ Specialist: $35–NO CHANGE$125 per visit–$35 increase$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/50% coinsurance–NO CHANGE$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$200 per year$690-$1,890 copay per aid, per year

$500 per year$0 for one home safety visit per year;$0 for six home safety products per year

5353

HMO Rx Choice–H3907-057-002

Service Area: Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington,

Westmoreland, Harrison (OH), and Jefferson (OH) counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$36 per monthNot applicable

$35 per month–$1decreaseNot applicable–NO CHANGE$0–NO CHANGE$5,000–$500 increase$400 per stay–$5 increase$300 per service–$50 increasePCP: $0/ Specialist: $35–NO CHANGE

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist(in-office and telehealth)

$0$4,500$395 per stay$250 per servicePCP: $0/ Specialist: $35

Emergency Care

$90 per visit

$125 per visit–$35 increase

Urgent CareDiabetes Test Strips

$45 per visit$0 copay for LifeScan Diabetes Test Strips

$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE

Dental Allowance

$5,000/50% coinsurance

$5,000/50% coinsurance–NO CHANGE

Vision AllowanceHearing AidsFlex Spend CardHome Safety

$200 per year$690-$1,890 copay per aid, per year

$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE

$250 per year–medical services, OTC, fitness, home safety products;

$500 per year$0 for one home safety visit per year;$0 for six home safety products per year

$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

5454

HMO Rx Choice–H3907-057-003

Service Area: Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer,

Venango, and Warren counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$36 per monthNot applicable

$34 per month–$2decreaseNot applicable–NO CHANGE$0–NO CHANGE

Deductible

$0

Maximum Out-of-Pocket

$4,500

$5,000–$500 increase

Inpatient HospitalOutpatient Surgery

$395 per stay$250 per servicePCP: $0/ Specialist: $35$90 per visit$45 per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance

$395 per stay–NO CHANGEASC: $225 per service–$25 decrease; Facility: $250 per service–NO CHANGEPCP: $0/ Specialist: $35–NO CHANGE$125 per visit–$35 increase$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/50% coinsurance–NO CHANGE$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing servicesSee Flex Spend Card for home safety products

PCP/Specialist

(in-office and telehealth)Emergency Care

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$200 per year$690-$1,890 copay per aid, per year

$500 per year

$0 for one home safety visit per year;

$0 for one home safety visit per year–NO CHANGE;

$0 for six home safety products per year

5555

HMO Rx Choice–H3907-057-004

Service Area: Adams, Bradford, Carbon, Centre, Clinton, Cumberland, Dauphin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Lycoming, Mifflin, Montour, Northampton, Perry, Potter, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming, and York counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$36 per monthNot applicable

$35 per month–$1decreaseNot applicable–NO CHANGE

Deductible

$0

$0–NO CHANGE

Maximum Out-of-PocketInpatient Hospital

$4,500$395 per stay

$6,000–$1,500 increase$395 per stay–NO CHANGE

Outpatient Surgery

$250 per service

$250 per service–NO CHANGE

PCP/Specialist (in-office and telehealth)Emergency Care

PCP: $0/ Specialist: $35$90 per visit$45 per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance

PCP: $0/ Specialist: $35–NO CHANGE$125 per visit–$35 increase$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/50% coinsurance–NO CHANGE$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$200 per year$690-$1,890 copay per aid, per year

$500 per year$0 for one home safety visit per year;$0 for six home safety products per year

5656

HMO Rx Choice–H3907-057-005

Service Area: Bedford, Blair, Cambria, Huntingdon, and Somerset counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$36 per monthNot applicable

$35 per month–$1decreaseNot applicable–NO CHANGE$0–NO CHANGE$6,000–$1,500 increase$195 per day, days 1-5, $0 per day, days 6 and beyond–change from

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist(in-office and telehealth)Emergency Care

$0$4,500$395 per stay$250 per servicePCP: $0/ Specialist: $35$90per visit$45per visit

per stay to per day$300 per service–$50 increasePCP: $0/ Specialist: $35–NO CHANGE$125 per visit–$35 increase$55 per visit–$10 increase

Urgent Care

Diabetes Test Strips

$0 copay for LifeScan Diabetes Test Strips

$0 copay for LifeScan Diabetes Test Strips–NO CHANGE

Dental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$5,000/50% coinsurance$200 per year$690-$1,890 copay per aid, per year

$5,000/50% coinsurance–NO CHANGE$200 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$250 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$500 per year$0 for one home safety visit per year;$0 for six home safety products per year

5757

HMO Rx

Here’s the product value story and target audience for this plan.

Value story

Who should buy this plan?

This plan gives you peace of mind when you need medical care and take many prescriptions. You have a low $4,500 annual maximum out-of-pocket and lower copays for medical services. Plus, this plan does not have a Part D prescription deductible, which means you get first-dollar coverage at the pharmacy.

•••

Medicare Advantage switcherMedicare Supp switcherWilling to pay a high premium to have a low MOOP and low cost

Prescription coverage.You get our richest prescription drug benefits. $0 copays for Tier 1 and 2 prescriptions at preferred pharmacies and low copays for diabetes medications.

ooExtra benefits.Dental, vision, hearing, free gym memberships, home safety, personal counseling, travel coverage, and more.The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and dental, vision, and hearing services.

sharing

•••

Moderate use of medical servicesTake several prescriptionsMembers who use many medical services should stay in this plan instead of switching down to a lower

oo

premium plan

Has the highest Flex Spend Card

amount to help members get the additional care and health care products they need

Doctor access.Access to UPMC and additional community providers across PA and Emergency and urgent care anywhere in the U.S.The UPMC for Life Travel Concierge program for worry-free trips.

ooo

out of state.

5858

HMO Rx–H3907-058-001

Service Area: Adams, Allegheny, Armstrong, Beaver, Bradford, Butler, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Lycoming, McKean, Mercer, Mifflin, Montour, Northampton, Perry, Potter, Snyder, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne,

Westmoreland, Wyoming, York, Harrison (OH), and Jefferson (OH) counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$81 per month$2 per month

$90 per month–$9 increase$1 per month–$1 decrease$0–NO CHANGE$4,500–NO CHANGE$295 per stay–NO CHANGE$200 per service–NO CHANGEPCP: $0/ Specialist: $25–NO CHANGE$125 IN/OON per visit–$35 increase$55 IN/OON–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/30% coinsurance–coinsurance decrease from 50% to 30%

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient Surgery

$0$4,500$295 per stay$200 per servicePCP: $0/ Specialist: $25$90 IN/OON per visit$45 IN/OON per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance

PCP/Specialist

(in-office and telehealth)Emergency Care

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$225 per year$690-$1,890 copay per aid, per year

$225 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$500 per year–medical services, OTC, fitness, home safety products;$500 per year–dental, vision, and hearing servicesSee Flex Spend Card for home safety products

$1,000 per year

$0 for one home safety visit per year;

$0 for one home safety visit per year–NO CHANGE;

$0 for six home safety products per year

5959

HMO Rx–H3907-058-002

Service Area: Bedford, Blair, Cambria, Huntingdon, and Somerset counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$81 per month$2 per month

$97 per month–$16 increase$1 per month–$1 decrease$0–NO CHANGE$4,500–NO CHANGE$295 per stay–NO CHANGE$200 per service–NO CHANGEPCP: $0/ Specialist: $25–NO CHANGE$125 per visit–$35 increase$55 per visit–$10 increase$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,000/30% coinsurance–coinsurance decrease from 50% to 30%

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$0$4,500$295 per stay$200 per servicePCP: $0/ Specialist: $25$90 per visit$45 per visit$0 copay for LifeScan Diabetes Test Strips$5,000/50% coinsurance

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$225 per year$690-$1,890 copay per aid, per year

$225 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$500 per year–medical services, OTC, fitness, home safety products;$500 per year–dental, vision, and hearing services$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$1,000 per year$0 for one home safety visit per year;$0 for six home safety products per year

6060

Legacy plans

These plans include:

GOAL:

HMO Deductible Rx

ooo

PPO High Deductible RxPPO Rx EnhancedHMO Rx Enhanced

These plans continue to have

strong membership

These plans no longer experience much new sales growth.

that we’d like to

keep.

Many of these plans do not have new and improved benefits and continue to have the highest maximum out-of-pocket (MOOP) available.

6161

HMO Deductible Rx

Here’s the product value story and target audience for this plan.

Value story

Please note: DME is now 20% on this plan (deductible does not apply). Physical therapy copays are now $30 after deductible, the same amount as a regular specialist copay.

Prescription coverage.

oo

You get our richest prescription drug benefits.$0 copays for Tier 1 and 2 prescriptions at preferred pharmacies and low copays for

diabetes medications.

Extra benefits.Dental, vision, hearing, free gym memberships, home safety, personal counseling,

travel coverage, and more.

The UPMC for Life Flex Spend Card gives you additional dollars each year to pay for medical service costs, OTC products, fitness, home safety products, and

dental, vision, and hearing services.

Doctor access.

Access to UPMC and additional community providers across PA and out of state.

oo

Emergency and urgent care anywhere in the U.S. Use the UPMC for Life Travel Concierge program for worry-free trips.

6262

HMO Deductible Rx–H3907-037

Service Area: Adams, Allegheny, Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Lycoming, McKean, Mercer, Mifflin, Montour, Northampton, Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York, Harrison (OH), and

Jefferson (OH) counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$20.80Not applicable

$22 per month–$1.20 increaseNot applicable–NO CHANGE

DeductibleMaximum Out-of-Pocket

$750$6,000

$750–NO CHANGE$6,000–NO CHANGE

Inpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$300 per stay after deductible$125 after deductiblePCP: $0/ Specialist: $35(deductible does not apply)$90 per visit (deductible does not apply)

$300 per stay after deductible–NO CHANGE$125 after deductible–NO CHANGEPCP: $0/ Specialist: $30–specialist $5 decrease(deductible does not apply)$125 per visit (deductible does not apply)–$35 increase

Urgent Care

$45 per visit (deductible does not apply)

$55 per visit (deductible does not apply)–$10 increase

Diabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$0 copay for LifeScan Diabetes Test Strips$2,250/50% coinsurance

$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$3,225/50% coinsurance–$975 increase$150 per year–NO CHANGE$690-$1,890 copay per aid, per year–NO CHANGE$250 per year–medical services, OTC, fitness, home safety products;$0 for one home safety visit per year–NO CHANGE;See Flex Spend Card for home safety products

$150 per year$690-$1,890 copay per aid, per year

$500 per year$0 for one home safety visit per year;$0 for six home safety products per year

$250 per year–dental, vision, and hearing services

6363

PPO High Deductible Rx

Here’s the product value story and target audience for this plan.

Value story

Who should buy this plan?

Are you seeking a low-cost premium that allows you to use in- and out-of-network doctors?

For $33 per month, you can get just that!It sounds like you are in good health and seeking

that “just in case” coverage? Our PPO High Deductible Rx plan will give you both medical

and drug coverage, in- or out-of-network.Prescription coverage. You get our richest prescription drug benefits.$0 copays for Tier 1 and 2 prescriptions at preferred pharmacies and low copays for

oo

diabetes medications.

Extra benefits.Dental, vision, hearing, free gym memberships, home safety, personal counseling, worldwide travel assistance, and more.

Doctor access.

Access to doctors and hospitals in- and out-of-network.

ooo

You can see any provider that accepts Medicare in the U.S. and agrees to see youEmergency and urgent care anywhere in the U.S. 24/7 worldwide emergency medical assistance when you travel 100 miles or more

away from home.

6464

PPO High Deductible Rx–H5533-003

Service Area: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Carbon, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Somerset, Venango, Warren, Washington, and Westmoreland counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$29.50 per monthNot applicable$1,250 IN/OON$7,550 IN/$11,300 IN/OON per year$300 IN/30% coinsurance OON per stay after

$33 per month–$4.50 increase$0.50 per month–Part B giveback NEW!$1,250 IN/OON–NO CHANGE$7,550 IN/$11,300 IN/OON per year–NO CHANGE$300 IN/30% coinsurance OON per stay after deductible–NO

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient Surgery

deductible$175 IN/30% coinsurance OON after deductiblePCP: $0 IN (deductible does not apply)/ $40 OON after deductible; Specialist: $50 IN (deductible does not apply)/$60 OON after deductible (OON telehealth not covered)$90 IN/OON (deductible does not apply)$45 IN/OON (deductible does not apply)$0 copay for LifeScan Diabetic test strips$250 IN/OON (standard allowance)

CHANGE$175 IN/30% coinsurance OON after deductible–NO CHANGEPCP: $0 IN (deductible does not apply)/$40 OON after Specialist: $40 IN (deductible does not apply)/$60 OON after deductible (OON telehealth not covered)–$10 decrease IN$110 IN/OON per visit (deductible does not apply)–$20 increase$45 IN/OON per visit (deductible does not apply)–NO CHANGE$0 copay for LifeScan Diabetic test strips–NO CHANGE$350 IN/OON (standard allowance)–$100 increase$125 IN/OON per year–$25 increase$690-$1,890 copay per aid, per year–NO CHANGE

PCP/Specialist (in-office and telehealth)

deductible; –NO CHANGE

Emergency CareUrgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$100 IN/OON per year$690-$1,890 copay per aid, per year

Not covered$0 for one home safety visit per year;$0 for six home safety products per year

Not covered–NO CHANGE$0 for one home safety visit per year–NO CHANGE;$0 for six home safety products per year–NO CHANGE

6565

PPO Rx Enhanced plans

Here’s the product value story and target audience for these plans.

Value story

Who should buy this plan?

••

You get medical and prescription drug coverage in one easy-to-use plan.

Prescription coverage. You get our richest prescription drug benefits.

$0 copays for Tier 1 and 2 prescriptions at preferred pharmacies and low copays for

diabetes medications.

Extra benefits.Dental, vision, hearing, free gym memberships, home safety, personal counseling, worldwide travel assistance, and more.

Doctor access. Access to doctors and hospitals in- and out-of-network.You can see any provider that accepts Medicare in the U.S. and agrees to see you.Emergency and urgent care anywhere in the U.S. 24/7 worldwide emergency medical assistance when traveling out of the country or

oooo

100 miles away from home.

6666

PPO Rx Enhanced–H5533-005

Service Area: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Carbon, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Somerset, Venango, Warren, Washington, and Westmoreland

counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$134 per monthNot applicable$500 OON$7,550 IN/$11,300 IN/OON per year$250 IN per stay/30% coinsurance OON after

$140 per month–$6 increase$1 per month–Part B giveback NEW!$500 OON–NO CHANGE$7,550 IN/$11,300 IN/OON per year–NO CHANGE$250 IN per stay/30% coinsurance OON after deducible–NO

DeductibleMaximum Out-of-PocketInpatient HospitalOutpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

deducible$150 IN/30% coinsurance OON after deductiblePCP: $0 IN/$30 OON after deductibleSpecialist: $40 IN/$50 OON after deductible(OON telehealth not covered)$90 IN/OON per visit (deductible does not apply)$45 IN/OON per visit (deductible does not apply)$0 copay for LifeScan Diabetes test strips$1,000/50% coinsurance IN/OON

CHANGE$150 IN/30% coinsurance OON after deductible–NO CHANGEPCP: $0 IN/$30 OON after deductible–NO CHANGESpecialist: $40 IN/$50 OON after deductible–NO CHANGE$110 IN/OON per visit (deductible does not apply)–$20

(OON telehealth not covered

increase$45 IN/OON per visit (deductible does not apply)–NO CHANGE$0 copay for LifeScan Diabetes test strips–NO CHANGE$1,000/50% coinsurance IN/OON–NO CHANGE$250 IN/OON per year–$75 increase$690-$1,890 copay per aid, per year–NO CHANGE

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

$175 IN/OON per year$690-$1,890 copay per aid, per year

Not covered$0 for one home safety visit per year;$0 for six home safety products per year

Not covered–NO CHANGE$0 for one home safety visit per year–NO CHANGE;$0 for six home safety products per year–NO CHANGE

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PPO Rx Enhanced–H5533-008

Service Area: Adams, Berks, Bradford, Cumberland, Dauphin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Northampton, Perry, Susquehanna, Wayne,

Wyoming, and York counties

Plan Highlights

2024

2025

Plan PremiumPart B Premium Reduction

$58 per monthNot applicable$500 OON$7,550 IN/$11,300 OON per year$275 per day, days 1-5, $0 per day, days 6 and beyond IN after deductible40% coinsurance OON after deductible$250 IN/40% coinsurance OON after deductible

$58 per month–NO CHANGENot applicable–NO CHANGE$500 OON–NO CHANGE$7,550 IN/$11,300 OON per year–NO CHANGE$275 per day, days 1-5, $0 per day, days 6 and beyond IN after 40% coinsurance OON after deductible–NO CHANGE$250 IN/40% coinsurance OON after deductible–NO CHANGEPCP: $0 IN/$30 OON after deductible–NO CHANGESpecialist: $40 IN/40% coins. after deductible–NO CHANGE

DeductibleMaximum Out-of-Pocket

Inpatient Hospital

deductible–NO CHANGE

Outpatient Surgery

PCP/Specialist

PCP: $0 IN/$30 OON after deductible

(in-office and telehealth)Emergency Care

Specialist: $40 IN/40% coins. after deductible$90 IN/OON (deductible does not apply)$45 IN/OON (deductible does not apply)$0 copay for LifeScan Diabetes test strips$2,000/50% coinsurance IN/OON$200 IN/OON per year $690-$1,890 copay per aid, per year

(OON telehealth not covered)$110 IN/OON (deductible does not apply)–$20 increase$45 IN/OON (deductible does not apply)–NO CHANGE$0 copay for LifeScan test strips–NO CHANGE$2,900/50% coinsurance IN/OON–$900 increase$250 IN/OON per year–$50 increase$690-$1,890 copay per aid, per year–NO CHANGE

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend CardHome Safety

Not covered$0 for one home safety visit per year;$0 for three home safety products

Not covered–NO CHANGE$0 for one home safety visit per year–NO CHANGE;$0 for six home safety products per year–NO CHANGE

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HMO Rx Enhanced

Here’s the product value story and target audience for this plan.

Value story

If your employer is paying your premium and you want the best coverage that we have, the

HMO Rx Enhanced plan has the lowest copays across all our plans.

Prescription coverage. You get our richest prescription drug benefits.$0 copays for Tier 1 and 2 prescriptions at preferred pharmacies and low copays for

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diabetes medications.

Extra benefits.

Dental, vision, hearing, free gym memberships, home safety, personal counseling,

travel coverage, and more.

Doctor access. Access to UPMC and additional community providers across PA and out of state.Emergency and urgent care anywhere in the U.S.

oo

Use the UPMC for Life Travel Concierge program for worry-free trips.

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HMO Rx Enhanced–H3907-006

Service Area: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bradford, Butler, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Forest, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence, Lebanon, Lehigh, Lycoming, McKean, Mercer, Mifflin, Montour, Northampton, Perry, Potter, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington,

Wayne, Westmoreland, Wyoming, York, Harrison (OH), and Jefferson (OH) counties

Plan Highlights

2024

2025

Plan Premium

$295 per month

$295 per month–NO CHANGE

Part B Premium Reduction

Not applicable

$13 per month–Part B giveback NEW!

DeductibleMaximum Out-of-Pocket

$0$7,550 per year

$0–NO CHANGE$7,550 per year–NO CHANGE

Inpatient Hospital

$125 per stay

$125 per stay–NO CHANGE

Outpatient SurgeryPCP/Specialist (in-office and telehealth)Emergency Care

$80 per servicePCP: $0/ Specialist: $25 $90 per visit$45 per visit$0 copay for LifeScan test strips

$80 per service–NO CHANGEPCP: $0–NO CHANGESpecialist: $10–$15 decrease$110 per visit–$20 increase$45 per visit–NO CHANGE$0 copay for LifeScan Diabetes Test Strips–NO CHANGE$5,500/50% coinsurance–NEW!$350 per year–$150 increase$690-$1,890 copay per aid, per year–NO CHANGE

Urgent CareDiabetes Test StripsDental AllowanceVision AllowanceHearing AidsFlex Spend Card

Not covered$200 per year$690-$1,890 copay per aid, per year

Not covered$0 for one home safety visit per year;$0 for three products per year

Not covered–NO CHANGE$0 for one home safety visit per year–NO CHANGE;$0 for six home safety products per year–NO CHANGE

Home Safety

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Prescription

drug coverage

71

IRA and Part D changes

Due to the Inflation Reduction Act (IRA) of 2022, the Medicare Part D prescription drug stages are changing for 2025. The members' out-of-pocket drug costs change as they move through these stages. Costs can also depend on the UPMC for Life plan, the pharmacy used, and the drug's tier.

Plan name

Tiers 3, 4, and 5Deductible Amount

DEDUCTIBLE STAGE

Members do not have a deductible for Tier 1 and 2

HMO Premier RxPPO Essential Care Rx

$350

prescriptions. Most UPMC for Life

PPO Premier Rx

plans have a combined deductible for Tiers 3, 4, and 5. For drugs on these tiers, members pay the full cost of each prescription until they reach their plan’s deductible amount. See the chart to the right for UPMC for Life plans with an annual Part D deductible for Tiers 3, 4, and 5.

PPO Rx ChoiceHMO Rx ChoiceHMO Deductible Rx

$175

PPO High Deductible Rx

PPO Rx Enhanced (CPA)

HMO RxPPO Rx Enhanced (WPA)HMO Rx Enhanced

No deductible

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Part D stages

There will no longer be a coverage gap (donut hole) in 2025. Once the member’s total yearly drug costs reach $2,000, the member will move into the catastrophic coverage stage. In this stage the member will not pay anything for their covered drugs.

INITIAL COVERAGE STAGE

View the comprehensive laries onlifull list of the drugs we

UPMC for Life pays for its share of the member’s covered prescriptions starting in this stage. Members will pay a copay or coinsurance, depending onFor drugs on tiers with coinsurance, the member’s cost-share may change throughout the year depending on the drug and where the prescription is filled. Once the member’s total yearly out-of-pocket drug costs reach $2,000, they will move to the catastrophic coverage

formu

the me

dicatio

n's drug

ne f

tier

or

cover for each plan.

Select the plan type, state, and county to generate the appropriate

stage. See page 75 for copay information and costs by plan.

formulary.

CATASTROPHIC COVERAGE STAGE

There will no longer be a coverage gap (donut hole) in 2025. The member’s total yearly

drug costs will be capped at $2,000. Once the member’s total yearly out-of-pocket drug

costs reach $2,000, they will not pay anything for their drugs. Members will stay in this

stage through the end of the year.

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Save money on prescriptions

Here are two important ways UPMC for Life prescription drug coverage can help our members save money.

$0 copays for Tier 1 and 2 prescriptions

All plans with Part D coverage have a $0 copay for Tier 1 and 2

drugs when filled at preferred retail and mail-order pharmacies.Plans that use the Advantage Rx formulary also have $0 copay for brand-name (non-insulin) diabetes medications on Tier 2.

Low copays for insulin medications•$35 for 30-day supply at retail•$87.50 for 100-day supply at preferred mail order•$96.25 for 100-day supply at preferred retail

•$105 for 100-day supply at standard pharmacies

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UPMC for Life prescription costs

Plans with Part D prescription drug coverage have the copays/coinsurance listed below. This cost sharing applies only during the initial coverage stage.

30-Day SupplyRetail

100-Day Supply

Retail

Mail Order

Preferred

Standard

Preferred

Standard

Preferred

Standard

Tier

Pharmacy$0

Pharmacy$15

Pharmacy$0

Pharmacy$30

Pharmacy$0

Pharmacy$30

Tier 1Preferred Generic

Tier 2

$0

$20

$0

$40

$0

$40

Generic

Tier 3Preferred Brand

$47PPO Rx Choice: 37%; PPO Premier Rx Central PA: 39%; HMO Rx Choice: 40%; HMO Deductible Rx: 42%; PPO Rx Enhanced Central PA: 45%; PPO Premier Rx Western PA: 47%;

$47

$129.50

$141

$117.50

$141

Tier 4Non-Preferred

HMO Rx: 49%; HMO Premier Rx, PPO Essential Care Rx, PPO High Deductible Rx, PPO Rx

(coinsurance)

Enhanced Western PA, HMO Rx Enhanced: 50%Up to 30-day supply only: HMO Premier Rx, PPO Essential Care Rx, PPO Premier Rx: 28%; HMO Deductible Rx, PPO High Deductible Rx, PPO Rx Choice, HMO Rx Choice, PPO Rx Enhanced Central PA: 31%; HMO Rx, PPO Rx Enhanced Western PA, HMO Rx Enhanced: 33%

Tier 5Specialty

(coinsurance)

Covered Insulins

$35

$35

$96.25

$105

$87.50

$105

(deductible does not apply)

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Medicare Prescription Payment Plan (M3P)

NEW for 2025: Medicare Part D members will have the option to pay their out-of-pocket costs for prescription drugs in monthly amounts spread over the year.

The Medicare Prescription Payment Plan is a new payment option to help Medicare

members with high drug costs manage out-of-pocket drug costs, starting in 2025.

All Medicare drug plans and Medicare health plans with drug coverage (like a Medicare Advantage plan) must offer this payment option. This program spreads out what the member will pay each month across the year (January – December), so the member doesn’t have to pay out-of-pocket costs to the pharmacy at the time of receiving their prescription. All plans use the same formula to calculate the member’s

monthly payments.

If a member selects this payment option, they will pay their plan premium (if they have one) and get a bill from Express Scripts for prescription drugs (instead of paying the pharmacy) each

month.

Important things to know about this program:

The Medicare Prescription Payment Plan is free to join. Participation is voluntary.

••

There are no fees or interest charged under the program, even for late payment. The program does not reduce the total amount of cost-sharing a member owes for their

Part D prescriptions.Only certain members with high out-of-pocket drug costs will benefit from this program.

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How M3P works and enrollment

How do the member’s costs work with the

How do members enroll?

M3P program?

The payment plan option does not take effect until Jan. 1, 2025. To spread costs over as many months as possible, we do not recommend

When filling a prescription for a drug covered by Part D, the member won’t pay the pharmacy (including mail-order and specialty pharmacies).

Instead, the member will get a bill each month

enrolling into the payment plan later

from Express Scripts. The monthly bill is based on what the member owes for any prescriptions plus their previous month’s balance, divided by the number of

in the calendar year (after

September).Call UPMC for Life: 1-866-845-1803

(TTY: 711)

months left in the year.

Visit Medicare.gov/prescription-

Like any other debt, the member must pay the

payment-plan or call 1-800-MEDICARE (1-800- 633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.

amount owed by the due date provided. If the member does not make the monthly payments, they will be disenrolled from the Medicare Prescription Payment Plan and will pay the pharmacy directly for all their out-of-pocket drug costs. They will not be disenrolled from their UPMC for Life Medicare Advantage plan.

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Formulary

For 2025, there will be four comprehensive formulary booklets.

1. Premier Rx:

3. Complete Care (D-SNP)

How is our formulary different?

•••

HMO Premier RxPPO Essential Care RxPPO Premier Rx

All D-SNP plans use this

formulary

UPMC for Life aims to

4. Group (HMO/PPO)

provide superior access and affordability by working with our doctors, using the latest clinical information, and developing care management programs focused on whole-person care. We use real-world feedback from our doctors to make changes to our

2. Advantage Rx:

All group plans that offer Part D coverage use this

•••••••

PPO Rx ChoiceHMO Rx ChoiceHMO RxHMO Deductible RxPPO High Deductible RxPPO Rx EnhancedHMO Rx Enhanced

formulary

formulary.

All formularies can be found online. Select

the plan type, state, and county to see the appropriate formulary. Scan this code to

learn more:

7878

Formulary drug changes

Gabapentin capsules and tablets

Limited formulary changes

••••

Advantage Rx formulary: moving from Tier 2 to 3.Already on Tier 3 for Premier Rx formulary.Member cost share may be less than the Tier 3 copay.From a safety and quality standpoint, there are

Changes were limited to

provide stability for members.

measures looking at opioid use and triple threat

combinations. This includes the use of Gabapentin in combo with other sedating drugs, which increases risk for members. Other drugs on lower tiers may be more effective AND safer for the member’s conditions.

These changes were made in conjunction with our medical directors and CMS guidelines.

Members and their providers will be notified prior to Jan. 1 so that there is time to switch to an alternative or request an exception as needed.

Certain specialty medications

••

Moving from Tier 4 to 5.CMS sets the minimum monthly cost of a medication to be eligible for the Specialty Tier (Tier 5).

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Extra benefits

and services

80

We’re here for our members

Everything we do is focused on creating a better health care experience for our members. Here’s how our members can get help and information fast!

Health Care Concierge

Call us when you need help with your plan or have questions. We have a team of Medicare experts at the ready! UPMC Health Plan earned four 2024 Gold Stevie® Awards and a 2024 Grand Stevie Award for its customer service excellence!

UPMC Health Plan Tech Guides

This dedicated tech team is here to help you use all the free digital health care tools UPMC Health Plan offers. We can even help you set up your smart device and give you

tips on how to use it.

UPMC Health Plan Login

You can securely access your health insurance information on the go through the UPMC Health Plan member site or app. See your member ID card and plan information,

chat with a Health Care Concierge, find a doctor, check prescriptions, and much more!

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Here’s the plan for better health

Our members have extra benefits that help them stay active and independent.

SilverSneakers®

Personal counseling

Unlimited FREE gym memberships and one FREE personal training session

Six sessions per concern per

Scan this code to learn more:

year with a trained and

licensed counselor through UPMC Resources for Life.

per year.

Tools for caregivers

Personal care managers

The Powerful Tools for Caregivers program can help you, your family, and friends learn ways to reduce feelings of loss, loneliness, or stress.

We can help you understand

your doctor’s instructions,

outline your next steps after a diagnosis, and coordinate your future care.

UPMC Resources for Life

RxWell®

Get connected to help with legal concerns and financial

Get a personal plan to help

with anxiety, stress, depression, weight loss, healthy eating, physical activity, and quitting using

services.

tobacco.

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Helping our members get care, their way

UPMC for Life makes it easy for our members to get health care in the way that’s most convenient for them.

UPMC MyHealth 24/7 Nurse Line

UPMC AnywhereCare

MyUPMC

24/7 access to virtual

Schedule appointments, chat

urgent care for common

with your doctor, and track

Registered nurses give you

medical conditions right from your smartphone, tablet, or computer.

your health tests all through an easy-to-use app!

support and advice on a wide range of health issues.

Worldwide assistance

Travel Concierge

24/7 worldwide emergency assistance when you travel 100+ miles from home or to

HMO members pay the same cost sharing for covered routine medical services while visiting Arizona, Florida, Georgia, North Carolina, South Carolina, and Tennessee (at a Medicare-participating

provider).

another country.

Scan this code to learn more:

8383

Whole-person care

UPMC for Life looks at the whole health of our members. That means not just providing care through doctors and hospitals, but filling the gaps in care that exist by offering programs that support our members in all aspects of their lives.

Prior authorizations

Health and wellness programming

We have an automatic authorization process, for medical services. This makes it easier for

We’re dedicated to providing wellness programming to our communities that

providers and faster for doctors and members

helps older adults stay active and maintain

to get approvals.Almost 95% of our medical prior authorizations

their health. Here are some of the programs we offer:UPMC for Life Medicare Faith and

••••

are approved.

Wellness Powerful Tools for CaregiversZoo and Botanical Garden Walks

Value-based care

Over the past 10+ years, UPMC Health Plan has been a leader in collaborations with our local provider network and community organizations to move toward value-based care. Here are just a few ways we provide support in the community:UPMC Health Plan Neighborhood CenterPathways to Work program

National Senior Health & Fitness Day

Champions for Life

••

Member Advisory Council

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Support for certain conditions

UPMC for Life members who have certain conditions can get additional benefits to help them manage their illness.

Post-discharge meals for members with COPD, CHF, and diabetes

$0 nebulizers and drugs–COPD only

••

Contracts: H3907 and H5533.PBPs: 002, 037, 057, 058, 006, 003, 005.

Availablefor all HMO and PPO plans.

••

Prior authorization no longer required.For members with all three diagnoses of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and diabetes.This benefit is for a member who has been discharged from either an inpatient hospital stay,

Mental health/Extra Help (LIS)

••

This benefit is available on most plans (except PPO Salute and HMO Rx Enhanced).This is for members with Extra Help (LIS) and disabling mental health conditions limited to

observation stay, or a skilled nursing facility stay.

bipolar disorder, major depressive disorders,

56 meals (two meals per day for four weeks, 28 days) will be delivered to the member’s home in four deliveries (one per week). The meal benefit can only be used once after a discharge. It cannot be broken up into separate weeks.One meal benefit per year.

paranoid disorder, schizophrenia, and schizoaffective disorder.Members have a $15 copay for outpatient mental health services (in-person and telehealth).

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UPMC for Life

Complete Care

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D-SNP service area

No changes have been made to the service area for 2025.

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Plan highlights

Here are some key benefits and features of UPMC for Life Complete Care (HMO D-SNP) for 2025.

•••

Plan premiums–$0 per month.Medical services–$0 copays.Part D prescriptions–$0 copay for all covered prescriptions.

KEY TAKEAWAYS:

1.

Medical services and Part D

Dental and vision allowances–Yearly allowances for dental and

prescriptions–$0 copays.Dental and vision remain unchanged for 2025. Hearing aid benefit is now per year for

vision services are not changing for 2025.Hearing aids–$0 copay per ear per year for the plan in Western and Central PA. No change for NEPA/SEPA plans.Transportation–Rides to the doctor’s office, health care facilities, and pharmacies. Additionally, members can use

2.

WPA/CPA plan.Transportation–includes new nonmedical locations for WPA/CPA plan.Shop Healthy Card–members now have monthly allowances and receive a total allowance of $167 per month or $2,004 each year.

3.

some of their rides for locations like grocery stores, salons,

places of worship, libraries, fitness centers, and community centers. The plan in Western and Central PA has new locations: banks, county assistance offices, and funerals.The UPMC for Life Complete Care Shop Healthy Card allowance

4.

is now monthly.

$133 per month for OTC products and healthy food.

$34 per month for utilities (gas, water, electric, heating,

sewage, and trash).

8888

Dual-eligible Special Needs Plans

Here’s what you need to know about how D-SNP plans work.

What is a dual-eligible Special Needs Plan (D-SNP)?D-SNP plans are a type of Medicare Advantage plan. Plan benefits, provider choices, and prescription formularies are tailored to best meet the specific needs of these members.Individuals who qualify must be dual-eligible, meaning they have full Medicare (Part

••

A and B) and Medicaid coverage.

UPMC for Life Complete Care (HMO D-SNP):UPMC for Life Complete Care is a D-SNP plan whose membership is limited to people

with full Medicaid benefits.An individual can join UPMC for Life Complete Care if they are entitled to Medicare Part A, enrolled in Medicare Part B, and receive full Medicaid.

UPMC for Life Complete Care members must live in the service area.

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D-SNP + CHC = better health coverage!

UPMC for Life Complete Care is designed to work with UPMC Community HealthChoices Medicaid coverage. Members get extra benefits on top of their UPMC Community HealthChoices plan at no extra cost.

As a member of both plans, members can have peace of

KEY TAKEAWAYS:

mind that most of their health care services are covered.

Extra benefits and services–

Members get these benefits at no extra cost: UPMC for Life Complete Care Shop Healthy

1.

Extra benefits and services for D-SNP members

Card; vision, dental, and hearing benefits; transportation services; and unlimited free gym memberships.

2.

Care coordination

Care coordination

Members have a personal care manager who can work with their doctors, pharmacy, other health care providers, and insurance to ensure they get the right

3.

One member ID card and Health Care Concierge

care.Members also have a CHC coordinator who helps

4.

Health care coverage

ensure they get connected with additional community

through one company

support if needed.

One member ID card and point of contact with our award-winning Health Care Concierge team for all health

insurance needs.

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D-SNP member ID cards

Here are the member ID cards for the D-SNP only, CHC only, and D-SNP + CHC members.

UPMC for Life Complete Care HMO D-SNP

UPMC Community HealthChoices CHC

UPMC for Life Complete Care HMO D-SNP + CHC

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Enrollment changes for D-SNP plans

Starting January 1, 2025, there are new monthly Special Election Periods going into effect.

The quarterly Special Election Period (SEP) for dual and LIS eligibles is being eliminated and

will be replaced with the following new SEPs:

Dual eligibles and LIS eligibles: Individuals who are full dual eligible or who have

Low-Income Subsidy (LIS) will be permitted to change to Original Medicare and a

Prescription Drug Plan (PDP). This election cannot be used to enroll into a Medicare

Advantage plan.

Integrated D-SNP + CHC eligibles: Individuals enrolled or in the process of enrolling in a

Community HealthChoices (CHC) plan can only enroll in the D-SNP plan that is aligned

with their CHC plan. Other special elections may allow for unaligned enrollment.

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Plan benefits

The Medicare coverage through UPMC for Life Complete Care pays as primary. Medicaid pays as secondary no matter whether the member has coverage through UPMC CHC, another CHC-MCO, or ACCESS.

D-SNP plans provide all the usual services covered by Original Medicare plus additional

enhanced benefits.

Members must use the UPMC for Life Complete Care network of doctors, specialists, and hospitals to receive covered medical services.

If a member has UPMC Community HealthChoices (CHC) and UPMC for Life Complete Care, they receive only one ID card and it contains two member ID numbers. The first ID number is the D-SNP member number and is Primary.The second ID number is the CHC member number and is Secondary.

oo

UPMC for Life Complete Care members who are not enrolled with UPMC CHC must also show

their Access or CHC card along with their UPMC for Life Complete Care card. These members will receive only a UPMC for Life card.The secondary ID number on their card will be the member’s CHC recipient ID number.

oo

9393

Grace period

UPMC for Life Complete Care members have a 180-day grace period when they lose their Medicaid coverage.

During the grace period, UPMC for Life Complete Care members are encouraged to contact their

County Assistance Office to regain full Medicaid coverage.

UPMC for Life Complete Care members who are unable to regain full Medicaid coverage will be

disenrolled after the grace period ends.

Once the member is disenrolled, they will return to Original Medicare unless they enroll in

another Medicare Advantage plan.

While in the grace period:Members will continue to be covered by UPMC for Life while in the grace period. They may be responsible for copays and/or coinsurance during this time.Members will remain responsible for the Part B premium at all times, unless this amount is

paid on their behalf.

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D-SNP formulary changes and VBID

UPMC for Life Complete Care members will have a one-tier formulary and will continue to have the Part D VBID program for 2025.

Formulary changesThe D-SNP formulary will be one tier in 2025. All medications are on the same tier and there is no

Value-Based Insurance Design (VBID)The VBID program is part of an initiative from the Centers for Medicare & Medicaid Services

preferred or standard cost-share.

Part D VBID$0 copay for ALL covered Part D prescriptions at participating pharmacies.Applies through each phase of the pharmacy

(CMS) to increase the quality

and decrease the cost of care for members in Medicare Advantage and dual-eligible Special Needs Plans. This

benefit: initial and catastrophic.

All members receive this benefit, which applies to

all Extra Help (LIS) levels.

allows plans to create

What should members do when filling prescriptions?Members should use a participating pharmacy with a covered prescription. When they show their UPMC for Life Complete Care membership ID card, they will automatically

specialized benefits for their

members.

receive a $0 copay.

9595

Hearing aids and transportation

Here are some additional details on these enhancements.

Hearing aids

•••

WPA/CPA: $0 copay for one hearing aid per ear per year.NEPA/SEPA: $0 copay for one hearing aid per ear every three years.Members must use our hearing aid vendor, Amplifon, to take advantage of this benefit.

Members can choose from over 700 hearing aids and will get expert help selecting the best

hearing aid for their needs. Rechargeable and Bluetooth options are available.To get started, members can call Amplifon at 1-855-807-3919 (TTY: 711) or visit

amplifonusa.com/lp/upmcforlife.

Transportation

Members get trips for FREE with our transportation program–they can go to doctor’s offices,

medical facilities, and pharmacies. Members can use some of their one-way trips to go to approved nonmedical locations (up to a 30-mile limit per trip), like fitness centers, grocery stores, places of worship, salons, libraries,

and community centers. WPA/CPA: 60 one-way trips; up to 34 can be used for nonmedical locations, now including banks, county assistance offices, and funerals.NEPA/SEPA: 20 one-way trips; up to 8 can be used for nonmedical locations.To schedule a nonmedical trip, members call the same phone number as they would currently:

••

1-844-335-5921 (TTY: 711).

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UPMC for Life Complete Care Shop Healthy Card

The Shop Healthy Card allowance will now be monthly. Members get $167 per month, a total of $2,004 per year. Pet supplies, household items, and pest control have been removed for 2025.

What is it? $133 monthly allowance for OTC products and healthy foods. No longer includes pet care supplies,

Shop Healthy Card Amounts

$34

household items, and pest control.

$34 monthly allowance for household utilities (gas, water, electric, heating,

$167 per

sewage, trash).This allowance does not roll over from

month

$133

month to month.

Automatic participationAll D-SNP members receive these benefits.Current members can continue using their current Shop Healthy Card for next year.

••

Utilities (gas, water, electric, heating, sewage, trash)

OTC and healthy food

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Shop Healthy Card benefits

Members can spend up to $133 monthly on OTC products and healthy foods. They can also spend up to $34 monthly on household utilities.

OTC products and healthy foodsMembers can purchase OTC products and healthy foods at participating retail stores. Members can buy up to 50 covered products per transaction.OTC products can also be purchased through mail order (online or catalog).Some participating retail stores include Giant Eagle, Rite Aid, Walgreens, and Walmart. Members can use the Merchant Locator tool in the UPMC Health Plan member site to search for additional participating locations.

••

Utilities (gas, water, electric, heating, sewage, and trash)Members can purchase household utilities through the vendor of their choice. The utility provider must accept MasterCard as a form of payment. They can use their Shop

Healthy Card to pay their utility bills.They can also self-pay for services up front and request reimbursement for the cost.

Utilities include gas, water, electric, heating, sewage, and trash.

Members CANNOT use their card to pay their landlord or to pay for rent, internet service, cell phone coverage, or TV cable or subscription streaming services.

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Shop Healthy Card reimbursement

Members can use their card up front to pay their bills or self-pay and submit a claim for reimbursement.

Submitting a claim for reimbursement

Members who pay out of pocket for OTC products, healthy food, or utilities can

submit a claim for reimbursement. Members can be reimbursed up to their

allowance amount.Members must include proper documentation, including a copy of their third-party receipt, with their claim, and they must have allowance dollars availableon their

card to be reimbursed.Reimbursement claims cannot be submitted for items purchased through our

mail-order vendor.Members will be reimbursed by check or can set up direct deposit on the UPMCfor LifeComplete Care Shop Healthy Card portal.Members can go to upmchp.us/member-shop-healthytolearn how to set updirect deposit.

Here are all the ways to submit a claim:

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Online: upmchealthplan.com/members or through the UPMC Health Plan app

Fax: 1-844-361-4700Mail: UPMC Health Plan, PO BOX 2784, Fargo, ND 58108

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Shop Healthy Card quick guide

This chart helps you to quickly see how the Shop Healthy Card benefits can be used and to which allowance they belong.

Allowance

Benefit

Retail

Mail order

Bill pay

Reimbursement

$34 per

Utilities

N/A

N/A

Yes

Yes

month

OTC products

Yes

Yes

N/A

Yes

$133 per month

Healthy foods

Yes

No

N/A

Yes

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Preventive incentive rewards

Members get rewarded for getting the preventive care they need. Their rewards dollars get loaded on to their Shop Healthy Card.

Preventive care rewards

Earning reward dollars

Members can earn reward dollars for completing certain

The member should have already

preventive screenings by Dec. 31 each year. We'll let members know which preventive screenings they are eligible for in 2025.

received their card in the mail with instructions on how to use it. After the member completes eligible preventive care screenings, reward dollars will be automatically added to this card. We will add reward dollars to the

Using reward dollars

UPMC for Life members can use preventive care reward dollars to buy healthy foods at participating stores. They can choose from

member's card as they complete

healthy foods like fruits/vegetables, meats/seafood, healthy

additional preventive care screening(s).They can check their card balance on the UPMC Health Plan member site or through the UPMC Health Plan app.

grains, and pantry staples. Reward dollars will not be accepted on

retailer websites or apps.Preventive care reward dollars can only be used on healthy foods.

If shopping for both OTC products and healthy foods using the Shop Healthy Card, swipe the Shop Healthy Card at checkout. Preventive care reward dollars will go toward healthy foods. Any remaining amount for

OTC and healthy foods will be deducted from the Shop Healthy Card

benefit allowance.oRewards dollars are always deducted first.

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Shop Healthy Card resources

Here are some helpful resources that can help our members get information they need to use their Shop Healthy Card.

Getting OTC products by mail:

Find participating retail stores

Here are two easy ways to access the UPMC for Life UPMC Health Plan member site: upmchealthplan.com/members →SpendingAccounts → UPMC for Life Complete Care Shop Healthy Visit the UPMC for Life OTC Website.UPMC Health Plan app View Shop Healthy Card

••

Public website: upmchp.us/member-shop-healthy.UPMC Health Plan member site: upmchealthplan.com/members View Account Summary Healthy Card Portal. Once on the portal, go to Tools and Support and click Merchant Locator Tool.

OTC online store:

→UPMC for Life Shop

Spending Accounts

→ View Account Summary

Card

→→

→ Over-the-Counter

Insurance Tab

Scanning products at retail stores

Members can scan products while they shop to see if they’re covered. Log in to the UPMC Health Plan app Scan Items.

Store.Choose products from our OTC catalog and complete an order form. Mail to: OTC Servicing Center, PO Box 526266, Miami, FL 33152-9819.Call 1-800-688-2515 (TTY: 711) Monday through

Insurance Tab

Members should check their card balance every

time before they use it. Here are three easy ways

Friday from 8 a.m. to 11 p.m.

to check real-time 24/7:

••

Call our automated system: 1-833-293-6484 (TTY: 711).UPMC Health Plan member site: upmchealthplan.com/members UPMC for Life Complete Care Shop Healthy Card Insurance Tab.

Your Insurance

UPMC Health Plan app

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Health and wellness kits

UPMC for Life Complete Care members can choose two Health and Wellness Kits per year for FREE.

How do members order?

What do members get?

By phone: Call 1-888-356-5009 (TTY: 711) seven

Members can select a healthy food box with prepared meals or fresh fruit and produce or a health and wellness kit.

days a week from 8 a.m. to 8 p.m. Please have your UPMC for Life member ID card and date of

birth ready.Member site: Go to upmchealthplan.com/ members/access to log in to the UPMC Health Plan member site. Under Better Health and Wellness on the homepage, click Health and Wellness Kits. Look at all the available kits, including kit details and images. When ready to order, add the kit to your cart and check out. You will not owe anything out-of-pocket for

Some examples of kit options that will

be available include assorted fruit kit,fitness essentials kit,and health

care seasonal kit.

How do members select the kit they

want and what is the order deadline?

Members can order their kits starting Jan. 1. They cannot pre-order before

your kit.

Jan. 1.Kit 1 must be ordered betweenJan. 1 and June 30, 2025.Kit 2 must be ordered betweenJuly 1

UPMC Health Plan app: Open and log in to the

•••

UPMC Health Plan app. Tap the Wellness tab, then tap Health and Wellness Kits. Look at all the available kits, including kit details and images. When ready to order, add the kit to your cart and check out. You will not owe anything out-of-pocket for your kit.

and Dec. 31, 2025.

If the member does not select a kit by the deadline, they will not receive one.

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Complete Care (HMO D-SNP)–H4279-001

Service Area: Adams, Allegheny, Armstrong, Beaver, Bedford, Blair, Bradford, Butler, Cambria, Cameron, Centre, Clarion, Clearfield, Clinton, Crawford, Cumberland, Dauphin, Elk, Erie, Fayette, Lebanon, Lycoming, McKean, Mercer, Mifflin, Montour, Perry, Potter, Snyder,Somerset, Sullivan, Tioga, Union, Venango, Warren, Washington, Westmoreland, and York counties

Forest, Franklin, Fulton, Greene, Huntingdon, Indiana, Jefferson, Juniata, Lancaster, Lawrence,

Plan Highlights

2024

2025

Plan PremiumMedical CopaysPart D CopaysMaximum Out-of-PocketDental AllowanceVision AllowanceHearing Aids

$0 per month$0 copays$0 copays$8,850 per year$8,250 per year$575 per year$0 copay per ear every three years 60 one-way trips per year/28 can be used for nonmedical locations within 30 miles$0 for one home safety visit per year; $0 for six home safety products per year$400 per quarter for OTC, healthy foods, household/pet care supplies, and pest

$0 per month–NO CHANGE$0 copays–NO CHANGE$0 copays for all covered prescriptions–NO CHANGE$8,850 per year–NO CHANGE$8,250 per year–NO CHANGE$575 per year–NO CHANGE$0 copay per ear per year–per year instead of every

three years60 one-way trips per year/34 can be used for nonmedical locations–added 6 nonmedical trips$0 for one home safety visit per year–NO CHANGE;$0 for six home safety products per year–NO CHANGE$133 per month (no rollover) for OTC and healthy food;$34 per month (no rollover) for utilities–changed to monthly; removed pet supplies, household items, and One health and wellness kit every six months–NO

Transportation

Home Safety

Shop Healthy Card

control;$100 per quarter for utilities

pest controlCHANGE

One health and wellness kit every six

Health and Wellness Kit

months

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Complete Care (HMO D-SNP)–H4279-004

Service Area: Berks, Carbon, Lackawanna, Lehigh Luzerne, Monroe, Northampton, Pike, Schuylkill, Susquehanna, Wayne, and Wyoming counties

Plan Highlights

2024

2025

Plan PremiumMedical CopaysPart D CopaysMaximum Out-of-PocketDental AllowanceVision AllowanceHearing Aids

$0 per month$0 copays$0 copays$8,850 per year$5,000 per year$575 per year$0 copay per ear every three years20 one-way trips per year/8 can be used for nonmedical locations within 30 miles$0 for one home safety visit per year; $0 for six home safety products per year$400 per quarter for OTC, healthy foods, household/pet care supplies, and pest

$0 per month–NO CHANGE$0 copays–NO CHANGE$0 copays for all covered prescriptions–NO CHANGE$8,850 per year–NO CHANGE$5,000 per year–NO CHANGE$575 per year–NO CHANGE$0 copay per ear every three years–NO CHANGE20 one-way trips per year/8 can be used for nonmedical $0 for one home safety visit per year–NO CHANGE;$0 for six home safety products per year–NO CHANGE$133 per month (no rollover) for OTC and healthy food;$34 per month (no rollover) for utilities–changed to monthly; removed pet supplies, household items, and One health and wellness kit every six months–NO

Transportation

locations–NO CHANGE

Home Safety

Shop Healthy Card

control;$100 per quarter for utilities

pest controlCHANGE

One health and wellness kit every six

Health and Wellness Kit

months

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Complete Care (HMO D-SNP)–H7123-001

Service Area: Bucks, Chester, Delaware, Montgomery, and Philadelphia counties

Plan Highlights

2024

2025

Plan PremiumMedical CopaysPart D CopaysMaximum Out-of-PocketDental AllowanceVision AllowanceHearing Aids

$0 per month$0 copays$0 copays$8,850 per year$4,000 per year$575 per year$0 copay per ear every three years20 one-way trips per year/8 can be used for nonmedical locations within 30 miles$0 for one home safety visit per year; $0 for six home safety products per year$400 per quarter for OTC, healthy foods, household/pet care supplies, and pest

$0 per month–NO CHANGE$0 copays–NO CHANGE$0 copays for all covered prescriptions–NO CHANGE$8,850 per year–NO CHANGE$4,000 per year–NO CHANGE$575 per year–NO CHANGE$0 copay per ear every three years–NO CHANGE20 one-way trips per year/8 can be used for nonmedical $0 for one home safety visit per year–NO CHANGE;$0 for six home safety products per year–NO CHANGE$133 per month (no rollover) for OTC and healthy food;$34 per month (no rollover) for utilities–changed to monthly; removed pet supplies, household items, and One health and wellness kit every six months–NO

Transportation

locations–NO CHANGE

Home Safety

Shop Healthy Card

control;$100 per quarter for utilities

pest controlCHANGE

One health and wellness kit every six

Health and Wellness Kit

months

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Plan documents

and marketing

107

Member plan documents

Here are some of the documents our members will be mailed during AEP.

Annual Notice of Changes (ANOC)

••

Mailing Sept. 12-23 to arrive by Sept. 30.Members who requested an electronic copy will be emailed the link to their

electronic ANOC on Sept. 15.

Low Income Subsidy (LIS)

•••

Mailing Sept. 12-23 to arrive by Sept. 30.CMS does not require D-SNP members that have $0 cost sharing for all

Part D drugs to receive an LIS rider.Members who requested an electronic copy will be emailed the link to their

electronic LIS on Sept. 15.

Summary of Benefits

•••

Only available upon request for members; ready to mail Oct. 1.Available on the UPMC for Life public website by Oct. 15.Included in the enrollment kit for prospective members.

Evidence of Coverage, prescription formulary, and provider directory

Hard copies will be mailed to members who previously requested a hard copy.

••

Documents will be mailed Oct. 8 to arrive by Oct. 15.Members who requested an electronic copy will be emailed the link to our secure member site to see their electronic documents on Oct. 15.

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Documents on Converge

To order materials on Converge, go to https://upmcmemberservices.klicorders.com/login.aspx.

The following documents can be found and requested on Converge:

•••

Annual Notice of ChangesEvidence of CoverageSummary of Benefits

Print-on-demand (POD) formsPlan change formPrescription reimbursement formOut-of-network claim formFlu shot reimbursement formID card holderPharmacy directory

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Prescription drug formulary

•••••

Enrollment kitOver-the-counter catalogPlan comparisonWelcome kitMember calendar

PA advance directives

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Member Rights and ResponsibilitiesDental out-of-network claim formBlood pressure log

Bathroom safety catalog

Vision claim form

If you are new to Converge or have a question about how to request materials, please review the quick reference guide under the Questions? header

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Marketing Storefront

To order materials on the Marketing Storefront (formally Converge), go to upmchp.klicorders.com.

The following documents can be found and ordered on the Marketing Storefront:

••••

Enrollment kitSummary of BenefitsSales Seminar PowerPoint kitMember Retention PowerPoint kit(UPMC staff only)D-SNP PowerPoint

Personalized marketing materials

Veterans

oooSales collateral–Internal users only. Broker agents can request from broker manager:

5-starD-SNPGeneral Medicare and D-SNP

•••

Lead sheetsMember meeting evaluation(UPMC staff only)Prescription drug formularyOver-the-counter catalogPlan comparisonExtra benefits fliers Spanish materialsIf you are new to Converge or have a question about how to request materials, please review the

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SignageMember benefit and programs booklets

•••••

Greeting cards

PDF user guide on the left side of the page.

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Find materials online

Here’s where to find important plan documents and materials online.

These plan documents can be found on the SHOP page

Scan these codes with your smartphone:

of our public website:Annual Notice of ChangesSummary of BenefitsEvidence of CoverageStar ratingsPrescription drug formularyProvider directory

••••••

SHOP page:

To view a plan document, go to https://www.upmchealthplan.com/medicare/shop/.Click Yes for Are you a current UPMC for Life member.

Documents

and forms:

Enter the member or prospect ZIP code.

••

Find your plan then click View Plan Details.Scroll down and click the link for the document.

Other plan documents are still located on the Documents and forms tab.

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Thank You

Y0069_251024_C

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