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UPMC FIRST CARE


FOCUS ON YOUR CARE, NOT YOUR COPAY

 1. 
    Individuals & Family
    
 2. Plans and Services
    
 3. UPMC First Care Plan

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UPMC First Care™ is an innovative plan that helps you put your health first. It
offers a $0 copay for a variety of visits, making it easy and affordable for you
to get the care you need.

Cost savings

 * $0 copay for first in-person primary care and specialist visits
 * $0 copay for first virtual primary care and specialist visits
 * $0 copay for all behavioral health office visits
 * $0 copay for all urgent care visits using UPMC AnywhereCare1

Choice

 * Access to convenient, low-cost care virtually or in person
 * 24/7 access to care through UPMC AnywhereCare

Experience

 * $0 copay automatically applied for qualifying visits—no need for a payment
   card to access benefits
 * Digital resources to help you manage your plan, including a member website,
   app, and health and wellness discounts


FREQUENTLY ASKED QUESTIONS

Which services have a $0 copay with UPMC First Care?

The following services are covered with no copayment:

 * First in-person primary care visit
 * First virtual primary care visit
 * First in-person specialist visit
 * First virtual specialist visit
 * All behavioral health office visits (in person or virtual)
 * All urgent care visits via UPMC AnywhereCare

Many annual preventive services are covered at 100 percent2.

Is this plan available only to new UPMC Health Plan members?

No. UPMC First Care is available to anyone who purchases or renews an individual
or family plan through Pennie® or the UPMC Health Plan Marketplace. The $0 first
copay benefit will restart every plan year that you have this plan.

Is this plan only for virtual medical visits?

No, you can use UPMC First Care to have virtual or in-person visits.

Can this only be used for one member of a household?

No, $0 copay benefits are included for each individual on the plan.

Will I received $0 copays each plan year?

Yes. The $0 first copays are annual and will restart with every plan year that
you have this plan.

Is there anything I need to do to receive the $0 copays?

No. The $0 copay is automatically credited to the first claim UPMC Health Plan
receives for qualifying visits.

Are virtual and in-person behavioral health services covered?

Yes. You’ll have $0 copays for all in-person and virtual behavioral health
office visits.

Purchase UPMC First Care coverage

We’re here to help!

Call, click, or visit.

Call 1–877-563-0292 (TTY: 711).

Call your agent.

Enroll online at upmchealthplan.com/marketplace.

Visit one of our UPMC Health Plan Connect Centers. Call 1-855-306-8834 (TTY:
711) to find the location nearest you.

1 UPMC Health Plan members who are in Pennsylvania at the time of a virtual
visit may select a UPMC-employed provider, subject to availability and
discretion of the provider. Members located outside of Pennsylvania at the time
of service will receive care from a provider employed or contracted by Online
Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an
affiliate of UPMC. Limitations may apply for members of ASO plans that have
opted out of coverage. Providers are not available to treat members who are in
Puerto Rico. This health insurance policy may not cover all of your health care
expenses. Read your contract or member handbook carefully to determine which
health care services are covered. For more information, contact your producer or
account manager or call 1-833-825-2696 (TTY: 711).

2 Preventive care will covered at 100 percent only when it is received from
participating provider and it is billed as preventive. A separate cost share may
apply if additional medical services are received during the same visit or if
your preventive care appointment becomes diagnostic in nature.

 
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