2016 UPMC Advantage Network Guide

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1 2016 UPMC Advantage Network Guide

2 Selecting the right health insurance plan is important. And selecting a plan also means that you are choosing a network. The network refers to the specific hospitals, facilities, physicians, and other providers participating with the plan. Understanding the network is important so you know where you can go when you need health care. UPMC Health Plan offers three different provider networks. All of our networks offer full in-network access to UPMC doctors and hospitals as well as many local community doctors and hospitals. Here is a brief description of each network: UPMC Partner Network (EPO) The Partner plans were created for residents of,, Blair, and counties and feature providers within those counties. All UPMC owned hospitals plus Kane Community Hospital and Corry Memorial Hospital are included in the network, along with a robust list of physicians and specialists to cover all of your health care needs. An Exclusive Provider Organization (EPO) enables you to seek care within the network. Medical services are not covered outside the network, except for emergency care. UPMC Select Network (EPO) The Select plans were created for residents of,,,, and counties and feature select providers within those counties, including Grove City Medical Center located in county. All UPMC owned and most community hospitals within the five-county service area are included in the network. This plan is also an Exclusive Provider Organization (EPO), which enables you to seek care within the network. Medical services are not covered outside the network, except for emergency care. UPMC Premium Network (PPO) The UPMC Premium Network is UPMC Health Plan s broadest network. The Premium plans were created for residents of western Pennsylvania who want the option to seek care in and out of network. A Preferred Provider Organization (PPO) plan gives you the flexibility to go outside of the network for care at a greater share of the cost. Emergency care is covered outside the network with the same copayment as in the network. To get the full list of the hospitals included in each network, turn to the appropriate pages of this guide. Remember, if you need emergency care, your care will be covered no matter which emergency department you go to. You also have coverage when traveling 100 miles or more away from home for business or for pleasure. UPMC Health Plan coverage gives you access to Assist America the Health Plan s global emergency assistance partner. If an emergency comes up, Assist America provides immediate access to doctors, hospitals, pharmacies, and other services. The service is available 24 hours a day, 365 days a year. Finding a participating doctor or facility To see if your provider is part of the network, use the online provider directory that includes hospital affiliations for each participating doctor. You can search for specific providers by following these steps: 1. Visit 2. Select your type of care. 3. Type your current provider s last name or search by ZIP code. 4. Select the UPMC Health Plan option you are thinking about purchasing. 5. If desired, filter by specialty, language, or gender. 6. Click the Find Providers Now button. The UPMC Health Plan Marketplace is a shopping site only for UPMC Health Plan products and is not the federal Health Insurance Marketplace. To access, please log in to To access the federal Health Insurance Marketplace, please visit

3 UPMC Partner Network Only residents of,, Blair, and counties are able to purchase this plan. You will have in-network access to all UPMC-owned facilities and providers within the 28-county service area and other select facilities within,, Blair, and counties. Warren McKean Susquehanna Tioga Bradford Potter Crawford Wayne Forest Wyoming Elk Cameron Sullivan Lackawanna Lycoming Pike Clarion Clinton Jefferson Luzerne Lawrence Columbia Monroe Clearfield Union Montour Centre Carbon Armstrong Northumberland Snyder Northampton Schuylkill Indiana Mifflin Lehigh Juniata Cambria Blair Perry Dauphin Berks Lebanon Bucks Huntingdon Montgomery Cumberland Lancaster Somerset Chester Philadelphia Fayette Fulton Franklin York Delaware Greene Adams Plan offered to individuals living in these counties This information is subject to change. For the most up-to-date information, visit Access to care from UPMC-owned facilities and providers located in these counties In-network hospitals* Children s Hospital of Pittsburgh of UPMC Eye & Ear Institute Magee-Womens Hospital of UPMC UPMC East UPMC McKeesport UPMC Mercy UPMC Montefiore UPMC Passavant McCandless UPMC Presbyterian UPMC St. Margaret UPMC Shadyside Western Psychiatric Institute and Clinic of UPMC UPMC Memorial Blair UPMC Altoona UPMC Passavant Cranberry Corry Memorial Hospital UPMC Hamot McKean Kane Community Hospital UPMC Horizon Greenville UPMC Horizon Shenango Valley UPMC Northwest

4 UPMC Select Network Only residents of,,,, or county are able to purchase this plan. You will be covered for services when you seek care from participating providers within the UPMC Select Network. These include all UPMC-owned facilities and providers in addition to other select facilities. Warren McKean Susquehanna Tioga Bradford Potter Crawford Wayne Forest Wyoming Elk Cameron Sullivan Lackawanna Lycoming Pike Clarion Clinton Jefferson Luzerne Lawrence Columbia Monroe Clearfield Union Montour Centre Carbon Armstrong Northumberland Snyder Northampton Schuylkill Indiana Mifflin Lehigh Juniata Cambria Blair Perry Dauphin Berks Lebanon Bucks Huntingdon Montgomery Cumberland Lancaster Somerset Chester Philadelphia Fayette Fulton Franklin Yor ork Delaware Greene Adams Plan offered to individuals living in these counties This information is subject to change. For the most up-to-date information, visit Access to care from UPMC-owned facilities and providers located in these counties

5 In-network hospitals* Children s Hospital of Pittsburgh of UPMC Eye & Ear Institute Heritage Valley Health System - Heritage Valley Sewickley Magee-Womens Hospital of UPMC UPMC East UPMC McKeesport UPMC Mercy UPMC Montefiore UPMC Passavant - McCandless Campus UPMC Presbyterian UPMC Shadyside UPMC St. Margaret Western Psychiatric Institute and Clinic of UPMC Heritage Valley Health System Heritage Valley UPMC Memorial Blair UPMC Altoona Memorial Hospital UPMC Passavant Cranberry Campus UPMC Hamot McKean Kane Community Hospital Grove City Medical Center UPMC Horizon Greenville UPMC Horizon Shenango UPMC Northwest Monongahela Valley Hospital Hospital Excela Health Frick Hospital Excela Health Latrobe Hospital Excela Health Hospital

6 UPMC Premium Network Only residents of the 29 counties in our service area are able to purchase this plan. You will be covered for services when you seek care from participating providers within the UPMC Premium Network. These include all UPMC-owned facilities and providers in addition to other network facilities. Warren McKean Susquehanna Tioga Bradford Potter Crawford Wayne Forest Wyoming Elk Cameron Sullivan Lackawanna Lycoming Pike Clarion Clinton Jefferson Luzerne Lawrence Columbia Monroe Clearfield Union Montour Centre Carbon Armstrong Northumberland Snyder Northampton Schuylkill Indiana Mifflin Lehigh Juniata Cambria Blair Perry Dauphin Berks Lebanon Bucks Huntingdon Montgomery Cumberland Lancaster Somerset Chester Philadelphia Fayette Fulton Franklin York Delaware Greene Adams Access to care from doctors and hospitals located in these counties This information is subject to change. For the most up-to-date information, visit In-network hospitals* Western Pennsylvania Children s Hospital of Pittsburgh of UPMC Eye & Ear Institute Heritage Valley Health System Heritage Valley Sewickley Jefferson Hospital Kindred Hospital Pittsburgh Kindred Hospital Pittsburgh North Shore LifeCare Hospitals of Pittsburgh Main LifeCare Hospitals of Pittsburgh Suburban Magee-Womens Hospital of UPMC Ohio Valley Hospital Select Specialty Hospital McKeesport Select Specialty Hospital Pittsburgh St. Clair Hospital The Children s Home of Pittsburgh The Children s Institute UPMC East UPMC McKeesport UPMC Mercy UPMC Montefiore UPMC Passavant McCandless UPMC Presbyterian UPMC St. Margaret UPMC Shadyside Western Psychiatric Institute and Clinic of UPMC Armstrong Armstrong County Memorial Hospital Heritage Valley Health System Heritage Valley UPMC Memorial Blair Nason Hospital Tyrone Hospital UPMC Altoona

7 Memorial Hospital UPMC Passavant Cranberry Cambria Conemaugh Miners Medical Center Conemaugh Memorial Medical Center Lee Campus of Conemaugh Memorial Medical Center Select Specialty Hospital Johnstown Centre Mount Nittany Medical Center Clarion Clarion Hospital Clearfield Penn Highlands Clearfield Penn Highlands DuBois Crawford Meadville Medical Center Titusville Area Hospital Elk Penn Highlands Elk St. Mary s Campus Corry Memorial Hospital Millcreek Community Hospital Saint Vincent Hospital Select Specialty Hospital UPMC Hamot Fayette Highlands Hospital Uniontown Hospital Greene Southwest Regional Medical Center Huntingdon J.C. Blair Memorial Hospital Indiana Indiana Regional Medical Center Jefferson Penn Highlands Brookville Punxsutawney Area Hospital Lawrence Ellwood City Hospital Jameson Hospital North Campus Jameson Hospital South Campus McKean Bradford Regional Medical Center Kane Community Hospital Grove City Medical Center UPMC Horizon Greenville UPMC Horizon Shenango Valley Potter Cole Memorial Somerset Conemaugh Meyersdale Medical Center Somerset Hospital Windber Medical Center UPMC Northwest Warren Warren General Hospital Monongahela Valley Hospital Hospital Excela Frick Hospital Excela Latrobe Hospital Excela Hospital Select Specialty Hospital Laurel Highlands Maryland Western Maryland Regional Medical Center New York Olean General Hospital West Virginia Mon General Hospital Ohio Valley Medical Center Reynolds Memorial Hospital Sistersville General Hospital Weirton Medical Center Wetzel County Hospital Wheeling Hospital

8 U.S. Steel Tower, 600 Grant Street Pittsburgh, PA Copyright 2015 UPMC Health Plan Inc. All rights reserved. IND NETWORK GUIDE 15PI0108 (CHEM) 9/28/15 20M KP

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