doc2016 UPMC Advantage Network Guide
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2016 UPMC Advantage Network Guide
2016 UPMC Advantage Network Guide 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 Allegheny, Bedford, Blair, and Erie 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 Allegheny, Beaver, Butler, Washington, and Westmoreland counties and feature select providers within those counties, including Grove City Medical Center located in Mercer 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. 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 www.upmchealthplan.com/coverage. To access the federal Health Insurance Marketplace, please visit www.healthcare.gov. 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 www.upmchealthplan.com/find 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. UPMC Partner Network Only residents of Allegheny, Bedford, Blair, and Erie 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 Allegheny, Bedford, Blair, and Erie counties. Erie Warren McKean Tioga Potter Crawford Bradford Wayne Forest Elk Venango Mercer Lawrence Clarion Butler Clinton Allegheny Greene Fayette Somerset Bedford Plan offered to individuals living in these counties Fulton Franklin Columbia Montour Monroe Carbon Northumberland Snyder Schuylkill Perry Huntingdon Washington Union Mifflin Juniata Blair Westmoreland Pike Luzerne Centre Indiana Cambria Wyoming Lackawanna Lycoming Jefferson Armstrong Beaver Sullivan Cameron Clearfield Susquehanna Dauphin Lebanon Lehigh Berks Bucks Montgomery Cumberland Adams Northampton Lancaster York Chester Philadelphia Delaware Access to care from UPMC-owned facilities and providers located in these counties This information is subject to change. For the most up-to-date information, visit www.upmchealthplan.com/find. In-network hospitals* Allegheny 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 Bedford UPMC Bedford Memorial Blair UPMC Altoona Butler UPMC Passavant – Cranberry Erie Corry Memorial Hospital UPMC Hamot McKean Kane Community Hospital Mercer UPMC Horizon – Greenville UPMC Horizon – Shenango Valley Venango UPMC Northwest UPMC Select Network Only residents of Allegheny, Beaver, Butler, Washington, or Westmoreland 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. Erie Warren McKean Tioga Potter Crawford Bradford Wayne Forest Elk Venango Mercer Lawrence Clarion Butler Jefferson Allegheny Greene Fayette Somerset Plan offered to individuals living g in these counties Bedford Fulton Franklin Columbia Montour Monroe Carbon Northumberland Snyder Schuylkill Perry Huntingdon Washington Union Mifflin Juniata Blair Westmoreland Pike Luzerne Centre Indiana Cambria Wyoming Lackawanna Lycoming Clinton Armstrong Beaver Sullivan Cameron Clearfield Susquehanna Dauphin Berks Bucks Montgomery Cumberland Adams Lebanon Northampton Lehigh Lancaster York Chester Philadelphia Delaware Access to care from UPMC-owned facilities and providers located in these counties This information is subject to change. For the most up-to-date information, visit www.upmchealthplan.com/find. In-network hospitals* Allegheny 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 Beaver Heritage Valley Health System – Heritage Valley Beaver Bedford UPMC Bedford Memorial Venango UPMC Northwest Blair UPMC Altoona Washington Monongahela Valley Hospital Washington Hospital Butler Butler Memorial Hospital UPMC Passavant – Cranberry Campus Erie UPMC Hamot McKean Kane Community Hospital Mercer Grove City Medical Center UPMC Horizon – Greenville UPMC Horizon – Shenango Westmoreland Excela Health Frick Hospital Excela Health Latrobe Hospital Excela Health Westmoreland Hospital 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. Erie Warren McKean Tioga Potter Crawford Bradford Wayne Forest Elk Venango Mercer Lawrence Clarion Butler Jefferson Allegheny Greene Fayette Somerset Bedford Fulton Franklin Columbia Montour Monroe Carbon Northumberland Snyder Schuylkill Perry Huntingdon Washington Union Mifflin Juniata Blair Westmoreland Pike Luzerne Centre Indiana Cambria Wyoming Lackawanna Lycoming Clinton Armstrong Beaver Sullivan Cameron Clearfield Susquehanna Dauphin Lehigh Berks Bucks Montgomery Cumberland Adams Lebanon Northampton Lancaster York Chester Philadelphia Delaware 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 www.upmchealthplan.com/find. In-network hospitals* Western Pennsylvania Allegheny 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 Beaver Heritage Valley Health System – Heritage Valley Beaver Bedford UPMC Bedford Memorial Blair Nason Hospital Tyrone Hospital UPMC Altoona Butler Butler 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 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 Clearfield Penn Highlands Clearfield Penn Highlands DuBois Mercer Grove City Medical Center UPMC Horizon – Greenville UPMC Horizon – Shenango Valley Crawford Meadville Medical Center Titusville Area Hospital Potter Cole Memorial Elk Penn Highlands Elk – St. Mary’s Campus Erie Corry Memorial Hospital Millcreek Community Hospital Saint Vincent Hospital Select Specialty Hospital – Erie UPMC Hamot Fayette Highlands Hospital Uniontown Hospital Greene Southwest Regional Medical Center Somerset Conemaugh Meyersdale Medical Center Somerset Hospital Windber Medical Center Venango UPMC Northwest Warren Warren General Hospital Washington Monongahela Valley Hospital Washington Hospital Westmoreland Excela Frick Hospital Excela Latrobe Hospital Excela Westmoreland 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 U.S. Steel Tower, 600 Grant Street Pittsburgh, PA 15219 www.upmchealthplan.com/coverage Copyright 2015 UPMC Health Plan Inc. All rights reserved. IND NETWORK GUIDE 15PI0108 (CHEM) 9/28/15 20M KP
