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Plan Profile

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You are here: FEHB Home > 2002 Plan Comparison > Pennsylvania > Plan Profile: UPMC Health Plan

General Information
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Plan Name: UPMC Health Plan
Service Area: Pittsburgh Area
Brochure: PDF Version
Brochure: Text Version
NCQA Accreditation: No
JCAHO Accreditation: No
URAC Accreditation: No
Plan Type: HMO
Enrollment Code-Self: 8W1
Enrollment Code-Self & Family: 8W2
Link to Plan Home Page: http://www.upmchealthplan.com
Telephone: 888/876-2756
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Benefits
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Doctor Care/ Primary Office Visits: $10
Hospital Inpatient Room and Board Charges: None
RX/ Generic/ Retail: $5
RX/ Brand/ Retail: $15
RX/ Brand/ NonFormulary: $15
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Rates
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Non-Postal
___Biweekly Self: $23.38 Self: & Family: $59.64
___Monthly Self: $50.66 Self: & Family: $129.22
___Twice Biweekly Self: $46.76 Self: & Family: $119.28
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Annuitants
___Monthly Self: $50.66 Self: & Family: $129.22
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U.S. Postal Service Employees (Type A)
___Monthly Self: $22.80 Self: & Family: $58.15
___Biweekly Self: $10.52 Self: & Family: $26.84
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U.S. Postal Service Employees (Type B)
___Monthly Self: $22.80 Self: & Family: $58.15
___Biweekly Self: $10.52 Self: & Family: $26.84
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Worker's Compensation Recipients
___Twice Biweekly Self: $46.76 Self: & Family: $119.28
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Certain Temporary Employees
___Monthly Self: $202.63 Self: & Family: $516.88
___Biweekly Self: $93.52 Self: & Family: $238.56
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Former Spouse Enrollees
___Monthly Self: $202.63 Self: & Family: $516.88
___Biweekly Self: $93.52 Self: & Family: $238.56
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Temporary Continuation of Coverage
___Monthly Self: $206.68 Self: & Family: $527.22
___Biweekly Self: $95.39 Self: & Family: $243.33
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FDIC
___Biweekly Self: $10.52 Self: & Family: $26.84
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