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Commercial Products

Commercial UPMC Health Plan Products are available through Group Enrollment only. If you wish to become a member, ask your employer or Human Resources Manager to provide UPMC Health Plan coverage for your group. The descriptions are for standard products and plan designs. Some employer groups may choose to offer non-standard plan designs.
Call ABI Agency at 724.864.3677
or Email ABI Agency for more information.

Point of Service (POS)

The Point-of-Service (POS) plan delivers coordinated care through the UPMC Health Plan network of doctors and hospitals. It also gives members the option at the point they obtain service to receive self-referred care from providers inside and outside of the network. Not only does the POS provide you with a wide range of features, it also delivers the flexibility needed to ensure the delivery of high-quality health care services.

When care is coordinated by your primary care physician (PCP):

• Benefits are paid at the highest level (specialist visits must be by referral from your PCP to be covered at this level)
• There are no deductibles, no paperwork, no annual or lifetime maximums, and low out-of-pocket costs.
• Low copayments (if applicable) for PCP and specialist office visits

When care is self-referred (in or out of the network):

• Only some preventive care services are covered.
• The member fills out claim forms for some services.
• The member is responsible for an annual deductible.
• The member pays a percentage of the charges after the deductible is met.
• The member pays the difference (if there is one) between the provider's charges and the Plan's payment (reasonable and customary amount).
• Benefits are subject to a lifetime maximum.
• Once you reach the annual out-of-pocket maximum, benefits are covered in full up to the reasonable and customary amount

Some of the key features of the POS plan are:

• Physician office visits

• Diagnostic services covered at 100% when performed at our network facilities and referred by your PCP, OB/GYN, or a network specialist

• Behavioral health treatment, provided through Western Behavioral HealthCare Network, is covered at 100% when received from network providers (copayment and visit limitations may apply)

• Hospital services, such as inpatient admissions, outpatient surgeries, pre-admission testing, surgeon fees, hospital provider visits, and skilled nursing facility and hospice care are covered at 100% when referred by your PCP, OB/GYN, or a network specialist (you must pre-notify before all inpatient admissions and some outpatient surgeries unless you self-refer to a UPMC Health Plan facility; if you do not pre-notify, you will be charged a penalty per incident)

• Emergency care, such as life-threatening emergency care, is covered at 100% when you contact your PCP or UPMC Health Plan Member Services (copayment may apply)

• Maternity, including provider, hospital or birthing center care, and nursing charges (prenatal, delivery, and postpartum care)
  Prescription drug coverage through our Pharmacy Network or our mail-order program

• Podiatrist and chiropractic services are covered at 100% (copayment may apply)

If you would like more information on how UPMC Health Plan can help increase the quality of your health care,
call ABI Agency at 724.864.3677,
or email ABI Agency for more information.


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Enhanced Access POS (EAPOS)

The Enhanced Access Point-of-Service (EAPOS) plan delivers coordinated care through the UPMC Health Plan network of doctors and hospitals. It also gives members the option at the point they obtain service to receive self-referred care from providers inside and outside of the network. Not only does the EAPOS provide you with a wide range of features, it also delivers the flexibility needed to ensure the delivery of high-quality health care services.

When care is coordinated by your primary care physician (PCP); or care is self referred in the network:

• Benefits are paid at the highest level (specialist visits must be by referral from your PCP to be covered at this level)
• There are no deductibles, no paperwork, no annual or lifetime maximums, and low out-of-pocket costs.
• Low copayments (if applicable) for PCP and specialist office visits

When care is self-referred (out of the network):

• Only some preventive care services are covered, after coinsurance.
• The member fills out claim forms for some services.
• The member is responsible for an annual deductible.
• The member pays a percentage of the charges after the deductible is met.
• The member pays the difference (if there is one) between the provider's charges and the Plan's payment (reasonable and customary amount).
• Benefits are subject to a lifetime maximum.
• Once you reach the annual out-of-pocket maximum, benefits are covered in full up to the reasonable and customary amount.

Some of the key features of the EAPOS plan are:

• Preventive care, such as regular physical examinations, well-baby visits, annual Pap tests and gynecological exams, mammograms, and immunizations (age restrictions and limitations may apply; self-referred and out-of-network preventive care services are not covered, except for state-mandated services)
• Physician office visits
• Diagnostic services covered at 100% when performed at our network facilities and referred by your PCP, OB/GYN, or a network specialist
• Behavioral health treatment, provided through Western Behavioral HealthCare Network, is covered at 100% when received from network providers (copayment and visit limitations may apply)
• Hospital services, such as inpatient admissions, outpatient surgeries, pre-admission testing, surgeon fees, hospital provider visits, and skilled nursing facility and hospice care are covered at 100% when referred by your PCP, OB/GYN, or a network specialist (you must pre-notify before all inpatient admissions and some outpatient surgeries unless you self-refer to a UPMC Health Plan facility; if you do not pre-notify, you will be charged a penalty per incident)
• Emergency care, such as life-threatening emergency care, is covered at 100% when you contact your PCP or UPMC Health Plan Member Services (copayment may apply)
• Maternity, including provider, hospital or birthing center care, and nursing charges (prenatal, delivery, and postpartum care)
• Prescription drug coverage through our Pharmacy Network or our mail-order program
• Podiatrist and chiropractic services are covered at 100% (copayment may apply)

If you would like more information on how UPMC Health Plan can help increase the quality of your health care,
call ABI Agency at 724.864.3677,
or email ABI Agency for more information.



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Preferred Provider Organization (PPO)

In-Network Care

• When a member visits a participating provider for care, it is considered in-network care.
• The member is reimbursed at UPMC Health Benefits highest benefit level (physician visits through a participating provider are covered at this level).
• There are no deductibles, no paperwork, and low out-of-pocket costs.
• Low copayments for physician office visits.

Out-of-Network Care

• When a member visits a non-participating provider for care, it is considered out-of-network care.
• The member pays an annual deductible.
• The member pays a percentage of the charge after they meet their deductible.
• The member is responsible for the difference between the provider's charge and the plan's payment.
• Once an annual out-of-pocket maximum is reached, benefits are covered at the in-network care level.
• Benefits are subject to a lifetime maximum.

Northern PPO Products

• Vantage

If you would like more information on how UPMC Health Plan can help increase the quality of your health care,
call ABI Agency at 724.864.3677,
or email ABI Agency for more information.









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