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UPMC Health Plan Commercial Plans

UPMC Health Plan Behavioral Health Services manages the behavioral health benefits for members of UPMC Health Plan HMO Plans; UPMC Health Plan POS Plans; UPMC Health Plan PPO Plans and UPMC Health Plan EPO Plans and is designed to serve the behavioral health needs of UPMC Health Plan members and their families. UPMC Health Plan Behavioral Health Services accomplishes this through effective and accessible behavioral health services. As a member of UPMC Health Plan, you are served by behavioral health providers of the UPMC Health Plan Behavioral Health Services Commercial Network. UPMC Health Plan Behavioral Health Services is committed to providing high quality services to our members. Many nationally recognized hospitals and facilities are integral parts of our comprehensive network that are available to you, the member. You will be using the services of UPMC Health Plan Behavioral Health Services when you need information about or want to seek care for behavioral health services. Behavioral health services include treatment for:

• A mental health condition
• An alcohol problem
• A drug problem

Information and Assistance

We can help with:

• Questions about your behavioral health benefits
• Planning your behavioral health treatment services
• Specialized referrals for your unique problems/concern

Commercial Benefit Plans

Commercial benefit plans for employer groups with two or more employees include Enhanced Access Health Maintenance Organization (EAHMO), Enhanced Access Point of Service (EAPOS), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) options.

Enhanced Access HMO (EAHMO)

• Behavioral health treatment which is medically necessary and managed through UPMC Health Plan Behavioral Health Services is covered at 100%, after co-payment, when received from network providers.

Enhanced Access Point of Service (EAPOS)

• Behavioral health treatment which is medically necessary and managed through UPMC Health Plan Behavioral Health Services, is covered at 100%, after co-payment, when received from network providers.
• Behavioral health treatment which is medically necessary and managed through UPMC Health Plan Behavioral Health Services, is covered at a lower rate, subject to deductibles and coinsurance, when received from out of network providers.

Exclusive Provider Organization (EPO)

• Behavioral health treatment which is medically necessary and managed through UPMC Health Plan Behavioral Health Services, is covered at 100%, after co-payment, when received from network providers.

Preferred Provider Organization (PPO)

• In-network care: You are covered at UPMC Health Plan's highest benefit level.
• Out-of-network care: When you visit a non-participating provider or facility for care, it is considered out-of-network care. You are responsible for the difference between the provider's charges and the Plan's payment (reasonable and customary amount).

Please note: Your benefit plan may not cover all your behavioral health care expenses. Co-payments, benefit limits, and other limitations may apply to the above mentioned benefits. Self-directed preventive care and out-of-network preventive care are not covered, except for state-mandated services. Read your contract carefully to determine which health care services are covered. You may also call UPMC Health Plan Behavioral Health Services Member Services at 1-888-251-0083 (TTY 1-877-877-3580) if you have questions about your behavioral health benefits.