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Deductibles for the UPMC HMO Plan
The UPMC plan includes deductibles for certain types* of medical services, per the chart below. This chart assumes services are obtained at providers in the UPMC HMO network. Please note that the plan does not provide coverage for out-of-network services.
 
UPMC Plan Feature
What you will pay…
Deductible
$400 per person, up to a maximum of $800 per family
* Deductibles do not apply to preventive care or to services for which a copay applies.
 
Definition of Plan Terms
Deductible–The amount you will pay for the applicable health care services before the health plan begins to pay.
Copay–A fixed, upfront dollar amount that you pay each time you receive certain health care services (such as an office visit or a prescription). The deductible does not apply to services subject to a copay.
Preventive Care
There are no member costs for preventive care – the plan pays 100% of the costs for qualifying preventive services. By following the recommendations in the preventive schedule, you may be able to either prevent certain medical conditions, or detect them before they become more serious.  
 
If your medical provider orders diagnostic tests/screenings that are not covered on the preventive schedule, those services may be subject to additional costs (e.g. Deductible)
 
The deductible only applies to certain types of health care expenses:
Here are some areas where the deductible does not apply.
Here are some common medical services where the deductible will apply.
Preventive Care
Preventive services (such as annual physicals, well-baby visits,
immunizations and mammograms) are covered at 100% by the health
plan; there is no member cost associated with these services.
 
Services to which a copay applies*–
If a copay applies to the service you are obtaining, then that service is
not subject to the deductible. This includes primary care and
specialist office visits, emergency room visits, and prescription drugs.
For these services, your cost is the associated member copay
amount.
 
*Your provider may charge you a facility fee, clinic charge or similar fee (in addition to any copays) if your office visit or service is provided at a location that qualifies as a hospital department or a satellite building of a hospital.
 
·      Diagnostic/Imaging Services (e.g., x-ray, MRI, nonpreventive lab/pathology).
·      Inpatient and outpatient surgery.
·      Hospitalization.
·      Durable medical equipment.
·      Chemotherapy, dialysis and infusion therapy.
·      Home health care, skilled nursing facility care and hospice care.
 
Not a comprehensive list of services, click here for more details.