About UPMC

UPMC Insurance Services Division Fast Facts

Western Pennsylvania is the proving ground for a new model of health insurance — a model in which the insurer serves as the front door to a wealth of renowned clinical services and delivers on the promise of using data to achieve better quality and lower costs. The UPMC Insurance Services Division is leading the way with innovative health plans for virtually all segments of society.

In just over a decade, Insurance Services has grown from about 300,000 to nearly 1.6 million members. The division provides health plans to employers and their employees and dependents, as well as to people eligible for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

Insurance Services also offers workers’ compensation, disability management, and leave management services, as well as some of the most comprehensive health improvement, wellness, and workplace productivity programs anywhere in the United States. Insurance Services also is the largest behavioral health insurance provider in Pennsylvania and operates two software development companies focused on helping health care providers and employers provide efficient health care and employee benefits.

Commercial Insurance Products — Founded in 1998 on the premise that providers armed with complete data and evidence-based guidelines could produce the best clinical outcomes, the Insurance Services Division’s UPMC Health Plan has become one of the most innovative insurance plans in the nation. UPMC Health Plan offers traditional HMOs, PPOs, and EPOs, as well as consumer-directed health plans, along with Health Savings Accounts and Health reimbursement Arrangements. In addition, UPMC Health Plan offers an individual plan, UPMC Individual Advantage, and provides dental coverage through its UPMC Dental Advantage plan. 

UPMC Health Plan works with the region’s employers and providers to develop better ways to deliver health care. The Health Plan has designed programs and tools to help consumers manage their health on a day-to-day basis and has created programs for patients with chronic conditions such as congestive heart failure, asthma, and diabetes. 

UPMC Health Plan was ranked in 2011 as the best in customer service in Pennsylvania by J.D. Power and Associates.

Worker Productivity and Health — Through UPMC WorkPartners, Insurance Services offers employers integrated productivity management programs, helping employers manage workers’ compensation, disability, and medical leave programs, including comprehensive health and wellness services. UPMC was recognized by the National Business Group on Health for the third consecutive year as one of America’s healthtiest places to work, thanks to the MyHealth program, an award-winning health and wellness program.

Employer Data Integration — Through EBenefits, Insurance Services offers the most sophisticated tools for integrating health plan and worker productivity data to assist employers in managing recordkeeping and improving productivity and efficiency. The bottom line is significant savings to employers. EBenefits is an Internet-based human resources and benefits administration platform serving clients throughout the United States.

Employee Assistance Program — LifeSolutions has been providing EAP services to address the emotional and physical concerns of employees — and positively impacting organizational productivity — for more than 30 years. By addressing these employee needs, LifeSolutions decreases absenteeism and reduces the impact of presenteeism. Confidential services include personal counseling and coaching, chemical dependency triage, disability and leave management support programs, and access to work-life balance resources.

Medicare Advantage Plans — Insurance Services provides coverage to Medicare beneficiaries through its UPMC for Life program, which offers benefits beyond those of traditional Medicare at affordable rates. UPMC for Life experienced extraordinary growth in 2010, with a nearly 12 percent increase in membership.

Medical Assistance — UPMC for You offers physical health care benefits to Medicaid recipients in western Pennsylvania as well as in the Lehigh-Capital region of the state. Recognized as a model program, UPMC for You was ranked in the top 10 of all Medicaid programs in the United States in 2011 and was the top-ranked Medicaid plan in Pennsylvania for the seventh time in eight years, according to the National Committee for Quality Assurance (NCQA).

Children’s Health Insurance Program (CHIP) — UPMC for Kids offers affordable plans to children in western Pennsylvania, no matter what their family’s income level. UPMC for Kids is one of the fastest growing CHIP programs in Pennsylvania.

Behavioral Health — Community Care Behavioral Health Organization (Community Care), part of the UPMC Insurance Services Division, is a nonprofit, recovery-focused, federally tax-exempt behavioral health managed care organization headquartered in Pittsburgh. Community Care manages mental health and substance abuse services for more than 600,000 members. Community Care’s mission is to improve the health and well-being of the community through the delivery of effective, cost-efficient, and accessible behavioral health services. Community Care has been awarded “full” accreditation — the highest possible level — from the National Committee for Quality Assurance (NCQA) for its Medicaid, as well as its disease management program.

Askesis Development Group — Askesis designs and implements software solutions that support behavioral health practice management. Part of the UPMC Insurance Services Division, Askesis has sold its software to behavioral health providers in more than 25 states. This software solution helps customers optimize staff productivity, decrease administrative errors, and demonstrate the favorable outcomes that prove clinical services are effective.

Partners in Excellence Program for Physicians — The UPMC Health Plan Partners in Excellence Program is designed to strengthen the doctor-patient relationship by encouraging coordinated care and guiding patients to make more informed health care choices. This model places the patient and physician at the center of care, with support from the family, the community, and UPMC Health Plan to more effectively meet the needs of patients.