Member Resources | UPMC for You
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Member Resources

On this page you can find electronic copies of many UPMC for You resources, including documents, forms, and more. If you require an alternative format or would like printed copies instead, please call a Health Care Concierge team at 1-800-286-4242 (TTY: 711). Help is available Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 8 a.m. to 8 p.m.

 

Member Handbook

Provider Directory

Formulary

We would like to inform you that the UPMC for You Formulary is undergoing updates and will be reposted soon. While the formulary is being updated, please use the Searchable Formulary below or you can call the Health Care Concierge team at 1-800-286-4242 (TTY: 711). Help is available Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 8 a.m. to 8 p.m.

Important Documents

 

Domestic Violence Links

Food and Nutrition Services

Managed Care Organizations (BH-MCOs) by County

Pennsylvania Head Start Programs

Medical Assistance Transportation Program

Safety Net Health Plans Link

National Museum of Dentistry

Advance Directives

Advance directives can help participants let others know what medical treatments they do or do not want. The resources below can assist with the development of advance directives.

Newsletter

Prior Authorization Metrics for Medical Items and Services (Excluding Drugs)
To comply with the CMS Interoperability and Prior Authorization final rule, UPMC for You is required to annually report aggregated prior authorization metrics on our website. This includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (approvals, denials, etc.) during the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. If you have questions about the data below, please contact Member Services.

These are the medical items and services for which we require prior authorization (excluding drugs)
Beginning Jan. 1, 2026, the CMS Interoperability and Prior Authorization final rule requires UPMC for You to send prior authorization decisions within:
• 72 hours for expedited requests (urgent)
• 7 calendar days for standard requests (nonurgent).

Standard/Expedited Quantities/Review Time data

This managed care plan may not cover all your health care expenses.

If you have questions about your benefits, call the UPMC for You Health Care Concierge team at 1-800-286-4242 (TTY 711). Representatives are available Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m.; Wednesday from 8 a.m. to 8 p.m.