CommercialCoverageMedium impact
Some COVID-19-related benefits will be extended through Dec. 31 with $0 cost share for UPMC <em>for You</em> members
UPMC Health Plan·Reimbursement
Effective date
Sep 30, 2024
We identified it
Aug 7, 2026
Summary
UPMC Health Plan is extending $0 cost sharing for specific COVID-19 services (diagnostic testing, OTC testing, evaluation, treatment, and vaccines) through December 31, 2024, for UPMC for You members only. This supersedes the previous Sept. 30, 2024 retirement date for COVID-19 Special Coverage. Billing teams must ensure claims for these services submitted through 12/31/24 reflect $0 member cost sharing and apply Medicaid-specific OTC test limits where applicable.
Action Required
By December 31, 2024: Billing team must ensure all COVID-19 related claims for UPMC for You members are processed with $0 cost sharing for the following services: COVID-19 diagnostic lab testing, OTC COVID-19 testing, COVID-19 evaluation and treatment, and COVID-19 vaccine administration. For Medicaid members specifically, apply OTC test coverage limits (up to 8 FDA-authorized tests per 28 days when purchased from retailers; 2 tests per 7 days up to 8 per 28-day period through participating pharmacies). Update billing system to ensure these services are not billed with copay, coinsurance, or deductible requirements. Verify encounter forms and system rules reflect extended coverage end date of 12/31/24. Contact UPMC Provider Services at 1-866-918-1595 with any billing questions. After 12/31/24, revert to standard cost sharing unless further guidance is issued.