SimpliveraCoverage Companion

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UPMC for Life HMO Rx (HMO) — UPMC HEALTH PLAN, INC. | Simplivera

UPMC for Life HMO Rx (HMO)

UPMC HEALTH PLAN, INC.

HMO

MOOP (in-network): $4,500
MOOP (combined): —
Part C+D premium: $56/mo
Part D premium: $56/mo

Plan information

Contract / Plan / Segment: H3907 / 058 / 001
Part D drug coverage: Included ($56/mo)

Other segments for this plan:

Segment 002 Segment 003

Service area

OH: 2 counties
PA: 35 counties