- Benefits described in this brochure give a general overview of the benefits available through UPMC. They represent the standard benefits for most UPMC staff members, but may not be applicable to all staff.
- Some business units have unique benefit programs. Additionally, certaiin job classifications may affect benefit eligibility. Physicians and members of collective bargaining units should refer to the terms of their contracts for information regarding their eligibility for UPMC benefits.
- Specific benefit related questions should be directed to the UPMC Employee Service Center at 1-800-994-2752, option 3.
- Dental Claim UPMC Dental Advantage (PDF)
- Dental Claim United Concordia (PDF)
The dental claim form is available from the Client's Corner section of the United Concordia website. - Flexible Spending Account Dependent Care Claim (PDF)
Use this form to submit claims and receive reimbursements from your dependent care FSA. - Flexible Spending Account Health Care Claim (PDF)
Use this form to submit claims and receive reimbursements from your health care FSA. - Flexible Spending Account Substantiation Form - Submitting receipts for substantiation of your FSA debit card expenses is only necessary when requested by the FSA administrator. To make this process as simple as possible, identify a current e-mail address in your online My Flex Advantage account. When substantiation is needed, you will be sent an e-mail or a letter with instructions. Already received a substantiation request but you misplaced your letter? Contact UPMC Health Plan to request a copy 1-888-876-2756 or send an e-mail to myflex@upmc.edu.
- Adoption Assistance Reimbursement (PDF)
Submit this form to the Employee Service Center along with requested documentation to verify expenses incurred during the adoption process. - Commuter Parking Account Reimbursement Request (PDF)
This form should be submitted along with documentation showing your work-related parking expenses incurred at a non-UPMC parking facility.
Annual Reports for Pension and Health and Welfare Programs
- Health and Welfare (PDF)
- 401(a) Retirement Savings Plan (PDF)
- 403 (b) Retirement Savings Plan (PDF)
- Basic Retirement Plan (PDF)
- Cash Balance Plan for UPMC Lee Regional (PDF)
- Magee Retirement Plan (PDF)
- Northwest Medical Center (PDF)
- Senior Living Corp (PDF)
- Staff Member Tuition Assistance Request Form (PDF)
- Staff Member Tuition Assistance Guidelines (PDF)
- Dependent Tuition Assistance Request Form (PDF)
- Dependent Tuition Assistance Guidelines (PDF)
- Tuition Assistance Eligibility Verification Request (PDF)
Staff who are interested in using the tuition assistance benefit for themself or a dependent may complete and submit this form to the Employee Service Center in order to determine if they qualify for assistance prior to enrolling in classes.
