Open Enrollment Information Now Available on Infonet - Extra

A biweekly guide to help you navigate your 2015 UPMC Benefits
Issue 2 • Oct. 8, 2014
Open Enrollment Information Now Available on Infonet
A newly updated 2015 Open Enrollment
section of Infonet is now available for you
to review the 2015 changes. Take a moment
to visit Infonet to access resources and
information, review changes and plan
highlights, and read frequently asked
questions (FAQs) about Open Enrollment.
New items will be added as we get closer to Open Enrollment,
so check back frequently. Look for updated tools, such as
videos, plan comparison charts, and profiles of “People Like You.”
Don’t Wait to Take a Healthy Step
Only 40 percent of your co-workers have earned the 2015 maximum medical plan deductible credit of
$1,000 for individual or $2,000 for family coverage. The Nov. 12, 2014 deadline is fast approaching.
To find out if you need to complete any additional requirements,
follow this path to see your current Take a Healthy Step (TAHS)
status: My HUB > Human Resources > MyHealth OnLine >
MyHealth Central.
Be aware that some
of the healthy step
activities take
time to complete.
They can also
take additional
time to be
processed and credited to your account. Don’t wait until right
before the deadline to check your status — do it now. You want
to be sure you receive the maximum credit available to lower
your medical plan deductible next year.
Understand that you will not receive any credit, including
a partial deductible credit, unless you complete the following
steps before the deadline:
•• MyHealth Questionnaire (if not completed since Dec. 1, 2013)
•• Biometric screening (if not completed since Dec. 1, 2009)
To get the maximum deductible credit, you must earn
additional credit dollars by completing Healthy Step activities:
•• Individual coverage, earn $600 deductible credit
•• Family coverage, earn $700 deductible credit
You can learn more by checking out the TAHS pages on Infonet.
Remember: Flu shot clinics are being held during many of
the upcoming benefit fairs. Stop in to get a flu shot before
the Nov. 12 deadline to earn $300 deductible credits towards
your 2015 TAHS requirements.
YOUR BENEFITS YOUR CHOICE 2014 1
Medical and Vision Payroll Deductions
The first issue of Your Benefits, Your Choice included payroll deduction
costs for each medical plan option. Remember, the Standard Vision
plan is included with all medical plans, and you may waive medical
coverage and purchase the Enhanced Vision as a stand-alone product.
The attached chart provides a side-by-side comparison of the
2015 medical and enhanced vision plan per-pay deductions for
full-time, flexible full-time, job share, and regular part-time
employees on a bi-weekly and monthly basis.
Medical Costs (Bi-weekly)
Full-time, Flexible Full-time
UPMC Health Plan
Job Share, Regular Part-time
Employee
Only
Employee &
Child(ren)
Employee
& Spouse
Employee
& Family
Employee
Only
Employee &
Child(ren)
Employee
& Spouse
Employee
& Family
Advantage Silver
with Standard Vision
$11.08
$21.23
$27.69
$29.54
$80.77
$154.62
$201.69
$213.69
Advantage Gold
with Standard Vision
$34.15
$66.00
$85.85
$90.92
$102.92
$198.00
$251.54
$265.85
Advantage HSA
with Standard Vision
$42.92
$84.46
$90.00
$93.69
$114.46
$222.00
$268.15
$281.08
Out-of-Area PPO with
Standard Vision
$43.38
$84.92
$108.92
$115.38
$119.08
$228.92
$298.15
$315.69
Additional Cost
for Enhanced Vision
with Medical
$2.15
$3.18
$3.97
$5.10
$2.15
$3.18
$3.97
$5.10
Enhanced Vision Only
— No Medical
$4.46
$6.39
$8.18
$10.47
$4.46
$6.39
$8.18
$10.47
Medical Costs (Monthly)
Full-time, Flexible Full-time
UPMC Health Plan
Job Share, Regular Part-time
Employee
Only
Employee &
Child(ren)
Employee
& Spouse
Employee
& Family
Employee
Only
Employee &
Child(ren)
Employee
& Spouse
Employee
& Family
Advantage Silver
with Standard Vision
$24.00
$46.00
$60.00
$64.00
$175.00
$335.00
$437.00
$463.00
Advantage Gold
with Standard Vision
$74.00
$143.00
$186.00
$197.00
$223.00
$429.00
$545.00
$576.00
Advantage HSA
with Standard Vision
$93.00
$183.00
$195.00
$203.00
$248.00
$481.00
$581.00
$609.00
Out-of-Area PPO with
Standard Vision
$94.00
$184.00
$236.00
$250.00
$258.00
$496.00
$646.00
$684.00
Additional Cost
for Enhanced Vision
with Medical
$4.66
$6.90
$8.61
$11.04
$4.66
$6.90
$8.61
$11.04
Enhanced Vision Only
— No Medical
$9.66
$13.84
$17.72
$22.69
$9.66
$13.84
$17.72
$22.69
2 YOUR BENEFITS YOUR CHOICE 2015
ISSUE 2 • Oct. 8, 2014
Is the Advantage HSA Option Right for You?
The Advantage HSA is a Consumer-Directed Health Plan (CDHP)
and the only medical plan accompanied by a health savings
account (HSA). An HSA is a tax-advantaged account that you can
use to pay for qualified medical expenses for you and your
tax-qualified dependents. An HSA is similar to a flexible spending
account (FSA), but with a very important difference — the HSA
does not expire each year. Instead, you receive an individual bank
account to keep your money in year after year, just like a savings
account. You can even invest the money to help you save for your
health care expenses when you retire.
Be sure to consider these points when thinking about whether
the Advantage HSA is right for you.
•• An HSA combines the savings features of a 403(b) or 401(k)
with the convenience of an FSA without the “use it or lose it”
limitation. The money is yours and rolls over from year to year.
•• An HSA gives you the flexibility to pay for current health care
expenses and the opportunity to save and invest for future
medical expenses in a tax advantaged bank account. You can
even use the account when you retire.
•• UPMC provides upfront funding into an HSA account for you
of $1,000 for an individual and $2,000 for any other level
of coverage.
•• You own and manage the account. You are encouraged to fund
or contribute to the account through pre-tax payroll deductions.
You should strive to build your account to cover your deductible
and your share of projected medical expenses for the current
year and into the future. The account is yours to cover medical
expenses even after you leave UPMC or retire.
•• Preventive care is covered at 100% under the Advantage HSA
and all other medical options.
•• With the Advantage HSA, all services (including physician
office visits and prescription drugs) are subject to the annual
deductible of $1,500 individual and $3,000 for any other
coverage level ($2,500 individual and $5,000 family if you
do NOT meet your Take a Healthy Step requirements).
•• Once you have met your deductible, all covered medical services
are paid at 90% up to the out-of-pocket maximum with one
exception. Prescriptions are included in the deductible and then
require copays once the plan deductible is met.
•• If you enroll your dependents in this plan, you will need to satisfy
the family deductible before the plan begins to pay. All family
members’ claims apply toward meeting the family deductible.
How does the HSA save me money?
•• First, monies put into the HSA by you will lower your federal
and state income taxes.
•• Second, if you use these monies to pay for qualified medical
expenses, you never pay taxes.
•• Third, your earnings are also never taxed if used for qualified
medical expenses.
Access the Open Enrollment section of Infonet to review the
available tools including videos, comparison charts, FAQs,
and savings calculators to learn more about the Advantage HSA.
YOUR BENEFITS YOUR CHOICE 2015 3
What is an EPO?
As you begin to review the medical plans for next year, you may
have noticed the acronym EPO appearing at the end of each
medical option and wondered what it meant. An EPO is an
Exclusive Provider Organization, which means that you must use
the Advantage Network or UPMC Health Plan network in order
to receive any benefit in the Advantage Silver, Gold, or HSA
medical options. No coverage is available outside the networks,
except for emergencies, so it is important when you seek
treatment that you find a provider and/or facility that participates
in the network. Covered services obtained at UPMC-owned or
affiliated hospitals or facilities are paid at the highest level of
benefits. Services obtained at other UPMC Health Plan
participating facilities are paid at the lower level. The Health Plan
network includes more than 11,500 doctors and 125 hospitals.
However, not all UPMC Health Plan physicians have admitting
privileges at UPMC Advantage Network facilities. You may obtain
services from any doctor who participates in the UPMC Health
Plan Network. However, it is recommended that you work with
UPMC Health Plan doctors who both admit to and perform testing
at UPMC Advantage Network facilities to ensure you receive the
highest level of benefits.
a UPMC Advantage Network facility are eligible for the Out-ofArea option. Keep in mind that the mileage to a UPMC facility
is measured from the center of the zip code in which you reside
and not from each individual’s home address. Eligibility for the
Out-of-Area option is reviewed on an annual basis.
Employees who reside outside the state or who live in Pennsylvania
but not within the Advantage Network service area are offered
an Out-of-Area medical option. If you are eligible for the Out-ofArea medical option, it will automatically be displayed as an
available option when you make your benefit elections during
Open Enrollment in My HUB.
The online provider directory at www.upmchealthplan.com
includes hospital affiliations for each participating doctor, in
addition to a complete list of the Advantage Network facilities,
including non-hospital facilities such as freestanding imaging
centers, diagnostic laboratories, rehabilitation centers, and skilled
nursing facilities. You can also call the UPMC Health Plan Health
Care Concierge team at 1-888-876-2756 for assistance (TTY
users should call 1-800-361-2629).
Effective Thursday, Jan. 1, 2015, the following hospitals
will be removed from the Advantage Network:
•• Conemaugh Health System (including Lee Campus,
Memorial Medical Center and Miners Medical Center)
•• Winber Medical Center
•• Meyersdale Medical Center
These hospitals will remain in the UPMC Health Plan
network, covered at the lower benefit level.
Out-of-Area Eligibility
Eligibility for the UPMC Health Plan Out-of-Area PPO is based
on your home zip code or state, county of residence, and relative
distance to a UPMC Advantage Network facility. Staff members
living in zip codes in excess of approximately 20 miles from a
UPMC Advantage Network hospital in the following five western
Pennsylvania counties — Allegheny, Beaver, Butler, Washington,
and Westmoreland — are eligible for the Out-of-Area PPO option.
In all other Pennsylvania counties outside of western Pennsylvania,
those living in zip codes in excess of approximately 30 miles from
Employees eligible for and enrolled in the Out-of-Area option have
access to UPMC Health Plan’s broader network that includes 125
hospitals and 11,500 physicians at the highest benefit level
as well as MultiPlan’s PHCS national network of 5,000 hospitals
and 500,000 physicians. Out-of-network benefits are paid at
a reduced level if you obtain non-emergency services from any
provider who is not in the UPMC Health Plan Out-of-Area network
of providers.
If you are eligible and elect the Out-of-Area PPO option and
receive care using these contracted networks, your benefits will
be similar to the Advantage Gold plan. However, you do not have
to elect the Out-of-Area option — the choice is yours. You may
instead choose to elect the Advantage Silver, Advantage Gold,
or Advantage HSA medical option. Those plans do not have access
to the Out-of-Area network and do not include out-of-network
benefits. If you choose one of those plans, you must use the
UPMC Advantage Network to receive the highest level of benefits.
Services obtained at other UPMC Health Plan participating
facilities are paid at the lower level, and you may obtain services
from any doctor who participates in the UPMC Health Plan Network.
4 YOUR BENEFITS YOUR CHOICE 2015
ISSUE 2 • Oct. 8, 2014
Vision
Employees who enroll in the Advantage Gold, Silver, HSA, or
Out-of-Area PPO automatically receive standard vision coverage
through Vision Benefits of America (VBA) at no additional cost.
You may choose from VBA’s extensive network of providers for
the greatest benefit. VBA also offers out-of-network benefits.
Covered Services
Eye exam
The vision benefit provides one exam and frames with lenses or
contacts** every 24 months for adults, including dependents
ages 21 or older. Children younger than 21 may receive one exam
and lenses or contacts** every 12 months, or frames once every
24 months.
Vision Network Provider
Non-network Provider
100%
$40
Lenses
$15 Copay
•• Single
100%
$40
•• Bifocal
100%
$50
•• Blended bifocal
100%
$50
•• Trifocal
100%
$75
•• Lenticular
100%
$100
•• Progressive*
available
$75
Frames
100%**
$50
•• Selected instead of glasses
$150***
$150
•• Medically required
UCR****
$300
Low vision aids
UCR ****
$500
Contact lenses
*Progressive lenses available in-network at an additional cost, ranging from $45 to $175 (typically $175 to $400)
**$50 wholesale allowance for Standard Option; $60 wholesale allowance for Enhanced Option
***Includes contact lenses and eye exam
****Usual, customary, and reasonable as determined by VBA
VBA Enhanced Vision Coverage
VBA also offers an enhanced vision option for an additional
cost which provides an annual benefit (eye exam and glasses
or contacts within allowances once every 12 months) and
an increased allowance for frames. The enhanced option also
allows staff not enrolled in the medical plan to obtain stand
alone vision coverage. See the rates included in this issue
to find out your per pay cost.
YOUR BENEFITS YOUR CHOICE 2015 5
What is a Benefit Band?
Three of the medical options — the Advantage Silver, Advantage
Gold, and Out-of-Area PPO — have deductibles and out-of pocket
maximums determined by Benefit Bands. These Benefit Bands are
used to help employees at all levels so that everyone can afford
health care coverage.
Your UPMC base hourly pay-rate approximately two weeks before
Open Enrollment begins is what defines your Benefit Band and
therefore, your deductible and out-of-pocket maximums for the
following year. The new hourly rates for the three bands are:
However, if you are rehired less than 30 days after your
termination, all benefits are reinstated consistent with your
enrollment prior to your termination, including your Benefit Band.
Information on the deductible and out-of-pocket maximum for
each of these medical plans was provided in the first issue of
the Your Benefits, Your Choice newsletter, and can also be found in
the benefits section of Infonet.
Benefit Band A = Hourly pay rate below $14.79
Benefit Band B = Hourly pay rate $14.79 to $29.56
Benefit Band C = Hourly pay rate above $29.56
Once your Benefit Band is established, it will not change during
the year, even if your salary changes and bumps you into a new
Benefit Band. In addition, income such as overtime and shift
differential does not count toward your base hourly rate of pay
and does not affect your Benefit Band. Newly hired staff will be
assigned a Benefit Band based on their hourly pay rate at time
of hire. If you terminate employment and are later rehired, your
hourly rate at the time of rehire will determine your Benefit Band.
Where Can I Find My Hourly
Rate of Pay?
Follow this path:
Infonet > My HUB > Human Resources >
View Job Information (under My Profile)
Understanding Key Terms
As you review the available medical plan options and prepare to make your Open Enrollment elections,
become familiar with the key insurance terms.
Deductible
Copayment
A deductible is a specified amount that
you pay out of pocket each year before
your medical plan begins to pay a share
of the benefit cost for certain services,
such as lab work, inpatient and outpatient
hospital services, surgery, anesthesia,
and diagnostic testing.
A copayment (or copay) is a specified
dollar amount that you generally pay
at the time of service, such as an office
visit or when you pick up a prescription,
depending on the medical option selected.
Coinsurance
Coinsurance is the percentage of eligible
expenses you are responsible for paying
after you satisfy your annual deductible.
The medical plan and the patient share
the cost of services. For example, if the
plan paid for covered medical services
at 90%, the patient would be responsible
for the other 10%.
Out-of-Pocket
This is the specified dollar amount at
which you stop paying coinsurance for
the plan year. Generally, your deductible
and coinsurance amounts count toward
the annual out-of-pocket maximum.
Once you’ve reached your Out-Of-Pocket
maximum, the plan pays 100 percent
for coinsurance-based covered services.
6 YOUR BENEFITS YOUR CHOICE 2015
ISSUE 2 • Oct. 8, 2014
Benefit Fairs Are Now Taking Place
Open Enrollment, your annual opportunity to make your benefit
elections will take place this fall from Wednesday, Oct. 29,
through Wednesday, Nov. 12. Benefit fairs are a great place to ask
questions and talk with experts about your UPMC benefits. All
UPMC employees are welcome to attend any benefits fair at one
of the many locations now through early November.
Add a Reminder to Your
Outlook Calendar
When you access the Benefits Fair schedule on Infonet,
you have the ability to add the event to your Outlook
calendar. Simply select your preferred fair location, click
on it to review the time and location details, then click
on “Add to my Outlook calendar”.
Don’t Forget the Ones You Love —
Check Your Beneficiary Designations
Have you experienced any life changes this year that may affect
your insurance policies? Take a moment to review and make any
necessary changes to your beneficiary designations for each life
insurance and accidental death and dismemberment policy that
you have, whether the policy is provided by UPMC at no cost to
you — or any supplemental policies that you may have elected.
Protecting those who depend on you makes sense. Don’t leave
things to chance in the event that something happens to you.
Please take a moment to complete your beneficiary designations
today. Follow the simple step-by-step beneficiary designation
guide, available at Infonet.UPMC.com/LifeInsurance to review
your current beneficiaries and make any necessary edits.
At the fairs, you can learn more about:
•• 2015 medical-plan options
•• Other UPMC provided benefits, including three new
voluntary plans
•• UPMC Savings Plan retirement benefits
Many fair locations also will be offering free flu shots clinics.
Flu shots not only help protect you, your family, co-workers, and
patients from influenza, but also provide the opportunity to earn
$300 deductible credits towards your 2015 Take a Healthy Step
requirements. Get a flu shot by the Wednesday, Nov. 12, 2014
deadline and reduce your 2015 medical plan deductible.
Note: During Open Enrollment you have the ability to increase your
supplemental life insurance by one times your base salary without
completion of an Evidence of Insurability (EOI) form (medical
questions). You may also increase spouse/domestic partner life
insurance by $10,000 without completion of an EOI. Should you
increase more than one salary level for yourself or $10,000 for your
spouse/domestic partner, an EOI must be submitted to our life
insurance carrier CIGNA, for review and approval.
What is a Beneficiary?
A beneficiary can be a person, a trust, your estate,
a charitable organization, etc. you have elected
to receive the proceeds from your life insurance
and (if applicable), AD&D policy (ies) in the event
you pass away.
YOUR BENEFITS YOUR CHOICE 2015 7
Fairs taking place during the next two weeks:
•• Magee-Women’s Hospital of UPMC
•• UPMC Horizon – Greenville
•• UPMC Mercy Southside
•• Heritage Place
•• Sherwood Oaks
•• UPMC McKeesport
Thursday, Oct. 9, 7 a.m. to 7 p.m.
Conference Rooms A and B, Level Z
Friday, Oct. 10, 8 a.m. to 1 p.m., Conference Rooms 1 and 2
Friday, Oct. 10, 11 a.m. to 4 p.m., Card Room
•• UPMC Horizon — Shenango
Monday, Oct. 13, 8 a.m. to 3:30 p.m., Conference Room 2
•• Sugarcreek Station
Monday, Oct. 13, 11 a.m. to 4 p.m., All Purpose Room
•• UPMC Mercy
Tuesday, Oct. 14, 7 a.m. to 4 p.m., Clark Auditorium
•• Corporate Services and UPMC Health Plan
Wednesday, Oct. 15, 10 a.m. to 3 p.m.
USS Training Room, Floor 31
Thursday, Oct. 16, 8 a.m. to 3:30 p.m.
Assembly Rooms D and E
Friday, Oct. 17, 7 a.m. to 4 p.m., First Floor Residents’ Lounge
Monday, Oct. 20, 7 a.m. to 3 p.m.
Kelly Conference Center, Ground Floor
•• UPMC South Hills
Tuesday, Oct. 21, 8 a.m. to noon., First Floor Conference Room
•• Consolidated Services
Tuesday, Oct. 21, 1 to 4 p.m., Breakroom
•• UPMC East
Wednesday, Oct. 22, 7:30 a.m. to 3 p.m.
Conference Center, Ground Floor
Benefit Advice is Available at the Mall
Choosing the best medical plan that will meet the
needs of you and your family for 2015 is an important
decision. Before Open Enrollment begins on
Wednesday, Oct. 29, you may want to meet face-toface with an expert who can provide answers to your
questions or concerns and help you make the right
choice. Visit the UPMC Health Plan Connect Service
and Sales Center at the mall nearest you to meet
one-on-one with a Health Care Concierge to get your
questions answered on the spot.
All locations are open during regular mall hours:
Century III Mall
First floor in front of Macy’s, next to the fountain
412-290-3653
Millcreek Mall
Near Best Buy Mobile, where the Sears
and JCPenney hallways meet
814-897-3408
Monroeville Mall
Second floor in front of Macy’s
412-290-1896
Ross Park Mall
First floor next to Starbucks
412-290-4003
South Hills Village
First floor in front of Target
412-290-3144
The Mall at Robinson
First floor in front of Macy’s
412-290-4255
The benefits described in this newsletter provide a general overview of the standard benefits available to most UPMC employees, but may not apply to all staff members.
Physicians and members of collective bargaining units should refer to the terms of their contracts for information regarding their eligibility for UPMC benefits.
8 YOUR BENEFITS YOUR CHOICE 2015
Copyright 2014 UPMC Health Plan, Inc. All rights reserved.
BEN413520 IB/SO 10/14