Open Enrollment Information Now Available on Infonet - Extra

Transcription

A guide to help you
navigate your
2016 UPMC Benefits
Issue 2
Oct. 14, 2015
Open Enrollment Information Now Available on Infonet
A newly updated 2016 Open Enrollment section of Infonet is now available for you to
review your 2016 benefit options. Take a moment to visit Infonet to access:
•• Plan highlights and comparison charts
•• Medical plan and FSA calculators
•• Medical plan videos
•• Employee contribution information
Take some time to review this information before Open
Enrollment begins on Wednesday, Oct. 28, so that you are
ready to make your 2016 benefit elections.
YOUR BENEFITS YOUR CHOICE 2016 1
Advantage Network
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. You can
also watch videos that describe
each term below in the Benefits U
page on Infonet.
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, CT scans, and other
diagnostic testing.
To obtain the highest level of benefits from any of the
Advantage medical plan options, it is very important that
you use the Advantage Network for covered services. The
Advantage Network includes UPMC-owned or affiliated
hospitals or facilities. Services obtained at other UPMC
Health Plan participating facilities are paid at a lower level.
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.
Keep in mind that not all physicians participating with UPMC
Health Plan have admitting privileges at UPMC Advantage
Network facilities. You may obtain services from any doctor
who participates in the UPMC Health Plan Network. 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 will receive the highest level
of benefits.
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 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.
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.
The UPMC Health Plan Network includes more than 11,500
doctors and 125 hospitals. 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. The directory includes
non-hospital facilities such as freestanding imaging centers,
diagnostic laboratories, rehabilitation centers, and skilled
nursing facilities. You also can call the UPMC Health Plan
Health Care Concierge team at 1-888-876-2756 for
assistance (TTY users should call 1-800-361-2629).
For additional information on Advantage medical plan options,
review the charts on pages 5 through 7.
2 YOUR BENEFITS YOUR CHOICE 2016
ISSUE 2 • Oct. 14, 2015
30 miles from a UPMC Advantage Network facility are eligible.
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. Employees living outside Pennsylvania are
automatically offered the Out-of-Area medical options.
Eligibility is reviewed on an annual basis. If you are eligible,
these options will be displayed when you make your benefit
elections during Open Enrollment in My HUB.
Am I required to elect Out-of-Area?
You do not have to elect an Out-of-Area option — the choice
is yours. In fact, many employees eligible for the Out-of-Area
medical options work at a UPMC facility and elect one of the
Advantage In-Area options. If you choose one of the Advantage
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.
New Out-of-Area Options This Year
Additional Plan Offerings for Those Living Outside the
Advantage Network Area
During Open Enrollment, if it is determined you are eligible
for the Out-of-Area options (based on your ZIP code), you
will be provided with two additional Out-of-Area medical plan
options for 2016, in addition to the In-Area UPMC Advantage
options. Until now, there has only been one Out-of-Area PPO
medical option available, which has mirrored the Advantage
Gold plan design.
The current Out-of-Area PPO option will change its name to
the Out-of-Area Gold, and the new options being offered will
be the Out-of-Area Silver and Out-of-Area HSA. These plans
will have the same designs as the Advantage plans, but will
have the ability to access UPMC Health Plan’s broader network
that includes 125 hospitals and 11,500 physicians. Using this
network will provide you with the highest benefit level as well
as the MultiPlan and 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
(MultiPlan and PHCS) network of providers.
Am I eligible for the Out-of-Area options?
Out-of-Area eligibility is based on your home ZIP code or state,
county of residence, and relative distance to a UPMC Advantage
Network facility. If you live 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 — you are
eligible for the Out-of-Area options, in addition to the Advantage
options. In all other Pennsylvania counties outside of western
Pennsylvania, those living in ZIP codes in excess of approximately
For additional information on these medical plan options,
review the charts on pages 8 through 10.
MARKET RATE ADJUSTMENT FOR THE
BENEFIT BANDS
The Advantage and Out-of-Area Silver and Gold medical
plan options have deductibles and out-of pocket
maximums determined by salary-based Benefit Bands.
These Benefit Bands are used to help employees at all
levels so that everyone can afford health care coverage.
Your Benefit Band is based on your base hourly rate, in
effect as of mid-October. Your Benefit Band determines
your deductible and out-of-pocket maximums for the
upcoming year. There are three Benefit Bands:
Benefit Band A = Hourly pay rate below $15.23
Benefit Band B = Hourly pay rate $15.23 to $30.45
Benefit Band C = Hourly pay rate above $30.45
Once your Benefit Band is established, it will not change
during 2016, even if your salary changes and bumps you
into a new Benefit Band.
Information on the deductible and out-of-pocket
maximum and Benefit Bands can be found in the Benefits
section of Infonet.
WHERE CAN I FIND MY HOURLY RATE
OF PAY?
Follow this path:
Infonet > My HUB > Human Resources > View Job
Information (under My Profile)
Take a Healthy Step and Reduce Your
2016 Medical Plan Deductible
You have less than a month to earn the 2016 maximum Take
a Healthy Step (TAHS) medical plan deductible credit of
$1,000 for individual or $2,000 for family coverage before
the Wednesday, Nov. 11, 2015 deadline.
Understand that you will not receive any credit, including
a partial deductible credit, unless you complete the
following two minimum requirements before the deadline:
•• MyHealth Questionnaire
(if not completed since Dec. 1, 2014)
•• Biometric screening (if not completed since Dec. 1, 2010)
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 $800 deductible credit
You can learn more by checking out the TAHS pages on Infonet.
Don’t delay — find out your current TAHS completion status
today. You now have two easy ways to do so:
1. Follow this path: My HUB > Human Resources >
MyHealth OnLine > MyHealth Central.
2. Access the UPMC Health Plan mobile app. The app is
available for iPhone, iPad, and Android phones and tablets.
You can download the app from your device’s app store by
searching for “UPMC Health Plan.”
•• When you download the app, you will be asked if you’re
a UPMC employee. Just answer a couple of short questions
and you’ll be on your way.
•• Two ways to sign in
1. Username and password
2. PIN code
•• After you sign in to the app, you can set a PIN by tapping on
the Settings icon. You’ll be prompted to enter and re-enter
a four digit PIN. When you come back to the app in the
future, you’ll just quickly enter your PIN to sign in.
•• Check your TAHS completion status by clicking on the Take
a Healthy Step icon and look for a check mark next to each
of the requirements to see if you have completed all of your
requirements. You can now complete the MyHealth
Questionnaire on the app!
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
2016 medical plan deductible.
ISSUE 2 • Oct. 14, 2015
Advantage HSA Medical Plan Option:
The Advantage HSA is a Consumer-Directed Health Plan
(CDHP), and is the only Advantage medical option offered by
UPMC that is accompanied by a health savings account (HSA).
•• Utilizing the UPMC Advantage Network assures you the
highest level of benefits for medical services.
•• A reduced benefit is provided when using non-Advantage
providers in the UPMC Health Plan Network.
Medical plan details
•• Preventive services are covered at 100%.
•• All UPMC Health Plan Network PCPs and specialists
•• With the Advantage HSA, all services (including physician
office visits and prescription drugs) are subject to the annual
deductible of $1,600 per individual and $3,200 for any other
coverage level ($2,600 individual and $5,200 family if you do
NOT complete your Take a Healthy Step requirements by the
Wednesday, Nov. 11, 2015 deadline).
are included.
•• No coverage is available outside the UPMC Health Plan
Network, except for emergencies.
•• 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 switch to copays once the plan deductible is met.
New this year! Each enrolled member of a family need only reach the individual deductible and out-of-pocket maximum levels.
All services for all enrolled family members combine toward the family limit.
UPMC ADVANTAGE HSA
Deductible*
Advantage Network*
Health Plan Network*
Individual
$1,600
$4,000
Family
$3,200
$8,000
Advantage Network
Health Plan Network
Coinsurance
Your responsibility
10%
40%
Plan pays
90%
60%
Advantage Network*
Health Plan Network*
Out-of-Pocket Maximum*
Individual
$3,200
$5,350
Family
$6,400
$10,700
PCP, Specialist, and Emergency
Department Visits (after deductible)
Health Plan Network
Your responsibility
10%
Plan pays
90%
Prescription Drug Copay
Until you reach your deductible
Your responsibility
Plan pays
After Deductible Met
30-day supply
90-day supply
Generic
$15
$30
Your Choice Network
100%
0%
Preferred Brand
$40
$80
Non-Preferred Brand
$90
$180
Specialty
$90
n/a
EMPLOYEE CONTRIBUTIONS (PER-PAY)
Full-time,
Full-time,
biweekly
monthly
Part-time
& Job Share,
biweekly
Part-time
& Job Share,
monthly
Employee Only
$42.92
$93.00
$114.46
$248.00
Employee and Child(ren)
$84.46
$183.00
$222.00
$481.00
Employee and Spouse
$90.00
$195.00
$268.15
$581.00
Employee and Family
$93.69
$203.00
$281.08
$609.00
* Assumes all Take a Healthy Step requirements for 2016 have been met by Nov. 11, 2015, and $1,000 individual/$2,000 family deductible credit has been applied.
Advantage Gold:
•• Copayments for physician and specialists office visits,
emergency room, therapy, and prescription drugs.
•• Services such as hospital care, lab work, diagnostic imaging,
and durable medical equipment are covered at 90% after
the salary-based Benefit Band annual deductible is met,
up to the out-of-pocket maximum.
•• Election of a Primary Care Physician (PCP) is encouraged;
no referral is needed for specialist office visits.
highest level of benefits for coinsurance-based services,
such as hospital, lab, and diagnostics. A reduced benefit
is provided when using non-Advantage providers in the
UPMC Health Plan Network. All UPMC Health Plan Network
PCPs and specialists are included.
•• $1,000 individual/$2,000 family deductible credit is available
when you satisfy your Take a Healthy Step requirements
by Wednesday, Nov. 11, 2015; annual deductible and out-ofpocket maximum levels are determined by your
Benefit Band.
•• Pretax contributions to a flexible spending account (FSA)
are permitted.
UPMC ADVANTAGE GOLD
Deductible*
Benefit Band
Hourly Rate
Advantage Network**
(ind./family)
Health Plan Network**
(ind./family)
A below $15.23
$250/$500
$850/$1,700
B $15.23 - $30.45
$350/$700
$950/$1,900
C above $30.45
Coinsurance
$450/$900
$1,050/$2,100
Advantage Network
Health Plan Network
Your responsibility
10%
40%
Plan pays
90%
60%
Benefit Band
Hourly Rate
Advantage Network**
(ind./family)
(ind./family)
A below $15.23
$1,250/$2,500
$3,750/$7,500
B $15.23 - $30.45
$1,750/$3,500
$4,750/$9,500
C above $30.45
$2,250/$4,500
$2,250/$10,500
Copay Services
Service
PCP Sick Visit
Health Plan Network
$20
Specialist/Urgent Care Visit
$40
Emergency Room Visit
$100
30-day supply
90-day supply
Generic
$15
$30
Preferred Brand
$40
$80
Non-Preferred Brand
$90
$180
Specialty
$90
n/a
Full-time,
Full-time,
biweekly
monthly
$79.00
Part-time
& Job Share,
biweekly
Part-time
& Job Share,
monthly
$104.31
$226.00
Employee Only
$36.46
$69.69
$151.00
$199.85
$433.00
Employee and Spouse
$92.77
$201.00
$259.38
$562.00
Employee and Family
$99.69
$216.00
$279.23
$605.00
*The deductible has been designed to assist employees at all levels so everyone can afford health care coverage. A snapshot of your UPMC base pay-rate (effective approximately two weeks prior to
Open Enrollment) determines the deductible and out-of-pocket maximum Benefit Band that applies to you for the following year.
** Assumes all Take a Healthy Step requirements for 2016 have been met by Nov. 11, 2015, and the $1,000 individual/$2,000 family deductible credit has been applied.
ISSUE 2 • Oct. 14, 2015
Advantage Silver:
the salary-based Benefit Band annual deductible is met, up
to the out-of-pocket maximum.
•• Election of a Primary Care Physician (PCP) is encouraged;
no referral is needed for specialist office visits.
highest level of benefits for coinsurance-based services,
such as hospital, lab, and diagnostics. A reduced benefit is
provided when using non-Advantage providers in the UPMC
Health Plan Network. All UPMC Health Plan Network PCPs
and specialists are included.
when you satisfy your Take a Healthy Step requirements
by Wednesday, Nov. 11, 2015; annual deductible and
out-of-pocket maximum levels are determined by your
Benefit Band.
are permitted.
UPMC ADVANTAGE SILVER
Deductible*
Benefit Band
Hourly Rate
Advantage Network**
(ind./family)
(ind./family)
A below $15.23
$550/$1,100
$1,550/$3,100
B $15.23 - $30.45
$650/$1,300
$1,650/$3,300
C above $30.45
Coinsurance
$750/$1,500
$1,750/$3,500
Advantage Network
Health Plan Network
Your responsibility
20%
50%
Plan pays
80%
50%
Benefit Band
Hourly Rate
Advantage Network**
(ind./family)
(ind./family)
A below $15.23
$2,750/$5,500
$5,500/$11,000
B $15.23 - $30.45
$3,250/$6,500
$5,500/$11,000
C above $30.45
$3,750/$7,500
$5,500/$11,000
Copay Services
Service
PCP Sick Visit
Health Plan Network
$30
$50
$150
30-day supply
90-day supply
Generic
$15
$30
Preferred Brand
$40
$80
Non-Preferred Brand
$90
$180
Specialty
$90
n/a
Full-time,
Full-time,
biweekly
monthly
$11.54
$25.00
Part-time
& Job Share,
biweekly
Part-time
& Job Share,
monthly
$80.77
$175.00
Employee Only
$22.15
$48.00
$155.08
$336.00
Employee and Spouse
$29.54
$64.00
$206.31
$447.00
Employee and Family
$32.31
$70.00
$222.46
$482.00
.
Out-of-Area HSA:
Out-of-Area HSA is a Consumer-Directed Health Plan (CDHP),
and is the only Out-of-Area medical option offered by UPMC
that is accompanied by a health savings account (HSA).
Medical plan details
•• With the Out-of-Area HSA, all services (including physician
office visits and prescription drugs) are subject to the annual
deductible of $1,600 per individual and $3,200 for any
other coverage level ($2,600 individual and $5,200 family
if you do NOT complete your Take a Healthy Step
requirements by the Wednesday, Nov. 11, 2015 deadline).
•• The UPMC Health Plan, PHCS, and MultiPlan Networks
assures you the highest level of benefits for all services,
such as hospital, lab, and diagnostics; a reduced benefit
is provided for using out-of-network providers.
with one exception. Prescriptions are included in the deductible
and then switch to copays once the plan deductible is met.
New this year! Each enrolled member of a family need only reach the individual deductible and out-of-pocket maximum levels.
All services for all enrolled family members combine toward the family limit.
OUT-OF-AREA HSA MEDICAL PLAN OPTION
Deductible*
Individual
Family
Coinsurance
UPMC Health Plan, PHCS, and
MultiPlan*
Out-of-Network*
$1,600
$4,000
$3,200
$8,000
UPMC Health Plan, PHCS, and MultiPlan
Out-of-Network
Your responsibility
10%
40%
Plan pays
90%
60%
MultiPlan*
Out-of-Network*
Individual
$3,200
$5,350
Family
$6,400
$10,700
PCP, Specialist, and Emergency
Department Visits (after deductible)
UPMC Health Plan, PHCS,
and MultiPlan
Your responsibility
Plan pays
Until you reach your deductible
Your responsibility
Plan pays
After Deductible Met
10%
90%
Your Choice Network
100%
0%
30-day supply
90-day supply
Generic
$15
$30
Preferred Brand
$40
$80
Non-Preferred Brand
$90
$180
Specialty
$90
n/a
Full-time,
Full-time,
biweekly
monthly
$56.31
Part-time
& Job Share,
biweekly
Part-time
& Job Share,
monthly
$122.00
$143.67
$311.28
Employee Only
$112.15
$243.00
$248.47
$538.35
Employee and Spouse
$115.38
$250.00
$324.18
$702.38
Employee and Family
$115.85
$251.00
$348.08
$754.18
* Assumes all Take a Healthy Step requirements for 2016 have been met by Nov. 11, 2015, and the $1,000 individual/$2,000 family deductible credit has been applied.
ISSUE 2 • Oct. 14, 2015
Out-of-Area Gold:
Those living outside the Advantage Network service area have
the ability to use the broader UPMC Health Plan Network,
including the PHCS and MultiPlan Networks. Should you
elect the Out-of-Area Gold and receive care using these
contracted networks, your benefits will be similar to the
Advantage Gold plan.
•• The UPMC Health Plan, PHCS, and MultiPlan Networks assures
you the highest level of benefits for coinsurance-based services,
such as hospital, lab, and diagnostics; a reduced benefit is
provided for using out-of-network providers.
the annual salary-based Benefit Band deductible is met, up
to the out-of-pocket maximum. Election of Primary Care
Physician (PCP) is encouraged; no referral is needed for
specialist office visits.
when you satisfy your Take a Healthy Step requirements by
Wednesday, Nov. 11, 2015; annual deductible and out-of-pocket
maximum levels are determined by your Benefit Band.
are permitted.
OUT-OF-AREA GOLD
Deductible*
Benefit Band
Hourly Rate
A below $15.23
B $15.23 - $30.45
$350/$700
$950/$1,900
C above $30.45
$450/$900
$1,050/$2,100
Out-of-Network
10%
40%
Coinsurance
Your responsibility
Plan pays
Benefit Band
Hourly Rate
MultiPlan** (ind./family)
Out-of-Network**
(ind./family)
$250/$500
$850/$1,700
90%
60%
Out-of-Network**
(ind./family)
A below $15.23
$1,250/$2,500
$3,750/$7,500
B $15.23 - $30.45
$1,750/$3,500
$4,750/$9,500
C above $30.45
$2,250/$4,500
$2,250/$10,500
Copay Services
Service
MultiPlan
PCP Sick Visit
$20
$40
$100
30-day supply
90-day supply
Generic
$15
$30
Preferred Brand
$40
$80
Non-Preferred Brand
$90
$180
Specialty
$90
n/a
Full-time,
Full-time,
biweekly
monthly
Employee Only
Part-time
& Job Share,
biweekly
Part-time
& Job Share,
monthly
$297.00
$47.08
$102.00
$137.08
$84.92
$184.00
$263.54
$571.00
Employee and Spouse
$120.46
$261.00
$349.85
$758.00
Employee and Family
$130.15
$282.00
$377.08
$817.00
Out-of-Area Silver:
Those living outside the Advantage Network service area have the
ability to use the broader UPMC Health Plan Network, including
the PHCS and MultiPlan Networks. Should you elect the Out-ofArea Silver and receive care using these contracted networks,
your benefits will be similar to the Advantage Silver plan.
•• The UPMC Health Plan, PHCS, and MultiPlan Networks
assures you the highest level of benefits for coinsurance-based
services, such as hospital, lab, and diagnostics; a reduced
benefit is provided for using out-of-network providers.
the annual salary-based Benefit Band deductible is met, up
to the out-of-pocket maximum. Election of Primary Care
Physician (PCP) is encouraged; no referral is needed for
specialist office visits.
when you satisfy your Take a Healthy Step requirements by
Wednesday, Nov. 11, 2015; annual deductible and out-of-pocket
maximum levels are determined by your Benefit Band.
•• Pretax contributions to a flexible spending account
(FSA) are permitted.
OUT-OF-AREA SILVER
Deductible*
Benefit Band
Hourly Rate
A below $15.23
$550/$1,100
$1,550/$3,100
B $15.23 - $30.45
$650/$1,300
$1,650/$3,300
C above $30.45
Coinsurance
Out-of-Network**
(ind./family)
$750/$1,500
$1,750/$3,500
Out-of-Network
Your responsibility
20%
50%
Plan pays
80%
50%
Benefit Band
Hourly Rate
Out-of-Network**
(ind./family)
A below $15.23
$2,750/$5,500
$5,500/$11,00
B $15.23 - $30.45
$3,250/$6,500
$5,500/$11,00
C above $30.45
$3,750/$7,500
$5,500/$11,00
Copay Services
Service
MultiPlan (ind./family)
PCP Sick Visit
$50
$150
$30
30-day supply
90-day supply
Generic
$15
$30
Preferred Brand
$40
$80
Non-Preferred Brand
$90
$180
Specialty
$90
n/a
Full-time,
Full-time,
biweekly
monthly
Part-time
& Job Share,
biweekly
Part-time
& Job Share,
monthly
Employee Only
$15.23
$33.00
$108.31
$234.66
$29.08
$63.00
$207.86
$450.36
Employee and Spouse
$38.77
$84.00
$276.15
$598.32
Employee and Family
$41.54
$90.00
$297.66
$644.93
ISSUE 2 • Oct. 14, 2015
Medical and Vision Payroll Deductions
This chart provides a side-by-side comparison of the 2016
medical and enhanced vision plan per-pay deductions for
full-time, flexible full-time, job share, and regular part-time
employees on a biweekly and monthly basis.
Medical Costs (Biweekly)
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
$11.54
$22.15
$29.54
$32.31
$80.77
$155.08
$206.31
$222.46
Advantage Gold
$36.46
$69.69
$92.77
$99.69
$104.31
$199.85
$259.38
$279.23
Advantage HSA
$42.92
$84.46
$90.00
$93.69
$114.46
$222.00
$268.15
$281.08
Out-of-Area Gold
$47.08
$84.92
$120.46
$130.15
$137.08
$263.54
$349.85
$377.08
Out-of-Area Silver with
Standard Vision
$15.23
$29.08
$38.77
$41.54
$108.31
$207.86
$276.15
$297.66
Out-of-Area HSA with
Standard Vision
$56.31
$112.15
$115.38
$115.85
$143.67
$248.47
$324.18
$348.08
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
$25.00
$48.00
$64.00
$70.00
$175.00
$336.00
$447.00
$482.00
Advantage Gold
$79.00
$151.00
$201.00
$216.00
$226.00
$433.00
$562.00
$605.00
Advantage HSA
$93.00
$183.00
$195.00
$203.00
$248.00
$481.00
$581.00
$609.00
Out-of-Area Gold
$102.00
$184.00
$261.00
$282.00
$297.00
$571.00
$758.00
$817.00
Out-of-Area Silver with
Standard Vision
$33.00
$63.00
$84.00
$90.00
$243.66
$450.36
$598.32
$644.93
Out-of-Area HSA
$122.00
$243.00
$250.00
$251.00
$311.28
$538.35
$702.38
$754.18
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
Why Should You Consider the HSA
Medical Plan Option?
The Advantage and Out-of-Area HSA medical plan options
are accompanied by a health savings account (HSA).
A tax-advantaged HSA is an account that can be funded and
then used to pay for eligible medical expenses not covered by
the medical plan for you and your tax-qualified dependents.
With an HSA, you receive an individual bank account. You
keep the money not spent on current health care needs in this
account 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 HSA medical plan option and account is right for you.
•• You own and manage the account. You are encouraged to
fund or contribute to the account through pretax 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. Your account is
yours to cover medical expenses even after you leave UPMC
or retire.
HSA Medical Options
•• Preventive care is covered at 100%.
•• With the HSA medical plan option, all services (including
physician office visits and prescription drugs) are subject
to the annual deductible of $1,600 individual and $3,200
for any other coverage level ($2,600 individual and
$5,200 family if you do NOT meet your Take a Healthy
Step requirements).
with one exception. Prescriptions are included in the
deductible and then require copays once the plan
deductible is met.
Visit the Open Enrollment section of Infonet to review the
available tools including videos, comparison charts, and FAQs
to learn more.
Vision Coverage
NEW THIS YEAR!
Each enrolled member of a family need only satisfy
the individual deductible and out-of-pocket
maximum levels. All services for all enrolled family
members combine toward the family limit.
Employees who enroll in any UPMC medical plan 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. The vision benefit
provides one exam and frames with lenses or contacts** every
24 months for adults, including dependents ages 21 to 26, and
one exam and lenses or contacts** every 12 months, or frames
once every 24 months, for children under age 21.
Health Savings Account
•• An HSA combines the savings features similar to 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.
•• 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.
ISSUE 2 • Oct. 14, 2015
COVERED SERVICES
VISION NETWORK PROVIDER
NON-NETWORK PROVIDER
EYE EXAM
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: No Increase in Employee
Contributions
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. The rates are included on
page 11 in this issue and remain the same as in 2015.
UPMC BASIC BRONZE OPTION
During Open Enrollment, part-time, job share, and
qualifying casual and limited part-time staff will be eligible
to enroll in the UPMC Basic Bronze medical option that
will be effective on Jan. 1, 2016. Mandated by the U.S.
government’s Affordable Care Act (ACA), this plan
provides the basic benefit levels as required by the ACA.
Employees should note, the Basic Bronze option does not
offer the same level of benefits as the other Advantage and
Out-of-Area options provide. Details about the Bronze Plan
are available at Infonet.UPMC.com/Medical.
In addition to the current medical options that part-time
and job share staff are eligible to elect, they also will be
offered the Basic Bronze medical option during Open
Enrollment. Eligible casual and limited part-time staff, who
have worked on average at least 30 hours per week during
the previous 12 months, will receive a letter in the mail at
their home address regarding the Basic Bronze option with
instructions on how to enroll, should they choose to elect
this coverage during the annual Open Enrollment period.
UPMC FINANCIAL EDUCATION CONSULTANTS ARE HERE TO HELP
How much should you save for retirement? How should
you invest your savings? How can you plan for the future?
You don’t have to answer these questions on your own
— UPMC’s Financial Education Consultants1 are here to
help. Sheila Guzzy and Tyler Rickel can help you make the
most of your UPMC retirement benefits so you can stay on
track for your future.
Meet them in person at an upcoming Benefits Fair. Sheila
or Tyler will be attending each fair that will be taking place
now through Oct. 30. At no cost to you, they are available
to discuss:
•• The UPMC Savings Plan and UPMC Cash Balance Plan2
•• Your investment options and resources, including the
new Roth IRA
•• How to get started in the Savings Plan (if you’re not
currently participating)
•• Questions you have about planning for retirement
For a listing of benefit fair dates and locations, visit the
Benefit Fairs page on Infonet so you can plan to attend.
Connect Any Time
Want to manage your retirement savings on your own?
The UPMC Retirement Center website is available yearround to provide important tips and targeted information
specifically for you. To access the website, simply follow
this path: Infonet > My HUB > Human Resources >
My Retirement. Or, call the UPMC Retirement Center at
1-877-206-8264. Representatives are available Monday
through Friday between 8:30 a.m. and 5 p.m. Eastern.
You can also arrange to meet with Sheila or Tyler
individually by emailing Sheila at [email protected]
or Tyler at [email protected].
Aon Hewitt Financial Education Consultants are registered representatives of Hewitt Financial Services, LLC, member FINRA and
SIPC, and Investment Advisor Representatives of Aon Hewitt Financial Advisors, LLC, an SEC Registered Investment Advisor.
1
Physicians and members of collective bargaining units should refer to the terms of their contracts for information regarding their
eligibility. Some business units and job classifications have unique benefit programs that may affect eligibility. An explicit definition
of eligibility and other plan provisions can be found in the Summary Plan Description (SPD) on the UPMC Retirement Center
website. If there are any discrepancies between the SPD and the plan documents, the plan documents will govern.
2
Going Shopping? Help Is at the Mall
Choosing the best medical plan that will meet the needs of you
and your family for 2016 is an important decision. Before Open
Enrollment begins on Wednesday, Oct. 28, you may want to
meet face-to-face 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. Meet one-on-one with a Health Care
Concierge and get your questions answered on the spot. All
locations are open 10 a.m. to 9 p.m., Monday through Saturday,
and 11 a.m. to 6 p.m., Sunday (except Monroeville, noon to 6 p.m.,
on Sunday).
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
Century III Mall
First floor next to Starbucks, 412-290-3653
Millcreek Mall
Near Best Buy Local, 814-897-3408
Monroeville Mall
Second floor across from Macy’s, 412-290-1896
ISSUE 2 • Oct. 14, 2015
Mark Your Calendar — Benefit Fairs
Taking Place Now
Open Enrollment, your annual opportunity to make your
benefit elections will take place this fall from Wednesday,
Oct. 28, through Wednesday, Nov. 11. 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 select locations taking place
through Friday, Oct. 30.
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”.
At the fairs, you can learn more about:
•• 2016 medical plan options
•• Other UPMC provided benefits
•• UPMC Savings Plan retirement benefits
•• The new HSA account administrator,
UPMC FlexAdvantage
Many fair locations also will be offering free flu shot clinics.
All employees, physicians, and other personnel who provide
patient care services or work on or within a patient care or
clinical care facility will be required to receive the annual
seasonal influenza vaccination unless otherwise formally
exempted by UPMC due to medical or religious reasons. The
flu shot is now worth $100 Take a Healthy Step deductible
credit. Make sure you complete enough Healthy Step Activities
($600 for an individual and $800 for a family), along with
the MyHealth Questionnaire and biometric screening prior
to the Nov. 11 deadline, to earn the maximum 2016 Take
a Healthy Step medical plan deductible credit.
Fairs taking place during the next two weeks:
•• UPMC Mercy Southside
Thursday, Oct. 15, 8:30 a.m. to 2:30 p.m.
Conference Rooms 1 and 2
•• UPMC St. Margaret
Friday, Oct. 16, 7 a.m. to 3:30 p.m.
Conference Centers ABC, First Floor
•• UPMC Passavant
Monday, Oct. 19, 8 a.m. to 2 p.m.
Assembly Hall
•• Quantum One
Tuesday, Oct. 20, 9 a.m. to 3 p.m.
Conference Room 151, First Floor
•• Magee-Womens Hospital of UPMC
Wednesday, Oct. 21, 8 a.m. to 4 p.m.
Conference Rooms A&B, Zero Level
•• UPMC Mercy
Thursday, Oct. 22, 7 a.m. to 4 p.m.
Clark Auditorium, Side A&B
•• U.S. Steel Tower
Friday, Oct. 23, 10 a.m. to 2 p.m.
Training Center, Floor 31
•• UPMC Northwest
Monday, Oct. 26, 10 a.m. to 3 p.m.
Courtyard Conference Center
•• UPMC Altoona
Wednesday, Oct. 28, 8 a.m. to 4 p.m.
Rotunda
BENEFIT
MYTHS VS. FACTS
Your UPMC Benefit Representatives are ready to answer your questions.
This new series continues in this issue of Your Benefits, Your Choice. Around the annual Open
Enrollment period, the Employee Service Center often receives numerous calls from employees
related to the same topic or around a common theme. This series will address some of the
frequent questions employees have about benefits as they get ready to make decisions and
changes for the upcoming year. If you have a question about your benefits that you think might
be good for this series, call the Employee Service Center at 1-800-994-2752, option 3.
MYTH:
The premium cost for family Advantage Gold is $216 per
month for 2016 and the Advantage HSA is $203 per month
— $13 is not enough of a savings for me to change to the
consumer driven health plan option because this plan has
a higher deductible of $1,600 for an individual and $3,200
for a family.
Outcomes During the Year
Unfortunately, medical plan expenses cannot be determined
in advance.
FACT:
If you elect the Advantage HSA during Open Enrollment,
beginning the first of January, UPMC will deposit $2,000
into a health savings account (HSA) when you enroll in
family coverage. If you add up how much your contributions
will be for the entire year:
•• If you have a year that you or a family member has had
Advantage HSA $203 x 12 months = $2,436
A $2,000 HSA that you are able to use for medical plan
expenses is included. The net amount you will contribute
for this coverage is $436. You will also have the ability
to contribute an additional amount up to $2,350 for
individual and $4,750 for family coverage on a pretax
basis to the health savings account that can rollover
from year to year, if you don’t use it.
Advantage Gold $216 x 12 months = $2,592
There is no health care flexible spending account (FSA)
included with this option. You will need to consider if you
should elect a pretax health care FSA, which would be an
additional per-pay contribution. If you are in Benefit Band B,
you will need to satisfy a $350 individual or $700 family
deductible in addition and pay for any services that are
covered by a copay.
•• If you have a good health year, the monies remaining
from both the UPMC provided funding and any additional
funding you may contribute to an HSA will remain in
your account to use in the future.
to use a number of health care services and incurred
out-of-pocket expenses, you will have the $2,000
employer-provided family contribution to help offset
the $1,600 individual deductible ($3,200 family deductible)
and the 10% coinsurance after the deductible has been
met. You will also have the ability to contribute an
additional amount on a pretax basis up to the maximums
stated above. If you don’t need the total amount you
contributed, the remaining amount will rollover and not
be lost.
•• The health care FSA, which is available with the Silver
and Gold options, includes a “use it or lose it” rule,
per IRS regulations, so you must budget carefully
when you decide how much to contribute for the
year. As previously mentioned, this is an additional
employee contribution.
•• New this year! Each enrolled member of a family need
only satisfy the individual deductible and out-of-pocket
maximum levels. All services for all enrolled family
members combine toward the family limit.
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.
Copyright 2015 UPMC Health Plan, Inc. All rights reserved.
BEN416813 IB/SO 10/15

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