Medical Plans

Pitt employees may choose among four medical benefit plans offered by UPMC Health Plan, including a health maintenance organization (HMO) plan and three preferred provider organization (PPO) options that provide greater flexibility to meet specific health care needs. All four plans offer a broad range of comprehensive benefits, including wellness and preventative-care benefits and the same Prescription Drug Program.

Learn more about the Healthy Incentives available for the 2016-2017 plan year.

Medical Plan Rates and Descriptions

View the current plan year’s rates (July 1, 2016-June 30, 2017)

Panther Gold HMO

The most popular of Pitt's medical plans, Panther Gold HMO does not carry an annual deductible or co-insurance. Members are responsible for copayments except for wellness and preventative care services.

Panther Gold with Advantage Network - Applies to Oakland and Titusville campuses only

Schedule of Benefits | Summary of Benefits and Coverage (SBC) | SBC for MHSF 

Panther Gold Plan - Applies to Bradford, Greensburg and Johnstown campuses only

Schedule of Benefits | Summary of Benefits and Coverage (SBC) 

Panther Advocate

The Panther Advocate PPO/HIA offers a broad array of health incentives that rewards members for making healthy choices. Health credits are placed in to a health incentive account (HIA) when members complete healthy activities.  The credits in the HIA are then applied to offset out-of-pocket costs such as the deductible, coinsurance and prescription drug copayments.

Schedule of Benefits | Summary of Benefits and Coverage (SBC) | SBC for MHSF 

Panther Plus

The Panther Plus PPO provides 80 percent co-insurance coverage after meeting the annual deductible.

Schedule of Benefits | Summary of Benefits and Coverage (SBC) | SBC for MHSF 

Panther Basic

The Panther Basic PPO Plan has been adjusted to meet the requirements of a Qualified High Deductible Health Plan (QHDHP).  This plan now allows the participants the option to open a new Health Savings Account (HSA).

Schedule of Benefits | Summary of Benefits and Coverage (SBC) | SBC for MHSF

UPMC PPO-PA Child Welfare Training Program

This plan is available only to faculty and staff in the Pennsylvania Child Welfare Training Program located in Mechanicsburg, Pa. 

Schedule of Benefits | Summary of Benefits and Coverage (SBC) | Premium Rates

 

Summary of Benefits Coverage/Uniform Glossary

For more information on Take a Healthy Step, Panther Advocate, and Panther Basic, review the UMPC Health Plans. Additional Questions? Contact UPMC Health Plan online or by phone: 1-888-499-6885.


Coverage and Resources

Certificate of Coverage

The Certificate of Coverage establishes the terms of coverage for your health benefit plan. The Certificate of Coverage explains:

  • Steps for adding a dependent to your plan
  • Steps for submitting a claim
  • Steps for filing an appeal
  • Description of Covered Services
  • Exclusions
  • Steps for resolving disputes with UPMC Health Plan

Certificate of Coverage (HMO)  |  Certificate of Coverage (PPO)

Certificate of Coverage for MHSF (HMO)  |  Certificate of Coverage for MHSF (PPO)

Autism Spectrum Disorders Coverage

The UPMC medical benefit plans cover all eligible members under the age of 21 for the diagnostic assessment and treatment of Autism Spectrum Disorders. Please refer to the Autism Spectrum Disorders Certificate of Coverage to review the covered services, definitions, and procedures.

Coverage for Eligible Dependent Children

Under the University of Pittsburgh insurance plans, children, up to the age of 26, are eligible for medical, dental, and vision coverage under their parent's insurance, provided they meet the requirements under the Patient Protection and Affordable Care Act.

Out-of-Area Coverage for Eligible Dependent Children

Enrolled dependent children and adult dependents up to age 26 that live or attend school outside of Western Pennsylvania have access to more than 5,000 facilities and 700,000 physicians nationwide through PHCS Multiplan and through SuperMed in Ohio.  The national pharmacy network includes more than 30,000 independent and retail chain pharmacy locations.

To find a provider: 

  1. Go to www.upmchealthplan.com
  2. At the top, right hand corner of the page, hover over the orange ‘Doctors’ icon
  3. Choose ‘Medical’ from the drop down menu
  4. Enter the Zip Code and a radius to search
  5. Under 'Know Your Plan Name?' choose ‘Coverage Through Your Employer’ from the drop down menu as the Coverage Type
  6. The following message will appear in the Search Results when a zip code is entered that falls outside of the UPMC Health Plan network service area: “The ZIP code you entered (XXXXX) falls outside the typical UPMC Health Plan network service area.”
  7. Under 'Find a doctor outside Western Pennsylvania', click the gray box that reads 'Care Outside Western Pa. and Ohio'
  8. You will be automatically routed to the MultiPlan page to search the PHCS and Multiplan Networks for participating providers
  9. If you are searching in a Ohio, click the Gray box "Care in Ohio" to search the SuperMed network.

Review screenshot instructions to search within the PHCS/Multiplan.

To find a pharmacy:

  1. Go to www.upmchealthplan.com
  2. At the top, right hand corner of the page, hover over the red ‘Hospital/Rx’ icon
  3. Choose ‘Pharmacy’ from the drop down menu
  4. Under the ‘Select Type of Pharmacy Coverage’ field, confirm that ‘Coverage through your Employer’ is auto populated
  5. Click the purple ‘Express-Scripts Pharmacy’ box
  6. You will be automatically routed to a white homepage that reads ‘Located a pharmacy’ at the top
  7. Enter your Zip Code or City/State
  8. Click the blue ‘Locate Pharmacy’ button

Dependent college students are also covered for urgent and emergent care obtained on or near their campus locations (i.e. Student Health Clinic), even if the provider is not participating with one of these networks.