Pitt faculty and staff may choose among five medical-benefit plans offered by UPMC Health Plan, including a very popular health maintenance organization (HMO) plan and four preferred provider organization (PPO) options that provide greater flexibility to meet specific health-care needs.
All five plans offer a broad range of comprehensive benefits. They also provide wellness and preventative-care benefits such as well-baby visits, annual physicals and exams, health coaching, smoking cessation, and nutritional counseling—all at no cost, and without the need to meet a deductible or contribute to a co-payment. Each plan offers the same Prescription Drug Program.
Medical Plan Rates and Descriptions
Questions? Contact UPMC Health Plan online or by phone: 1-888-499-6885.
Panther Gold HMO
The most popular of Pitt's medical plans, the aptly named Panther Gold HMO does not carry an annual deductible or co-insurance. Members are responsible for copayments except for wellness and preventative-care services.
The Panther Advocate PPO/HIA allows members to focus on wellness-based activities by offering a broad array of health incentives. Health credits are placed in to a health incentive account (HIA) when members complete healthy activities. The credits in the HIA are then automatically applied to offset out-of-pocket costs such as the deductible, coinsurance and prescription drug copayments.
The Panther Premier PPO gives members the flexibility to seek non-urgent or emergency services outside of UPMC Health Plan's network of providers and facilities. Panther Premier provides 90 percent co-insurance coverage after meeting an annual deductible (in-network co-insurance).
The Panther Plus PPO provides 80 percent co-insurance coverage after meeting the annual deductible.
Panther Basic PPO is a high-deductible plan, often referred to as providing “catastrophic coverage.” Panther Basic is intended for faculty and staff members who do not seek health services frequently.
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.
Medical Plan Comparison Calculator
(Compare Your Out-of-Pocket Cost for Panther Advocate to Other Medical Plans)
Medical Plan, Notices, Features, and Topics
Find a Doctor
On UPMC Health Plan's Web site you can access a provider directory and search for physicians, hospitals and facilities, urgent or convenience-care clinics, and behavioral health providers based on such criteria as name, office location, specialty, zip code, and personal characteristics.
Certificate of Coverage
The Certificate of Coverage establishes the terms of coverage for your health benefit plan. It specifies which services are, and are not, covered, and it explains the procedures you must follow to ensure that the health care services that you receive will be covered under your benefit plan. The Certificate of Coverage also explains:
- Steps for adding a dependent to your plan
- Steps for submitting a claim
- Steps for filing an appeal
- Description of Covered Services
- Steps for resolving disputes with UPMC Health Plan
UPMC Health Plan will cover medically necessary services, as set forth in the Infertility Rider, related to the diagnosis and treatment of infertility in accordance with UPMC Health Plan policies and procedures.
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 - Patient Protection and Affordable Care Act (Health Care Reform)
Effective July 1, 2011 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 (Health Care Reform).
Coverage for Eligible Dependent Children - Pennsylvania Act 4 (discontinued as of June 30, 2011)
Children, between the ages of 26 and 30 and enrolled in coverage under their parent's insurance as of June 30, 2011, will be grandfathered for coverage provided they meet the requirement under PA Act 4.
Act 4, signed into law by Pennsylvania Governor Edward G. Rendell, allows uninsured single, adult children up to the age of 30 to be covered under their parent's health insurance plan. Coverage is dependent upon the employers' willingness to offer this benefit to its employees. The University of Pittsburgh chose to offer this coverage effective January 1, 2010. However, this change in legislation does not apply to dental and vision coverage.
Beginning January 1, 2010, dependents were eligible for coverage if they met all five of the following criteria:
- Age is between 19 and 30
- Not married
- Have no dependents of his/her own
- A resident of Pennsylvania or enrolled as a full-time student
- Are not provided health insurance by any other policy or enrolled/eligible for other government health care program
Depending on the level of medical coverage you are currently enrolled in, there could be a change to your medical benefit elections (for example moving from two adults to family coverage) as a result of enrolling your dependent. If this change in your medical plan occurs this will result in a higher premium cost for you.