Medical Plans

Pitt faculty and staff may choose among four medical-benefit plans offered by UPMC Health Plan, including a very popular 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. 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.

Summary of Benefits Coverage/Uniform Glossary

Medical Plan Rates and Descriptions

For additional information on the Panther Advocate and Panther Basic plan, click here. Additional questions? Contact UPMC Health Plan online or by phone: 1-888-499-6885.

Rates

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.

Panther Gold with Advantage Network - Applies to Oakland, Johnstown and Titusville campuses
 
 Panther Gold Plan - Applied to Bradford and Greensburg campuses only

Panther Advocate

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.

Plan Grid | Plan Grid for MHSF | Schedule of Benefits | Certificate of Coverage Prescription Drug Program

Panther Plus

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

Plan Grid | Plan Grid for MHSF | Schedule of Benefits | Certificate of Coverage Prescription Drug Program

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).

Plan Grid | Plan Grid for MHSF | Schedule of Benefits | Certificate of Coverage Prescription Drug Program

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. 

Plan Grid | Schedule of Benefits | Certificate of Coverage | Premium Rates|   Prescription Drug Program

Medical Plan Comparison Calculator

(Compare Your Out-of-Pocket Cost for Panther Advocate to Other Medical Plans)

Medical Plans - Cost Comparison Calculator

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
  • 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)

Infertility Rider

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).

Forms  

To access benefit enrollment forms, please click here.

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: 

  • Go to www.upmchealthplan.com
  • At the top, right hand corner of the page, hover over the orange ‘Doctors’ icon
  • Choose ‘Medical’ from the drop down menu
  • Enter the Zip Code and a radius to search
  • Under 'Know Your Plan Name?' choose ‘Coverage Through Your Employer’ from the drop down menu as the Coverage Type
  • 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.”
  • Under 'Find a doctor outside Western Pennsylvania', click the gray box that reads 'Care Outside Western Pa. and Ohio'
  • You will be automatically routed to the MultiPlan page to search the PHCS and Multiplan Networks for participating providers
  • If you are searching in a Ohio, click the Gray box "Care in Ohio" to search the SuperMed network.
  • Screenshot instructions to search within the PHCS/ Multiplan are in the attached PDF.

To find a pharmacy:

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