The medical insurance for staff and faculty is provided
by UPMC Health Plan. The current plans remain in effect through June
30, 2009. The plans can only be changed during the annual open
enrollment and will take effect July 1st. The only exception to
make a change outside of the open enrollment period is through a
status change. For information on how to make a status change,
click here.
Each plan covers the same medical treatments, surgical procedures, and
other eligible expenses and services. The differences among the plans are
the managed care requirements, co-payments/co-insurance, choice, and
out-of-pocket expenses. Each plan also has the same Prescription Drug Program.
This information is intended to be a general overview by the Benefits Department.
For official information provided by the insurance company, view the Summary Plan Description (SPD) and/or the Certificates of Coverage (COC) and Riders.
Medical Plan Definitions and Explanations
Coverage for dependents under your policy (spouse,
partners, and children)
Medical Plans:
Premium Rates for each of the four plans.
Medical Plans: Summary Plan Description (SPD)
Panther Gold
Advantage Plan
(Oakland, Johnstown, Titusville)
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Panther Gold
Enhanced Access HMO
(Bradford and Greensburg)
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UPMC PPO
(PA Child Welfare
Training Program)
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Panther Premier
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Panther Plus
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Panther Basic
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Medical Plans: Certificates of Coverage (COC) and Riders
HMO
Infertility Rider
(HMO)
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PPO
Infertility Rider
(PPO)
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Dependent Child Eligibility Rider
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Medical Plan Notices and Features
Coverage While Away From Home
To locate participating physicians and facilities in the UPMC network if you reside in Western Pennsylvania:
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Go to www.upmchealthplan.com
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Click on "Find a Provider."
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To locate physicians for all plans, click on "Find a Doctor."
To locate the full listing of UPMC hospitals and facilities, click on "Find a Hospital or Facility."
Prescription Drug Plan: (same for all four plans)
Upon reaching the UPMC Health Plan Web page, there are a choice of links. One is to a Formulary Guide for purposes of
conducting an Online search tailored to particular circumstances or interests. Another at the very bottom is to the
Guide Booklet, a complete explanation and listing.
The Guide Booklet includes an explanation of the mandatory generic policy, which is commonly known as "generic first".
This means that if a drug has a generic equivalent, you use the generic form. If you choose a brand-name drug when a generic is
available, you must pay the preferred-brand (second-tier) co-payment in addition to the retail cost difference between the brand-name
and generic forms of the drug. If your doctor requests that you receive a brand-name drug instead of its generic equivalent if a
generic is available, your doctor must request a Medical Necessity Review. If the request is approved, you will pay the third-tier
co-payment for this drug.
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Previous Year's Documents
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