•Panther Gold Plan
You may use your Primary Care Physician for woman's health care.
However, you have the option to separately identify an OB-GYN from the UPMC
Health Plan Network of Physicians and you have direct access without a referral
for general woman's health care. If your routine check-up by the OB-GYN
discloses a medical condition that requires further treatment, your OB-GYN can
arrange for these services directly - you are not required to go back to
our PCP for authorization for further treatment.
•Panther Premier, Panther Plus, Panther Basic
These plans do not require the designation of either a Primary Care Physician or
an OB-GYN. However, you have the option to separately identify either a
PCP or OB-GYN from the UPMC Health Plan Network of Physicians.
You have direct access without a referral for woman's health care. If your
routine check-up by the OB-GYN discloses a medical condition that requires
further treatment, your OB-GYN can arrange for these services directly.
You also have direct access to an OB-GYN who is not a member of the UPMC Health
Plan Network; however, the coverage would be according to the out-of-network
provision.
•Coverage for Individuals Temporarily Outside the Network Service Area
| No coverage |
60% after deductible |
60% after deductible |
50% after deductible |
|
100% after $10 copayment. Must contact
PCP for referral to provider outside of
UPMC Health Plan Network(1)
|
90% after deductible(2)
|
80% after deductible(2)
|
70% after deductible(2)
|
100% after $50 copayment for adults and $30 copayment for dependents under 10
(copayment waived
if admitted)(3)
|
90% after deductible
(coinsurance waived if
admitted)(3)
|
80% after deductible
(coinsurance waived if
admitted)(3)
|
70% after deductible
(coinsurance waived if admitted)(3)
|
|
100% after $10 copayment/visit Must contact
PCP for referral to non-network provider(1)
|
90% after deductible(2)
|
80% after deductible(2)
|
70% after deductible(2)
|
Important Information
(1) For Panther Gold members, you must contact PCP for
referral to a provider outside of the UPMC Health Plan Network
(2) For Panther Premier, Plus and Basic members, when
receiving care outside of the UPMC Health Plan Network, please contact UPMC
Health Plan University of Pittsburgh Member Services at 1-888-499-6885 within
24 to 48 hours of the incident in order to receive the highest level of
benefits.
(3) Under all plans, please contact your PCP (if
applicable) or UPMC Health Plan University of Pittsburgh Member Services at
1-888-499-6885 within 24 to 48 hours after treatment for emergency situations.
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