Faculty & Librarians (Union): Medical

Administered by UPMC, the Panther Gold Health Maintenance Organization (HMO) plan offers a broad network of providers within the UPMC Advantage and Health Plan Access networks in the Western PA area. The Panther Gold HMO plan requires the selection of a Primary Care Physician (PCP). If a PCP is not designated, one will be assigned based on the zip code on file with the University.

When you use health care providers who are part of the UPMC Advantage or UPMC Health Plan Access network:

• Preventative care services are covered at 100%
• Depending on the type of service obtained, a deductible and/or copay may apply.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

Important Considerations for Selecting Panther Gold HMO

If your Home Address on file with the University is outside of Western Pennsylvania, you may want to carefully evaluate the suitability of the Panther Gold HMO Medical Plan.

The in-network service area for this plan is restricted to Western Pennsylvania with limited provider access outside of this region. Certain counties—such as Bucks, Chester, Delaware, Franklin, Fulton, Juniata, Mifflin, Montgomery, Montour, and Philadelphia—are excluded from the network. If your Home Address on file with the University is outside of Western Pennsylvania, you may experience significant restrictions in available healthcare providers.

Please note: Urgent Care and Emergency Room visits are covered under Panther Gold even if outside the service area. Please review the SOB for member responsibility. 

The Panther Gold plan meets the current J1 Visa status requirements.

Note: If your Home Address on file with the University is outside of Western Pennsylvania, you may want to carefully evaluate the suitability of the Panther Gold HMO Medical Plan as it has regional coverage limitations that could affect access to care. The coverage/in-network area for the Panther Gold (HMO) plan is limited to the Western PA area. Counties excluded from this Western PA network include: Bucks, Chester, Delaware, Franklin, Fulton, Juniata, Mifflin, Montgomery, Montour, and Philadelphia.

Panther Gold with Advantage Network - Applies to Pittsburgh and Titusville campuses only | Schedule of Benefits | Summary of Benefits and Coverage (SBC) | SBC for MHSF | Certificate of Coverage (HMO) | Certificate of Coverage for MHSF (HMO)

Panther Gold Plan - Applies to Bradford, Greensburg and Johnstown campuses only | Schedule of Benefits | Summary of Benefits and Coverage (SBC) | SBC for MHSF | Certificate of Coverage (HMO) | Certificate of Coverage for MHSF (HMO)

Administered by UPMC, the Panther Preferred Provider Organization (PPO) plan offers a broad network of providers across the United States with access to the Cigna Extended Network. The Panther PPO plan does not require the selection of a Primary Care Physician (PCP).

When you use health care providers who are in-network:

• Preventative care services are covered at 100%
• In-network deductible will apply for non-preventative services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

When you use health care providers who are out-of-network:

• All services, including preventative care, will be subject to coinsurance.
• Out-of-network deductible applies to all services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

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

Want to learn more about High Deductible Health Plans (HDHP)? View our presentation.

Administered by UPMC, the Panther Basic Qualified High Deductible Health Plan (QHDHP) plan offers a broad network of providers across the United States with access to the Cigna Extended Network. The Panther Basic plan does not require the selection of a Primary Care Physician (PCP).

When you use health care providers who are in-network:

• Preventative care services are covered at 100%.
• In-network deductible will apply for non-preventative services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

When you use health care providers who are out-of-network:

• All services, including preventative care, will be subject to coinsurance.
• Out-of-network deductible applies to all services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

Panther Basic with HSA Option meets the requirements of a Qualified High Deductible Health Plan (QHDHP). This plan allows participants the option to open a Health Savings Account (HSA). Learn more about HSAs in the “Health Expense and Savings Account” section of this UPMC FAQ.

Health Savings Account (HSA)

Employees in the Panther Basic PPO plan can newly enroll, waive, or make changes to their HSA elections at any time throughout the year by submitting the HSA Election/Change/Termination Form. The change will be effective the first of the month following the submission of the form (for example, a form submitted on Oct. 31 will be effective on Nov. 1).

The maximum contribution for an eligible individual with self-only coverage is $4,300. The maximum contribution for an eligible individual with family coverage is $8,550.

HSA holders age 55 and older can save an extra $1,000, which means $5,300 for an individual and $9,550 for a family. These contributions are tax-deductible.

Under the Last Month Rule, if you are an eligible individual on the first day of the last month of the taxable year (December for most taxpayers), you are considered an eligible individual for the entire year. As such, you can make a full HSA contribution (plus a catch-up contribution if you will be age 55 or older by year's end).^ You must remain an eligible individual during a "testing period," which for most taxpayers would run from Dec. 1 through Dec. 31 of the following year.

Catch-up contributions are allowed for people older than 55 ($1,000). Catch-up contributions can be made at any time during the year in which the HSA participant turns 55.

For more detailed information on HSAs and taxes, visit the U.S. Department of Treasury website at ustreas.gov or talk with your tax advisor.

Please note: you cannot participate in/contribute to the HSA through the Panther Basic plan if you or your spouse/domestic partner are age 65 or older and enrolled in Medicare.

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

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

Administered by UPMC, this plan mirrors the Panther Gold plan in regards to plan design and premiums. However, this plan is a PPO plan that offers a broad network of providers across the United States with access to the Cigna Extended Network. This plan does not require the selection of a Primary Care Physician (PCP).

When you use health care providers who are in-network:

• Preventative care services are covered at 100%.
• In-network deductible will apply for non-preventative services.

When you use health care providers who are out-of-network:

• All services, including preventative care, will be subject to coinsurance.
• Out-of-network deductible applies to all services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

Schedule of Benefits | Summary of Benefits and Coverage (SBC) | Certificate of Coverage (HMO) Note: Premium rates follow Panther Gold plan rates

Administered by UPMC, the Panther Health Maintenance Organization (HMO) plan offers a broad network of providers within the UPMC Advantage and Health Plan Access networks in the Western PA area. The Panther HMO plan requires the selection of a Primary Care Physician (PCP). If a PCP is not designated, one will be assigned based on the zip code on file with the University.

When you use health care providers who are part of the UPMC Advantage or UPMC Health Plan Access network:

• Preventative care services are covered at 100%
• Depending on the type of service obtained, a deductible and/or copay may apply.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

Important Considerations for Selecting Panther HMO

If your Home Address on file with the University is outside of Western Pennsylvania, you may want to carefully evaluate the suitability of the Panther HMO Medical Plan.

The in-network service area for this plan is restricted to Western Pennsylvania with limited provider access outside of this region. Certain counties—such as Bucks, Chester, Delaware, Franklin, Fulton, Juniata, Mifflin, Montgomery, Montour, and Philadelphia—are excluded from the network. If your Home Address on file with the University is outside of Western Pennsylvania, you may experience significant restrictions in available healthcare providers.

Please note: Urgent Care and Emergency Room visits are covered under Panther HMO even if outside the service area. Please review the SOB for member responsibility. 

The Panther HMO plan meets the current J1 Visa status requirements.

Note: If your Home Address on file with the University is outside of Western Pennsylvania, you may want to carefully evaluate the suitability of the Panther HMO Medical Plan as it has regional coverage limitations that could affect access to care. The coverage/in-network area for the Panther HMO plan is limited to the Western PA area. Counties excluded from this Western PA network include: Bucks, Chester, Delaware, Franklin, Fulton, Juniata, Mifflin, Montgomery, Montour, and Philadelphia.

Panther HMO with Advantage Network - Applies to Pittsburgh and Titusville campuses only | Schedule of Benefits (PDF) | Summary of Benefits and Coverage (SBC) (PDF) | SBC for MHSF (PDF)

Panther HMO - Applies to Bradford, Greensburg and Johnstown campuses only | Schedule of Benefits (PDF) | Summary of Benefits and Coverage (SBC) (PDF) | SBC for MHSF (PDF)

Administered by UPMC, the Panther Preferred Provider Organization (PPO) plan offers a broad network of providers across the United States with access to the Cigna Extended Network. The Panther PPO plan does not require the selection of a Primary Care Physician (PCP).

When you use health care providers who are in-network:

• Preventative care services are covered at 100%
• In-network deductible will apply for non-preventative services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

When you use health care providers who are out-of-network:

• All services, including preventative care, will be subject to coinsurance.
• Out-of-network deductible applies to all services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

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

Want to learn more about High Deductible Health Plans (HDHP)? View our presentation.

Administered by UPMC, the Panther High Deductible Health Plan (HDHP) plan offers a broad network of providers across the United States with access to the Cigna Extended Network. The Panther HDHP plan does not require the selection of a Primary Care Physician (PCP).

When you use health care providers who are in-network:

• Preventative care services are covered at 100%.
• In-network deductible will apply for non-preventative services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

When you use health care providers who are out-of-network:

• All services, including preventative care, will be subject to coinsurance.
• Out-of-network deductible applies to all services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

Panther HDHP meets the requirements of a Qualified High Deductible Health Plan (QHDHP). This plan allows participants the option to open a Health Savings Account (HSA). Learn more about HSAs in the “Health Expense and Savings Account” section of this UPMC FAQ.

Health Savings Account (HSA)

Employees in the Panther HDHP plan can newly enroll, waive, or make changes to their HSA elections at any time throughout the year by submitting the HSA Election/Change/Termination Form. The change will be effective the first of the month following the submission of the form (for example, a form submitted on Oct. 31 will be effective on Nov. 1).

The maximum contribution for an eligible individual with self-only coverage is $4,300. The maximum contribution for an eligible individual with family coverage is $8,550.

HSA holders age 55 and older can save an extra $1,000, which means $5,300 for an individual and $9,550 for a family. These contributions are tax-deductible.

Under the Last Month Rule, if you are an eligible individual on the first day of the last month of the taxable year (December for most taxpayers), you are considered an eligible individual for the entire year. As such, you can make a full HSA contribution (plus a catch-up contribution if you will be age 55 or older by year's end).^ You must remain an eligible individual during a "testing period," which for most taxpayers would run from Dec. 1 through Dec. 31 of the following year.

Catch-up contributions are allowed for people older than 55 ($1,000). Catch-up contributions can be made at any time during the year in which the HSA participant turns 55.

For more detailed information on HSAs and taxes, visit the U.S. Department of Treasury website at ustreas.gov or talk with your tax advisor.

Please note: you cannot participate in/contribute to the HSA through the Panther HDHP plan if you or your spouse/domestic partner are age 65 or older and enrolled in Medicare.

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

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

Administered by UPMC, this plan mirrors the Panther HMO plan in regards to plan design and premiums. However, this plan is a PPO plan that offers a broad network of providers across the United States with access to the Cigna Extended Network. This plan does not require the selection of a Primary Care Physician (PCP).

When you use health care providers who are in-network:

• Preventative care services are covered at 100%.
• In-network deductible will apply for non-preventative services.

When you use health care providers who are out-of-network:

• All services, including preventative care, will be subject to coinsurance.
• Out-of-network deductible applies to all services.

Please review the Schedule of Benefits (SOB) below to view the member out-of-pocket costs for services.

Schedule of Benefits (PDF) | Summary of Benefits and Coverage (SBC) (PDF) | Note: Premium rates follow Panther HMO plan rates

Searching for a new doctor or facility or want to know if your current doctor takes a certain medical plan? Learn how to find a UPMC physician or facility. 

If you need access to a temporary medical card, you can view or print one online. Learn how to obtain a temporary medical card (PDF). You can also access your medical card from the UPMC Health Plan mobile app.

Faculty and staff can participate in the Wellness Incentives program by earning reward dollars for every healthy activity you complete. Get more information about the Wellness Incentive program and how you can earn rewards for your healthy activities.

Employees with UPMC Health Plan coverage can take advantage of the hearing aid benefit through Amplifon. Visit Amplifon's website to learn more. For questions about the benefit through Amplifon, please contact Amplifon directly by calling 1-866-978-9379. Amplifon's hours are Monday through Friday from 8 a.m. to 9 p.m. ET.

If you are a UPMC Health Plan member currently in Pennsylvania, you and your family can take advantage of virtual visits through UPMC. These visits are available 24/7 at a low cost for faculty, staff, covered spouses and domestic partners with UPMC Health Plan coverage, and can help treat a number of symptoms and illnesses. Learn more about UPMC Virtual Urgent Care.

The Affordable Care Act includes an individual mandate that requires most Americans to obtain and maintain health insurance each month or pay a tax penalty. The penalty for not having coverage will be paid on your Federal Income Tax Returns for each full month you, or a family member, does not have health insurance.

The Affordable Care Act requires employers to send Form 1095-C to certain employees. This form contains detailed information about your health care coverage. The IRS will use the information reported on your 1095-C to determine whether you will pay a penalty for failing to have health care coverage as required by the Patient Protection and Affordable Care Act. If you received an Advance Premium Tax Credit, the information on the form will also help the IRS determine if you should repay any of the tax credit or receive an additional credit.

Understanding Form 1095-C 

• Learn more about the codes on the document.
• To obtain a duplicate of Form 1095-C, please contact the Benefits Department.
• If you have additional questions about your Form 1095-C, please contact the University of Pittsburgh’s Benefits Department. You may also visit IRS website or Healthcare.gov website to learn more.

Find more information about the Form 1095-C.

The UPMC medical benefit plans cover all eligible members 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.

In the state of Pennsylvania, children (up to age 21) with significant, permanent, or longstanding hearing loss are provided with bilateral hearing aids through the Medical Assistance (MA) state program regardless of income. Providers bill the primary insurance first and whatever is not paid is then billed to the MA program. Medicaid pays in a bundled fashion (device + services); hearing aid companies all have “Medicaid” pricing (significantly reduced compared to typical pricing) that is offered if the provider indicates that they are providing hearing aids to an individual receiving Medicaid. This program ends when the young person turns 21 and then most of these individuals will not have insurance coverage to continue their hearing health care other than for hearing testing. With questions or for more information, please contact:

Children’s Hospital of Pittsburgh of UPMC
Audiology and Speech-Language Pathology
(412) 692-5580
Hearing Aid webpage

UPMC Health Plan members who are interested in learning more about transgender coverage can call UPMC Member Services at 1-844-202-0126 or the phone number on the back of their insurance card.

This information is only applicable to employees or spouses/domestic partners enrolled in a PPO plan and living outside of the UPMC service area, or any member traveling outside the UPMC service area in need of Urgent Care.

UPMC Health Plan provides access to an extended network of providers, urgent and emergency care, and telehealth options. Learn more about the extended network and how to access providers (PDF).

To find a provider: 

1. Go to the UPMC Health Plan website and select "Find Care."
2. Enter the member ID number to find participating providers specific to the member's plan and then select the "Find my plan" button.
   1. If the member does not have their ID number, they choose the "I'm Just Browsing" tab.
3. In the "I'm Just Browsing" tab, choose "Medical" or "Behavioral Health" and "My employer provides my health insurance" from the appropriate drop-down menus.
4. The member can search for a specific provider or practice name by choosing the "By their name" option or search by specialty.
5. Enter the zip code for the area, choose the mile radius, and select the "Search" button.
6. When searching for a zip code outside of the service area, a statement will display that states "The location you entered is outside UPMC Health Plan's service." Select the message that states "Find care outside UPMC Health Plan's service area."
7. The box will expand and display additional search options. Select the link that best matches your needs.

For assistance with finding a provider or facility in the Extended Network, please contact UPMC Member Services by calling 1-888-499-6885.

To find a pharmacy:

1. Go to the UPMC Health Plan website and select "Find Care."
2. If you are a member, select "I’m a Member" and enter your ID number. For members that do not have their ID number, select the "I'm Just Browsing" tab.
3. Select the kind of care you need (medical, behavioral health, dental, vision, home- and community-based services, or pharmacy). Select "pharmacy."
4. Select "My employer provides my health insurance" from the "How do you get your health insurance" dropdown menu.
   1. Members will not have this message displayed if they entered their UPMC member ID at the start of the search.
5. The member can search by pharmacy name or pharmacy type. Enter the place, address, city, or zip code where you want to receive services. Select the distance, and then select Search.

It's important for your dependents (up to age 26) to have access to the care they need and where they need it. UPMC Health Plan provides access to an extended network of providers, urgent and emergency care, and telehealth options. Learn more about the extended network and how to access providers (PDF).

Enrolled dependent children and adult dependents up to age 26 that live or attend school outside of Western Pennsylvania have full access to all UPMC-owned providers, the community-based doctors and hospitals in UPMC's Premium Network, and a national extended network. This national network is composed of the Cigna PPO Network for members who are outside of the UPMC Health Plan service area and not in Ohio, and the SuperMed PPO Network for members in Ohio. The Cigna PPO Network has more than one million health care providers and 6,100 hospitals.

To find a provider: 

1. Go to the UPMC Health Plan website and select "Find Care."
2. Enter the member ID number to find participating providers specific to the member's plan and then select the "Find my plan" button.
   1. If the member does not have their ID number, they choose the "I'm Just Browsing" tab.
3. In the "I'm Just Browsing" tab, choose "Medical" or "Behavioral Health" and "My employer provides my health insurance" from the appropriate drop-down menus.
4. The member can search for a specific provider or practice name by choosing the "By their name" option or search by specialty.
5. Enter the zip code for the area, choose the mile radius, and select the "Search" button.
6. When searching for a zip code outside of the service area, a statement will display that states "The location you entered is outside UPMC Health Plan's service." Select the message that states "Find care outside UPMC Health Plan's service area."
7. The box will expand and display additional search options. Select the link that best matches your needs.

For assistance with finding a provider or facility in the Extended Network, please contact UPMC Member Services by calling 1-888-499-6885.

To find a pharmacy:

1. Go to the UPMC Health Plan website and select "Find Care."
2. If you are a member, select "I’m a Member" and enter your ID number. For members that do not have their ID number, select the "I'm Just Browsing" tab.
3. Select the kind of care you need (medical, behavioral health, dental, vision, home- and community-based services, or pharmacy). Select "pharmacy."
4. Select "My employer provides my health insurance" from the "How do you get your health insurance" dropdown menu.
   1. Members will not have this message displayed if they entered their UPMC member ID at the start of the search.
5. The member can search by pharmacy name or pharmacy type. Enter the place, address, city, or zip code where you want to receive services. Select the distance, and then select Search.

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.

Employees traveling on an academic or work-related assignment can utilize a travel and security assistance protection plan through International SOS. Learn about this travel coverage and find other resources if you're traveling on the Coverage While Traveling page.

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• Parental Leave Staff Examples (via Sharepoint)
• Parental Leave Administrative Reference Guide (via Sharepoint) (for administrators only)