Pitt employees may choose among four medical benefit plans offered by UPMC Health Plan, including a 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, including wellness and preventative-care benefits and the same Prescription Drug Program.
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
Visit mytaxform.com/form-1095-decoder to 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 www.irs.gov or www.healthcare.gov to learn more.
Please visit this page for more information about the Form 1095-C.
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
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
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. Please refer to the following list of frequently asked questions to understand how to access care and to find a variety of ways to contact UPMC and Assist America.
To find a provider:
- Go to www.upmchealthplan.com and select "Find Care."
- Enter the member ID number to find participating providers specific to the member's plan and then select the "Find my plan" button.
- If the member does not have their ID number, they choose the "I'm Just Browsing" tab.
- In the "I'm Just Browsing" tab, choose "Medical" or "Behavioral healt" and "My employer provides my health insurance" from the appropriate drop-down menus.
- The member can search for a specific provider or practice name by choosing the "By their name" option or search by specialty.
- Enter the zip code for the area, choose the mile radius, and select the "Search" button.
- When searching for a zip code outside of the service area, the member will see a message in a gray box that states "Find care outside UPMC Health Plan's service area."
- Select the down arrow in the gray box to expand the menu and then choose "All Other Members: Care Outside Western PA and Ohio."
- This will direct the user to Multiplan's search. Note, when using Multiplan/PHCS, providers always verify with the office if the specific doctor and practice are still participating."
- Enter the specialty, facility name or provider name, and the zip code to begin your search.
Review additional screenshot instructions to search within the PHCS/Multiplan.
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.