Medical Plans

2022 Benefits Open Enrollment

The 2022-2023 Benefits Open Enrollment period takes place April 27 through May 25, 2022. Visit openenroll.hr.pitt.edu to get started with enrolling in or making changes to your benefits, find the summary guide to benefits, and discover more resources.

Note: If you do not wish to make changes to your current benefits elections, no action is required. However, it is recommended that you proceed through the benefits enrollment process in Pitt Worx to ensure your elections are accurate.

COVID-19: Contacting the Benefits Department

In response to the COVID-19 pandemic, the Office of Human Resources has limited on-site support and is primarily working remotely. During this time, Craig Hall is not open to the public; walk-ins will not be accepted and forms cannot be dropped off in-person or faxed. During this time, we recommend submitting all requests and inquiries online in lieu of sending physical mail. For Benefits forms not completed online via Pitt Worx or DocuSign, please submit an inquiry online.

If you have a Benefits-related inquiry, including the submission of forms or documentation, the quickest way to receive assistance is to call the Benefits Department at 833-852-2210. You can also submit an inquiry at www.hr.pitt.edu/contact-ohr.

All information presented on this page, including links to plan documents and descriptions, is specific to the plan year of July 1, 2021 - June 30, 2022.

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.

Medical Plan Rates and Descriptions

View the current plan year’s rates (July 1, 2021 - June 30, 2022)

Panther Gold HMO

The most popular of Pitt's medical plans, Panther Gold HMO does not carry an annual deductible or co-insurance. Members are responsible for copayments except for wellness and preventative care services.

The Panther Gold plan meets the J1 Visa status requirements.

Note: If you live, or are planning to live, outside of the Western PA area, it is recommended that you do not select the Panther Gold Plan. 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 Oakland and Titusville campuses only | Schedule of Benefits | Summary of Benefits and Coverage (SBC) | SBC for MHSF

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

Panther Advocate PPO

The Panther Advocate PPO/HIA offers a broad array of health incentives that rewards members for making healthy choices. Health credits are placed in to a health incentive account (HIA) when members complete healthy activities. The credits in the HIA are then applied to offset out-of-pocket costs such as the deductible, coinsurance and prescription drug copayments.

The Panther Advocate plan meets the J1 Visa status requirements.

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

Panther Plus PPO

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

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

Panther Basic PPO

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). Learn more about HSAs in the "Health Expense and Savings Account" section of this UPMC FAQ.

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

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. 

Schedule of Benefits | Summary of Benefits and Coverage (SBC) | Premium Rates

UPMC and Wellness Resources

Find a UPMC Physician or Facility

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.

Obtain a Temporary Medical Card

If you need access to a temporary medical card, you can view or print one online. Learn how to obtain a temporary medical card.

You can also access your medical card from the UPMC Health Plan mobile app.

Wellness for Life Health Incentives

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.

Amplifon Hearing Health Care

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.

Coverage and Additional Documentation

Certificate of Coverage

The Certificate of Coverage establishes the terms of coverage for your health benefit plan. The Certificate of Coverage 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)

Employer-Provided Health Coverage - Form 1095-C

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.

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

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.

Hearing Aid Coverage for Dependent Children

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
http://www.chp.edu/our-services/audiology/patient-procedures/hearing-aids

Extended Network Coverage for Employees and Spouses/Domestic Partners

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.

To find a provider: 

  1. Go to www.upmchealthplan.com 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.
    • 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 www.upmchealthplan.com 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.
    • 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.

Extended Network Coverage for Eligible Dependent Children

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.

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 www.upmchealthplan.com 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.
    • 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 www.upmchealthplan.com 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.
    • 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.

Coverage While Traveling

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.

Additional Resources

Leave Guides

 

Please visit the Glossary of Terms page for commonly used medical terms and definitions.