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.
Women's Health and Cancer Rights Acts
(HR4328, Public Law 105-277)
As required by law, listed below is a notice that must be distributed to all employees, retirees, and COBRA participants.
Under the University of Pittsburgh's health plans, coverage will be provided to a member who is receiving benefits for medically necessary mastectomy and who elects breast reconstruction after the mastectomy for:
Reconstruction of the breast on which a mastectomy has been performed
Surgery and reconstruction of the other breast to produce a symmetrical appearance
Treatment of physical complications of all stages of mastectomy, including lymphomas
This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same co-insurance and any applicable annual deductibles that apply for the mastectomy.
With the UPMC Health Plans, individuals experiencing fertility complications may be able to obtain infertility treatment based upon the provisions of their employers health plan. Infertility is defined as services provided to achieve pregnancy including monitoring and evaluation of the treatment plan. Individuals must use participating physicians to obtain coverage under the "Infertility Benefit Program."
Additional details about the list of authorized medications and benefits level are below. If you have specific questions regarding the level of infertility coverage or participating physicians, please contact UPMC Health Member Services at 1-888-876-2756.
|Fertility Testing Benefits Level
|Diagnosis and treatment up to diagnosis of infertility
||Covered in full
|Assisted Fertilization Procedures
||$250 copayment (medical procedures) $10,000 medical procedure lifetime benefit
|Infertility Prescriptions (Prescriptions must be dispensed from a participating pharmacy)
$10,000 prescription lifetime benefit 20% coinsurance on prescriptions
Authorized Prescription Drug List:
- Gonal F
- Clomphene Citrate