Retirees and their eligible spouses/domestic partners that are between the ages of 62 and 65 have two choices:
- Continue with the same coverage as active faculty and staff. You will continue to be responsible for your cost share which on average is 20% of the total cost, OR
- Start receiving the Defined Dollar Benefit (DDB) credits. The credits adjust annually. You may take the credits and purchase retirement coverage elsewhere or you may “bank” the credits for future use if you have other coverage. Please refer to the chart in the section titled Defined Dollar Benefit Program. DDB credits cannot be used to purchase active coverage through another employer.
- Spouses/domestic partners under age 62 are responsible for the full premium until cost sharing begins at age 62.
As a reminder, the medical plans offered to eligible spouses/domestic partners prior to age 65 are:
Panther Gold HMO
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 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*
*Coming soon!
Panther PPO
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*
*Coming soon!
Panther Basic PPO with HSA Option
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)
Retirees in the Panther Basic PPO plan can newly enroll, waive, or make changes to their HSA elections at any time throughout the year by contacting UPMC Member Services directly at 1-888-499-6885.
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.
| Contribution limit | 55+ contribution | |
|---|---|---|
| Single | $4,300 | +$1,000 |
| Family | $8,550 | +$1,000 |
^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*
*Coming soon!
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.
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.
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)* | Note: Premium rates follow Panther Gold plan rates
*Coming soon!
Listed below are a few examples of what usually takes place if someone retires prior to age 65:
- Many retired faculty and staff members who had University coverage prior to retirement continue with that same coverage until they reach age 65.
- Some retired faculty and staff enroll in a spouse/domestic partner’s employer’s plan. That spouse may be employed by the University of Pittsburgh or elsewhere.
- Some retired faculty and staff enroll in the active medical plan of another employer.
In examples two and three above, you are eligible to receive DDB credits if you have coverage elsewhere. The only exception is that you cannot obtain active coverage from the University of Pittsburgh and receive DDB credits at the same time.