2017 Health Benefits
01 Network access 02 Your plan 03 Tools and features 2
01 Network access 3
PPO Premium Network The UPMC Premium Network is our broadest network. The UPMC Premium Network includes: • Providers in UPMC Health Plan’s 29-county service area • Most UPMC providers and UPMC-owned facilities • Many community providers and facilities 5
HMO Standard Network The UPMC Standard Network is our HMO referral product network. The UPMC Standard Network includes: • Providers in UPMC Health Plan’s 28-county service area • Most UPMC providers and UPMC-owned facilities • Many community providers and facilities 6
PPO Out-of-Area Network • 4,750 hospitals • 87,000 ancillary care facilities • 750,000 healthcare professionals • 163 hospitals • 14,033 primary care physicians • 54,122 specialist practitioners 7
Global Emergency Travel emergencies can Assistance happen anywhere, anytime. Assist America has you covered. • Medical Consultation, Evaluation, and Referral • Hospital Admission Assistance • Emergency Medical Evacuation • Medical Repatriation • Prescription Assistance • Care of Minor Children • Compassionate Visit • Lost Luggage and Document Assistance • Interpreter and Legal Referrals • Repatriation of Mortal Remains For more information About Assist America call 1-800-872-1414 or visit ww.assistamerica.com 8
Out-of-Area Coverage Dependent Children Living or PPO and HMO Attending School Outside Western PA Service Area • Have access to UPMC Health Plan’s extended network with Medical Mutual in Ohio and PHCS Multiplan in the remaining U.S. • HMO dependents do not need a specialist referral • Students may also use on-campus student health centers. • Parents do not need to notify UPMC Health Plan of student enrollment or residence outside western PA. • Emergencies are covered at the highest level, regardless of provider. • Public extended network provider directory at www.upmchealthplan.com/find. 9
Pharmacy Network More than 30,000 pharmacies nationwide 10
02 Your plan 11
Your plan Your 2017 Plan 2017 Premium Network 2017 Standard Network Plan Design PPO HMO $4,500 individual $3,000 individual Deductible $9,000 family $6,000 family $6,450 individual $6,450 individual Out-of-Pocket Maximum $12,900 family $12,900 family Out-of-Network Coverage Yes No Participating Providers Our broadest network Our HMO referral network Yes In-network specialist, Referrals Needed No diagnostic, or treatment services are not covered unless PCP provides referral Most Preventive Care* 100% covered 100% covered *Once enrolled, you can find a complete list of covered preventive services when you log in to your My Health OnLine account. 12
You will have a PCP to help guide and Benefits of an coordinate your care. HMO Your PCP is essential to ensuring that you get the care you need, when you need it. PCP selection is required You can make your PCP selection and include on your enrollment application, please include the PCP number Partnering with your PCP achieves two main objectives: • Maintaining your health • Improving your health 13
How to Select a PCP There are multiple ways to find and select a PCP. • Browse and filter providers on www.upmchealthplan.com • Select a provider in My Health OnLine • Call a Health Care Concierge 14
Finding a Provider www.upmchealthplan.com To see if your doctor or behavioral health provider is part of our network, use the directory search tool. 1. Place the cursor over Doctors 2. Click on Medical 1 2 15
Finding a Provider www.upmchealthplan.com/ find To see if your doctor or behavioral health provider is part of our network, use the directory search tool. 1. Select your type of care: medical, or behavioral health. 2. Type your current provider’s last name/practice name, or search by location. 16
Finding a Provider www.upmchealthplan.com/ find 3. Click the dropdown menu to select the following coverage type and plan name (optional). 4. If desired, filter by specialty, provider type, language, or gender. 5. Click the “Find Providers Now” button. 17
Finding a Provider www.upmchealthplan.com/ find To see if your doctor or behavioral health provider is part of our network, use the directory search tool. 18
Finding a Provider www.upmchealthplan.com/ find Providers may participate in the network at some, but not all of the locations at which they see patients. Example only. Not an actual provider. 19
Finding a Provider www.upmchealthplan.com/ find Providers may participate in the network at some, but not all of the locations at which they see patients. Example only. Not an actual provider. 20
How to Select a PCP Log in to MyHealth OnLine at www.upmchealthplan.com. 21
How to Select a PCP Call a Health Care Concierge Use the number on the back of your member ID card: • Monday through Friday: 7 a.m. to 7 p.m. • Saturday: 8 a.m. to 3 p.m. • Notify the Concierge that you are an HMO member Your Health Care Concierge has a list of all network doctors and can help you choose one. 22
PCPs and referrals Call a Health Care Concierge Notes on Referrals: • You do NOT need a printed copy • Referrals will last for 90 days • Referrals will not be required for: • Pediatric specialists • Ob-gyns • Mental health professionals • Emergency Care / Urgent Care Centers • Members under age 21 will not need a referral 23
PCPs and referrals You can access and view the referral in My Health OnLine. Your PCP can request a referral online via the provider portal. You’ll see those referrals in your account on My Health OnLine. 24
Transition of Care For new HMO members 60 day Transition of Care “grace period” established Specialist referral penalty will be waved for the first 60 days beginning January 1, 2017. Goal is to help create a smooth transition to the HMO plan 25
Wellness incentive Take a Healthy Step and earn rewards Wellness incentive HSA/HRA funding by the WPA CBOP • $500 individual • $1,000 family Take a Healthy Step requirements: • Biometric Screening • MyHealth Questionnaire • Earn 300 Take a Healthy Step points (excludes covered spouses) • Employee and spouse must complete by October 31, 2016 (for 2017 funding) 26
HSA and HRA Health savings account (HSA) • Both plan options have an HSA available • Administered by Keystone United Methodist Federal Credit Union (KUMFCU) Health reimbursement arrangement (HRA) • For those not eligible or not enrolling in the HSA • Provided and administered by UPMC Health Plan 27
03 Tools and features 28
On-the-Go Options UPMC Health Plan mobile app • Access your member ID card right when you need it, with a 4-digit pin or fingerprint ID • Contact your doctor, pharmacist, even the UPMC My Health 24/7 Nurse Line — instantly • Check a recent claim • View your HRA funding account balance • Chat with Member Services anytime you have questions via secure text Available for free in the iTunes App Store or Google Play 29
UPMC UPMC Health Plan members AnywhereCare can e-visit a UPMC provider, anytime day or night. Using UPMC AnywhereCare is as easy as 1-2-3. 1. Visit upmcanywherecare.com and answer a few simple questions. 2. A UPMC provider will review your symptoms. 3. You will receive a personalized care plan through email, typically within 30 minutes, including prescriptions, if needed Get fast and convenient medical attention, for less than the cost of a PCP visit. Treatment for up to 24 common conditions, such as: • Colds and flu • Coughs and sore throats • Urinary symptoms • Sinus infections Individuals must be in the state of PA or MD at the time of their visit. Prescriptions do not include controlled substances. 30
UPMC My Health Quick access to a registered nurse 24/7 Nurse Line 24 hours a day, seven days a week! When you call, you will get prompt and efficient service for: • General health advice • Information about a sickness or an injury (like a fever at 2 a.m.) Call the UPMC My Health 24/7 Nurse Line at 1-866-918-1591 . 31
Health and Wellness Engagement Tool My Health OnLine • A single place to access your benefits and other information • World-class customer service • Check your Take a Healthy Step status. 32
Transparency tools Medical cost estimator • Lets users know what their estimated cost will be for medical procedures • It takes into account their plan design and their most recent claims • Lets users see how cost varies by facility • To get results, users choose appropriate medical procedure, and estimator delivers appropriate results 33
Transparency tools Treatment adviser • Lets users see all of the treatment options for a particular medical condition • Provides crowd-source data similar to what many websites offer with customer ratings and reviews • Users see what people who had the treatment thought of it • It also shows what doctors think of specific treatments 34
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