Open Enrollment site now available on Infonet
Information about 2014 medical plan changes is available on Infonet, and with Open Enrollment beginning in just two weeks, make sure to review the Open Enrollment page on Infonet to learn about all of your benefit options.
You must actively elect the medical plan that best meets your needs. If you are currently enrolled in the Advantage HMO, Advantage PPO, or Open Access PPO, you and your enrolled dependents will automatically be enrolled in the Advantage Silver plan (excluding GME Residents and Fellows) for coverage effective Jan. 1, 2014. If you are enrolled in the Out-of-Area plan, you will automatically be enrolled in the new Out-of-Area plan. If you have waived medical coverage, you will remain without coverage unless you elect coverage during Open Enrollment.
Don’t forget that the following benefits must be elected each year:
- PTO Buy/PTO Sell*
- Health care flexible spending account (FSA)
- Dependent care FSA
You should also take this opportunity to review the following benefits to verify whether you need to make any changes to your current coverage:
- Life Insurance (make sure your beneficiaries are up to date)
- Voluntary benefits
- Savings Plan
If you have questions on any of the benefits, call UPMC DirectLink at 1-800-994-2752, and select the menu option that connects with the appropriate benefit representative.
*Directors may sell PTO with their manager’s approval. Vice presidents and above are not permitted to sell or donate PTO.
People Like You
Understanding other people’s circumstances is a good way to think about which UPMC medical option is the right one for you. Included in this issue of Your Benefits, Your Choice ia a fictional profile of a family. You will see the medical plan option they selected and find out if the plan selected was appropriate for the medical services they used during the year. Read the scenario carefully — it may help you evaluate your options and make the choice that is best for you, because it’s Your Benefits, Your Choice.
Previous issues of this newsletter contained other People Like You profiles and these stories can now be reviewed on Infonet.
Age: 44 Dependents: Spouse Ron, age 47, daughter Abigail, age 18, and son Thomas, age 15
- Active family
- Has ongoing care for high blood pressure and diabetes
Health Care Considerations
- Susan’s spouse Ron has high blood pressure and son Thomas has diabetes.
- Susan makes sure that her family members treat their conditions by following up with doctors and specialist appointments for ongoing care.
- Susan schedules everyone in her family for preventive services, which are covered at 100%.
- She also completes her Take a Healthy Step (TAHS) requirements in advance of the November deadline. She doesn’t want to pay any extra amount toward her annual deductible. Susan enjoys attending occasional Lunch and Learns that her hospital sponsors. She has learned many healthy practices by going to these events, while accumulating deductible credit dollars to complete her TAHS requirements
Medical Plan Considerations
The medical service Susan and her family uses most often is filling prescription drugs. Ron is on two daily maintenance medications for his high blood pressure, and Thomas uses insulin pens to control his diabetes. They both follow up with their specialists several times a year, and they both have several laboratory tests done during the year. Susan and Abigail are fairly healthy, and their medical services are mainly preventive.
Susan is in Benefit Band B and, after evaluating the three medical options and how her family utilizes medical services, has decided to try the Silver Option this year. She knows that she will have the prescription drug and doctor visit copays, and the laboratory testing that Ron and Thomas have during the year will be applied to her deductible, so she has decided to put $60 per pay ($1,560) in a health care FSA, which should cover most of her family’s medical expenses.
Advantage Silver, with $1,560 health care FSA.
Did Susan choose the right plan?
Let’s fast-forward to the end of 2014 and see if the Advantage Silver met Susan and her family’s medical coverage goals. Susan wanted the lowest amount coming out of her paycheck and she knew that most of her services would consist of copays, along with some laboratory and diagnostic testing that would be applied to her deductible.
Since the Advantage Silver option had lower per-pay deductions, she paid $1,536 less for her family’s coverage than the Advantage Gold medical option. She was comfortable contributing $60 per pay ($1,560 for 2014) to a health care FSA. She knew with all of her copays and deductible expenses that she would be able to pay for a portion of her out-of-pocket costs with her FSA, while taking advantage of this pre-tax benefit and reducing her taxable income at the same time.
The Advantage Silver plan with a health care FSA met Susan’s needs, and provided her family with the lowest total costs for their medical plan and services received.
|2014 Estimated Costs||Advantage Silver
Benefit Band B
Benefit Band B
|Annual Amount Deducted from Susan’s Paycheck||$744||$2280||$2340|
|Susan’s Estimated Out-of-Pocket Costs||$3082||$2306||$4243|
|Minus Health Savings Account (HSA) Employer Contribution Dollars||N/A||N/A||($2000)|
|Susan’s Estimated Total Costs *||$3826||$4586||$4583|
|Amount the Plan Pays on Susan’s Behalf||$6036||$6812||$4875|
|Advantage HSA – Susan’s Health Savings Account|
|UPMC HSA Employer Contribution||$2000|
|Expected remaining HSA balance
(after estimated out-of-pocket costs)
|Susan’s contribution needed to cover current year estimated out-of-pocket costs||$2243|
|Maximum additional employee contribution allowable in 2014||$4,550|
*Estimated costs do not include a health care FSA or HSA contribution by Susan
Don't wait to Take a Healthy Step
Over 47% of your co-workers have already earned the 2014 maximum medical plan deductible credit of $1,000 for individual and $2,000 for family coverage. Do you know if you have met all your requirements? Here’s the path to find out your current Take a Healthy Step status: My HUB > Human Resources > MyHealth OnLine > MyHealth Central.
Some of the healthy step activities take time to complete, so you need to take action now and not wait until right before the Nov. 13 deadline. With the medical plan changes, it is even more important to make sure you are receiving the maximum credit to lower your deductible next year.
You will not receive any credit, including a partial deductible credit, unless you complete the:
- MyHealth Questionnaire (if not done since Dec. 1, 2012)
- Biometric screening (if not done since Dec. 1, 2008)
To receive the maximum deductible credit, you must earn additional credit dollars by completing Healthy Step activities:
- Individual coverage, earn $600 deductible credit
- Family coverage, earn $700 deductible credit
Learn more by accessing the Take a Healthy Step pages on Infonet. Flu shot clinics are being held during most benefit fairs, so stop in to get a flu shot and earn $300 deductible credit!
Payroll deductions for medical and vision plans
The chart below provides a side-by-side comparison of the new 2014 medical and enhanced vision plan per-pay deductions for full-time employees on a biweekly and monthly basis. Remember, the Standard Vision plan is included with all medical plans. You have the ability to waive medical coverage and purchase the Enhanced Vision as a stand-alone benefit during Open Enrollment. Part-time rates are available in the Open Enrollment section on Infonet.
Biweekly Payroll Deductions
|Full-time, Flex full-time|
|Plans||Employee Only||Employee & Children||Employee & Spouse/DP||Employee & Family|
|Advantage Silver with Standard Vision||$10.62||$20.77||$26.77||$28.62|
|Advantage Gold with Standard Vision||$33.23||$63.23||$82.15||$87.69|
|Advantage HSA with Standard Vision||$42.00||$84.00||$85.85||$90.00|
|Out-of-Area PPO with Standard Vision||$41.54||$78.46||$101.54||$108.92|
|Additional Cost for Enhanced Vision with Medical||$1.78||$2.64||$3.29||$4.23|
|Enhanced Vision Only - No Medical||$4.46||$6.39||$8.18||$10.47|
Monthly Payroll Deductions
|Full-time, Flex full-time|
|Plans||Employee Only||Employee & Children||Employee & Spouse/DP||Employee & Family|
|Advantage Silver with Standard Vision||$23.00||$45.00||$58.00||$62.00|
|Advantage Gold with Standard Vision||$72.00||$137.00||$178.00||$190.00|
|Advantage HSA with Standard Vision||$91.00||$182.00||$186.00||$195.00|
|Out-of-Area PPO with Standard Vision||$90.00||$170.00||$220.00||$236.00|
|Additional Cost for Enhanced Vision with Medical||$3.86||$5.72||$7.13||$9.16|
|Enhanced Vision Only - No Medical||$9.66||$13.84||$17.72||$22.69|
Dependent children living or learning outside of Western Pennsylvania
If you live in the UPMC Advantage network service area, but your covered dependent child lives or is attending school elsewhere, contact the UPMC Health Plan Health Care Concierge team at 1-888-876-2756 for assistance. Your child can be designated as an out-of-area dependent or a full-time student.
Dependent children designated as living out-of-area may access providers that participate with Medical Mutual/Super MED (in Ohio) or PHCS MultiPlan, Inc. (in all other states) to receive benefits. A participating doctor or facility may be selected through www.upmchealthplan.com.
Don’t forget that emergency care is covered at any facility at the highest level of benefits, if you have a life-threatening emergency medical situation.
Medical plan calculator now available
If you are looking for a tool to help you decide which of the 2014 medical plan options you will elect for you and your family during Open Enrollment (Oct. 30 – Nov. 13), you need to know that the Medical Plan Calculator is now available!
The medical plan calculator will help you estimate your out-of-pocket costs plus your annual payroll deductions and help you better understand the medical option that balances your health care needs and your budget.
Important note: Entering dependent information into the Medical Plan Calculator DOES NOT enroll your dependents in your UPMC benefits. Your dependents are added to your benefit selections only when you make selections during your My HUB enrollment session and you check the box next to their name.
Follow this path to access the Medical Plan Calculator:
My HUB > Human Resources > Medical Plan Calculator (under My Benefits).
You may go to the MyHealth OnLine website and click on “Your Spending and Claims” then the “Medical Claims/EOBs” or “Pharmacy Claims” tabs to view your historical medical and pharmacy claim information.
MyHealth OnLine — Confirming your information
In an effort to review and update your Primary Care Physician (PCP) information, the next time you enter MyHealth OnLine, will you see a screen similar to this image requesting you to confirm your (PCP). Your PCP serves as your main point of contact for medical care. A PCP typically provides basic medical care and coordinates and supervises other care. A PCP is usually a general or family care practitioner, or in some cases, an internist, pediatrician or ob-gyn. PCPs can provide referrals for specialist care and other medical services, although referrals are not required with the UPMC medical plan options.
Although the new 2014 medical plan options do not require you to select a PCP, it is strongly recommended. PCP information will be included on your Health Plan ID card. The 2014 medical options require you to receive care from network physicians and facilities in order to be covered. Remember, you must use the Advantage Network,* which includes UPMC-owned and affiliated hospitals and facilities to receive the highest level of benefits, and your physician must participate with the UPMC Health Plan network.
*Excludes those enrolled in the Out-of-Area medical option.
Helpful tools to evaluate the Health Savings Account (HSA)
HSA Account Toolkit calculators to estimate:
With all new medical options being offered in 2014, it is important to make sure you understand each plan before you make your Open Enrollment (Oct. 30 – Nov. 13) election. The Advantage HSA medical option includes an HSA, which has an initial UPMC contribution of $1,000 for individual and $2,000 for any other coverage level. Don’t forget that the 2014 IRS maximum allowed contribution to an HSA, including the UPMC initial contribution, is $3,300 for individual and $6,550 for any other coverage level.
Your long-term goal may be to save now on a pre-tax basis for future health care expenses. However, you may still have some unanswered questions and want to review more information.
You can access the HSA page on Infonet, where the HSA Account Toolkit has many resources for you to learn more.
your health care FSA balance by Dec. 31
If you are considering enrolling in the Advantage HSA medical plan and are currently enrolled in a health care FSA, you must exhaust your 2013 health care FSA balance prior to Dec. 31, 2013, in order to begin your HSA on Jan. 1, 2014. Your FSA account must reflect a zero ($0) balance at the end of 2013. If it has a balance of any amount and you elect the Advantage HSA for 2014, you will be prohibited from contributing to or receiving any funds from UPMC into your HSA until April 1, 2014, due to IRS regulations. Furthermore, health care expenses that you and your family incur between Jan. 1, 2014 and March 31, 2014 will not be eligible for reimbursement from your HSA.
Understanding your medical bills
It can be confusing to get more than one medical bill after a single trip to the hospital, or after outpatient surgery. Be aware that this is standard procedure.
To ensure you’re prepared the next time it happens, be sure you know how the billing process works. Let’s say you have to be admitted to the hospital for a procedure that requires a two-day stay. Several weeks later, you receive the hospital bill in the mail. This bill covers the cost of your room, meals, nursing care, tests, medications, therapy, and other standard services.
You may also receive bills from physicians, anesthesiologists, clinical professionals, ambulance services, and others who provided services during your stay. These people are usually not hospital employees.
Four common scenarios that require multiple billings
After outpatient surgery, you may receive a bill from:
- The facility where the surgery was done
- The surgeon
- The anesthesiologist who put you under
- The lab where your biopsy was sent
After an MRI, you may receive a bill from:
- The facility where you received the MRI
- The radiologist who read the results
After an ambulance ride to the hospital, you may receive a bill from:
- The ambulance service
- The emergency department doctor
- The hospital
- The radiology lab where your x-rays were sent
- The medical equipment supplier if you receive a brace or cane
After a visit to the hospital where you saw a specialist doctor, you may receive a bill from:
- The hospital
- The specialist doctor
- The lab that processed your blood work
Keeping track of your medical bills
When a medical bill arrives, it’s important to remember the following:
- Read the bill carefully to see which provider it came from.
- Realize that you may be billed by providers you only saw briefly — or not at all. For example, you may not meet with the radiologist who reads your x-ray.
- Verify the bill is accurate. For instance, be sure the dates on it match the dates you were in the hospital.
On rare occasions, there may be a billing error. If you think something is amiss or you have a question about a particular charge, call the provider who sent the bill.
Benefit fairs taking place at many locations
Open Enrollment (Oct. 30 to Nov. 13) is your annual opportunity to make benefit elections. It is especially important this year with all new medical plan options that begin on Jan. 1, 2014. The UPMC benefit fairs are a great place to ask questions, learn, and talk with experts about your benefits at UPMC. As a UPMC employee, you are welcome to attend any fair at one of the many locations at your convenience now through early November.
Take this opportunity to learn more about:
- 2014 medical plan options
- Other UPMC-provided benefits
- New UPMC Savings Plan retirement help options
- Voluntary employee benefits
Many fair locations will also offer free flu shots. Flu shots not only help protect you, your family, co-workers, and patients from influenza, but also are an easy way to earn 300 deductible credit dollars toward your 2014 Take a Healthy Step requirements.
Listed below are the remaining fairs that will be held between Oct. 17 and Nov. 4.
- Thursday, Oct. 17 — 7 a.m. to 5 p.m.
UPMC Presbyterian, Starzl Biomedical Science Tower Lobby
- Friday, Oct. 18 — 7:30 a.m. to 4 p.m.
UPMC Passavant, Assembly Hall
- Monday, Oct. 21 — 7 a.m. to 4 p.m.
UPMC Heritage, Dining Room, Main Entrance
- Tuesday, Oct. 22 — 7 a.m. to 4 p.m.
UPMC Northwest Courtyard Conference Center
- Wednesday, Oct. 23 — 7 a.m. to 4 p.m.
UPMC Canterbury Place, Solarium, Floor 1
- Thursday, Oct. 24 — 10 a.m. to 2 p.m.
UPMC South Side Distribution Center/Employee Transit, South Side Distribution Center Lunch Room
- Friday, Oct. 25 — 10 a.m. to 2 p.m.
UPMC Hamot, Employee Dining Area and Ground Floor Conference Rooms
- Monday, Oct. 28 — 7 a.m. to 4 p.m.
UPMC Mercy, Clark Auditorium
- Tuesday, Oct. 29 — 8 a.m. to 4 p.m.
Quantum One, Conference Room
- Wednesday, Oct. 30 — 8 a.m. to 3 p.m.
UPMC McKeesport, Kelly Conference Center
- Thursday, Oct. 31 — 7:30 a.m. to 4 p.m.
Children’s Hospital of Pittsburgh of UPMC, Rangos Auditorium
- Friday, Nov. 1 — 10 a.m. to 4 p.m.
Arnold Palmer Pavilion – Mt. View, Stacey Feiling Conference Room
- Monday, Nov. 4 — 7 a.m. to 3:30 p.m.
UPMC St. Margaret, Conference Centers A, B, and C, First Floor