Monthly Archives: January 2014

UPMC Correction to Creditable and Non-Creditable Coverage Letters

The letter below will be issued to groups who have received an incorrect notice.  BNGA has requested a list of impacted clients and will outreach to the appropriate agencies upon receipt.  Letters are scheduled to be sent from UPMC to the clients no later than January 27th, 2014. For additional information regarding employer responsibility and creditable coverage click here.

Dear Valued Customer:

UPMC Health Plan inadvertently sent incorrect information to you regarding your creditable or non-creditable prescription drug coverage. This mailing, which you received sometime in the past two weeks, included a letter and a Centers for Medicare & Medicaid Services (CMS) model language document.

Please disregard the documents that you previously received. A corrected package of information is included with this letter. If you already shared the earlier information with your employees, please make sure you share the corrected information as well.

We apologize for any inconvenience this error may have caused. If you have any questions, please contact your account manager.


UPMC Health Plan



UPMC SHOP Process Clarification

There are two distinct processes involved in taking advantage of your small business tax credit.  This tax credit is currently the only clear advantage to utilizing the SHOP.

For more details on tax credit eligibility click hereIf you or your client feel they are eligible for the tax credit they will need to get an official eligibility determination from the SHOP Marketplace.  In order to apply for the Small Business Healthcare Tax Credit use the application below.

SHOP Health Coverage Application for Employers.

 If your contact information is contained in Step 3 of the application you will have the ability to check on the status of the determination.  The final notice of eligibility is provided to the group directly.

If your client is eligible for the tax credit, in order to claim it, the group must be enrolled in a SHOP eligible plan. The credit will be claimed on their 2014 federal income tax return. The employer will need to have their SHOP eligibility notice from the SHOP Marketplace in order to do so.

For specific questions regarding tax credits and eligibility please advise your client to speak with a tax professional.

The UPMC SHOP Eligible plans are as follows:

  • Premium Platinum $25 – PPO Platinum 25 RX 8/38/76/95
  • Enhanced Bronze $3500 – EPO Bronze 3500 RX 8/38/76/95
  • Enhanced Bronze $4500 -EPO Bronze 4500 RX 8/38/76/95
  • Enhanced Bronze $5500 – EPO Bronze 5500 RX 8/38/76/95
  • Enhanced Silver $1500 – EPO Silver 1500 RX 15/45/90/50%
  • Standard Platinum LoCap $750 – HMO Platinum LoCap 750 RX 8/45/90/50%
  • Standard Gold $1000 – HMO Gold 1000 RX 15/45/90/50%
  • (InsideAdvantage) Premium Silver $5000 – IA PPO RX 8/38/76/95
  • (InsideAdvantage) Premium Platinum $500 – IA PPO Platinum 500 RX 8/38/76/95
  • (InsideAdvantage) Premium Platinum$1250 – IA PPO Platinum 1250 RX 8/38/76/95

 After the webinars last week, we were alerted to some additional UPMC plans that appear as SHOP eligible on the website. UPMC has confirmed they are working to deliver more information on these products, including pricing and plan descriptions.

  • Prmium Gold $1000 (90%)
  • Enhanced Gold $2000 – EPO Gold 2000 RX 8/38/76/95
  • Standard Silver $3000 – HMO Silver 3000 RX 15/45/90
  • Premium Platinum $40 – PPO Platinum 40 RX 38/76/95
  • Premium Platinum $250 $10/$40  – PPO Platinum 250 RX 8/38/76/95
  • (HealthyU) Rewards Rx HSA Silver $2000 – EPO Silver HIA Healthy U $2000/75% RX 8/38/76



  • New business – Go through the normal BNGA quoting and enrollment process.
  • Renewing Groups – Plan rates will appear on the client’s renewal rate page.

Small Business Tax Credits

We have had many questions recently about how a business can qualify for a small business tax credit that may offset a portion of healthcare premiums.   We have compiled information below  from the IRS in the hopes of simplifying the process for you.*

Tax Credits

The maximum tax credit available for tax years 2010 through 2013 is 35 percent of premiums paid for small business employers and 25 percent of premiums paid for small tax-exempt employers such as charities.

For tax years beginning in 2014 or later, there will be changes to the credit:

  • The maximum credit will increase to 50 percent of premiums paid for small business employers and 35 percent of premiums paid for small tax-exempt employers.
  • The credit will be available to eligible employers for two consecutive taxable years.

Businesses that are eligible for the tax credit :

  • have fewer than 25 full-time equivalent employees
  • pay an average wage of less than $50,000 a year, and
  • pay at least half of employee health insurance premiums

In order to qualify for the tax credit, a business must offer their employees a SHOP qualified health plan. These are available from both UPMC and Highmark in Western PA .  The business must also meet the following guidelines:

  • Have a primary business address within the state where you are buying coverage
  • Have at least one common-law employee

The application to see if you are eligible for the tax credit is fairly simple,  It asks only some basic information about your business and your employees.  There is no financial information required.  You can download it here. SHOP Health Coverage Application for Employers

If it is determined you are eligible for a tax credit, contact a benefit adviser at 724 940 9400 for help selecting a SHOP qualified plan.   As always, please seek the advice of a professional tax adviser for details on tax planning.  Benefits Network Consultants are not tax professionals.



Individual Health Insurance Enrollment Fair – Community Library of Allegheny Valley – January 28, 2014

Call 724 940 9490 to Reserve a Time or Walk In Anytime 11:30 AM – 6 PM

For More Information Click on the Flyer Below.

Individual Health Insurance Enrollment Fair