UPMC Health Plan Renewals

Renewing Your UPMC Clients

Please refer to the appropriate Benefit Plan Summary Brochures of the applicable helpful hintsplatform (non-ACA compliant vs. ACA) for compliance requirements and business rules on multiple plan offerings & participation.  If your group has a dual option in place currently, they may renew the dual offering with a maximum of two plan choices.   If you do not have a dual offering in place currently, depending on group size, you may still be eligible to put a dual offering in place.  Please call or email Melinda Baronetski with these requests.

If a group is eligible & wishes to offer multiple plans, please indicate on the renewal rate sheet,  the plans selected and the following information.

  • The UPMC Benefit Election Form for each employee enrolled
  • If the client is offering two or more plans, confirmation of  any change to the membership is required.

Small groups that do not submit renewal changes will be auto-renewed with their current medical (or mapped coverage if the current plan is unavailable to renew) plan design 30 days prior to renewal.  If a client will be making a change in plan design please notify us as soon as possible to request the group not be auto-renewed. UPMC will not permit any plan changes after the plan effective date.   Note:  If the group does not offer medical benefits and has stand alone supplemental benefits in place, a signed renewal copy is required. Stand-alone supplemental plans will not be auto-renewed.

upmc docFor groups who may be considering an HMO plan: members must choose an in-network Primary Care Provider (PCP). Please have the members indicate their PCP here on the UPMC Benefit Election Form

  • Note: If members do not choose a PCP for referrals, the health plan will assign one to them.  Because out of network providers are not covered, it is important to make sure all providers and specialists are in-network.

Clients utilizing BenefitWallet for current HSA administration: Benefit Wallet will no longer be the administrator of employee HSA accounts. At renewal clients will have an option that waives maintenance fees for participants. This new option is called UPMC ConsumerAdvantage.  If they wish to utilize UPMC ConsumerAdvantage please have the HSA Group Set Up Form completed by the company.  Also, the roll over form for employees is needed if they are transferring funds from Benefit Wallet to ConsumerAdvantage.  Employees do not have to move their accounts from Benefit Wallet to UPMC ConsumerAdvantage, but if they do not, any Benefit Wallet maintenance fees would be applicable.

Clients utilizing an HRA will need to submit an updated HRA Group Set Up Form.

Non-ACA Renewal Process

UPMC does not automatically include their 100% Consumer Driven options as alternatives on the non-ACA compliant renewals.  When you see plans listed that have an HRA or HSA in their title, they are most likely a part of the HealthyU product line that involves coinsurance of 90% or 80%. If you are seeking pricing for one of the following options, please outreach to our office & we will request rates from the carrier:

  • HRA $1250_100% (15/3050Rx not subject to deductible)
  • HRA $2500_100% (15/3050Rx not subject to deductible)
  • HSA $1300_100% (15/3050Rx after deductible is satisfied)
  • HSA $2500_100% (15/3050Rx after deductible is satisfied)

ACA Renewal Process

There is one pharmacy options available under UPMC’s ACA plans. It is:rx

  • $10/$40/$75/$95

Please refer to the 2017 product portfolio in your renewal email for additional information.  You will notice while reviewing the benefit summary guide the two networks are Standard (HMO) & Premium (EPO & PPO).

Supplemental Coverage

If supplemental coverage is not currently offered and is selected at renewal, New Applications will be needed for participants to be enrolled . Use this UPMC Benefit Election Form

dentalUPMC has made a change regarding dental. Groups that do not carry supplemental coverage for their employees currently are only eligible to elect a plan that does not include Orthodontic coverage.  Renewal rates include all of the non-ortho plans.  Previously these groups were only eligible to enroll in a Basic dental offering for the first 12 months

If your client does carry dental and is considering UPMC for replacement coverage, please let us know if you would like to see  rates for the plans with Ortho coverage. These rates can be requested from the Underwriting department for your review.

Vision Care

  • UPMC has partnered with NVA to offer a new competitively priced national network vision program.
  • Vision Care rates are included on renewal emails.  Please review  the ACA Benefit Plan Summaries.

Dental Discount 

  • UPMC’s discount program is available for groups with either a standalone plan option or along with the Basic Dental Advantage offering.  See the Dental Discount Brochure.

SHOP Tax Credit Eligible Plans

marketplace for small busEmployer groups eligible to receive the small business tax credit would need to enroll or renew via HealthCare.Gov.

 

  • Once the group has successfully enrolled in SHOP coverage a new group number will be issued.
  • If a client is not SHOP tax credit eligible or does not need to take advantage of the multi-carrier option, it will be most beneficial to renew coverage direct through the carrier rather than the Marketplace.

All completed renewals may be returned to Melinda Baronetski via email at  mbaronetski@benefitsnetwork.biz