Category Archives: UPMC Health Plan

Being Sick Isn’t Fun…Get Healthy

The Flu Is Sneaky

It follows you into classrooms, workplaces, airplanes, even movie theaters. Being sick and cold weather seem to go hand in hand. While the flu vaccine is not working as well as usual against the H3N2 virus, vaccination can still protect people and reduce hospitalizations and death, and it will protect against other flu viruses, according to the CDC.

At UPMC Health Plan, we want you, your clients, and their employees to stay healthy wherever they are. So protect yourself. Get your flu shot today. (And pass the word on to your clients.) To learn more, visit

Getting Medical Care Fast

UPMC AnywhereCare

Clients and their employees can e-visit a UPMC provider straight from their computer, anytime of the day or night.The service provides:

  • A personalized care plan and a prescription, if needed, from a UPMC provider – usually within 30 minutes.
  • Fast and convenient medical attention while cutting down on lost work time.

Individuals must be in the state of Pennsylvania at the time of their visit.

To learn more:

More Transparent Health Care with…

Medical Cost Estimator

  • Lets employees of your client know what their estimated cost will be for medical procedures.
  • It takes into account their plan and their most recent claims.
  • Lets employees see how cost varies by facility.
  • Log on to MyHealth OnLine to access the Medical Cost Estimator.

Treatment Adviser

  • Lets your clients’ employees 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.
  • Employees see what people who had the procedure thought of it.
  • It also shows what doctors think of specific treatments.
  • Log on to MyHealth OnLine to access the Medical Cost Estimator.

When members know all the treatment options – and their estimated cost – ahead of time, they make better, more informed decisions. More engaged employees can have a positive effect on your clients’ bottom line.

UPMC Shop Communications for Small Group

As mandated by the Centers for Medicare & Medicaid Services, UPMC Health Plan is required to notify both employers and members 90 days prior to their plan end date that their 2014 SHOP-eligible plan has been discontinued for 2015.
Therefore to ensure uninterrupted coverage for 2015, UPMC Health Plan is offering a comparable direct purchase plan as described in the renewal packets mailed to employers. These renewal packets provide information about changes being made to premiums, cost-sharing, and other specific plan details. Employers will be auto-enrolled in a comparable plan unless they choose to select a different plan.  For your convenience, we have attached copies of both letters that have been sent out for the last few months for your review:

UPMC Training Portfolio for 2-50 Employees

UPMC Healthplan is rolling out a new portfolio for employer groups with 2-50 employees for 2015.  The portfolio covers the following plan types:

  • UPMC Small Business Advantage
  • UPMC HealthyU
  • UPMC Consumer Advantage
  • UPMC Inside Advantage

Live training webinars will be held on Friday, October 3, from 9 AM to 10 AM and Thursday, October 9, from 1-2 PM.

Don’t miss this opportunity to learn details about our new plans and the following topics:

  • SHOP Marketplace
  • Affordable Care Act Updates
  • 2015 Networks


 After you register, login instructions will be sent.


Carriers Announce Fall Kick Off Seminars

Three of the area’s major carriers have announced dates and times of their Fall Sales and Strategy Sessions for the Broker Community.  Use the links below to register for the appropriate carrier’s session.

Highmark Fall Agency Strategy Session

October 14, 2014
8:00 AM to 9:00 AM Breakfast and Trade Show
9:00 AM Strategy Session

Pittsburgh Marriott North
100 Cranberry Woods Drive
Cranberry Township, PA 1606

UPMC Healthplan Fall Producer Kick Off

October 2, 2014
8:30 AM Registration and Continental Breakfast
9:00 AM – 12:00 PM Presentations

Marriott City Center
112 Washington Place
Pittsburgh, PA 15219


October 1, 2014
8:30 AM Registration & Breakfast
9:00 Presentation

Pittsburgh Marriott North
100 Cranberry Woods Drive
Cranberry Township, PA

PCORI Fee Explained

UPMC_HealthPlan_H_2C-selectionThe Patient-Centered Outcomes Research Institute (PCORI) was created by the Affordable Care Act (ACA). The PCORI funds independent projects that research, evaluate, and compare health outcomes and the clinical effectiveness, risks, and benefits of medical treatments and services.

In general, the PCORI fee applies to policy or plan years ending on or after October 1, 2012, through September 30, 2019, as outlined in the chart below


Policy or Plan Years Ending




$1 per covered life



$2 per covered life



$2 per covered life increased by projected per capita National Health Expenditures

The fee applies to coverage provided to active employees, former employees, and qualified beneficiaries, as well as to coverage provided under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), and to health reimbursement arrangements (HRAs) and flexible spending arrangements (FSAs) that are not treated as excepted benefits.

The fees for fully insured plans are built into renewals and will be remitted by UPMC Health Plan. Note: HRAs associated with medical plans may be considered separate self-funded plans, and the group must remit any fees for the HRA on their own. Federal regulations do not permit UPMC Health Plan to remit fees for self-funded plans, including HRAs.

UPMC Health Plan calculates the amount of covered lives with the snapshot method: The sum of the total number of lives covered on one date in each quarter (or equal dates each quarter) divided by the number of counts.

More information is available in the final regulations published by the IRS.