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2017 Health Benefits 01 Network access 02 Your plan 03 Tools and - - PowerPoint PPT Presentation
2017 Health Benefits 01 Network access 02 Your plan 03 Tools and - - PowerPoint PPT Presentation
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
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Network access
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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
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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
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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
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Global Emergency Assistance
- 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
Travel emergencies can happen anywhere, anytime. Assist America has you covered.
For more information About Assist America call 1-800-872-1414
- r visit ww.assistamerica.com
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Out-of-Area Coverage PPO and HMO
- 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
- f 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.
Dependent Children Living or Attending School Outside Western PA Service Area
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More than 30,000 pharmacies nationwide
Pharmacy Network
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02
Your plan
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Your 2017 Plan
Your plan
Plan Design 2017 Premium Network PPO 2017 Standard Network HMO Deductible $4,500 individual $9,000 family $3,000 individual $6,000 family Out-of-Pocket Maximum $6,450 individual $12,900 family $6,450 individual $12,900 family Out-of-Network Coverage Yes No Participating Providers Our broadest network Our HMO referral network Referrals Needed No Yes In-network specialist, 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 MyHealth OnLine account.
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You will have a PCP to help guide and coordinate your care.
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
Benefits of an HMO
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There are multiple ways to find and select a PCP.
- Browse and filter providers on www.upmchealthplan.com
- Select a provider in MyHealth OnLine
- Call a Health Care Concierge
How to Select a PCP
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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
Finding a Provider
1 2
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www.upmchealthplan.com/find
To see if your doctor or behavioral health provider is part of our network, use the directory search tool.
Finding a Provider
- 1. Select your type of care: medical, or behavioral health.
- 2. Type your current provider’s last name/practice name, or search by location.
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www.upmchealthplan.com/find
Finding a Provider
- 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.
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www.upmchealthplan.com/find
To see if your doctor or behavioral health provider is part of our network, use the directory search tool.
Finding a Provider
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www.upmchealthplan.com/find
Providers may participate in the network at some, but not all of the locations at which they see patients.
Finding a Provider
Example only. Not an actual provider.
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www.upmchealthplan.com/find
Providers may participate in the network at some, but not all of the locations at which they see patients.
Finding a Provider
Example only. Not an actual provider.
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Log in to MyHealth OnLine at www.upmchealthplan.com. How to Select a PCP
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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.
How to Select a PCP
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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
PCPs and referrals
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You can access and view the referral in MyHealth OnLine.
Your PCP can request a referral online via the provider portal. You’ll see those referrals in your account on MyHealth OnLine.
PCPs and referrals
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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
Transition of Care
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Wellness incentive
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)
Take a Healthy Step and earn rewards
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Health savings account (HSA)
- Both plan options have an HSA available
- Administered by Keystone United Methodist Federal Credit
Union (KUMFCU)
HSA and HRA Health reimbursement arrangement (HRA)
- For those not eligible or not enrolling in the HSA
- Provided and administered by UPMC Health Plan
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03
Tools and features
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On-the-Go Options
- 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 MyHealth 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
UPMC Health Plan mobile app
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UPMC AnywhereCare
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
UPMC Health Plan members can e-visit a UPMC provider, anytime day or night.
Individuals must be in the state of PA or MD at the time of their visit. Prescriptions do not include controlled substances.
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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 MyHealth 24/7 Nurse Line at 1-866-918-1591.
Quick access to a registered nurse 24 hours a day, seven days a week!
UPMC MyHealth 24/7 Nurse Line
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Health and Wellness Engagement Tool
MyHealth OnLine
- A single place to access your
benefits and other information
- World-class customer service
- Check your Take a Healthy Step status.
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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
Transparency tools
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Treatment adviser
- Lets users see all of the treatment options for a particular
medical condition
- Provides crowd-source data similar to what many websites
- ffer 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
Transparency tools
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Beating the Blues US
™ Help for you and your family members who may be suffering from anxiety, stress, and mild depression.
Beating the Blues US
TM is included at no additional cost for UPMC Health Plan enrollees.
What it is
- Eight-session, self-directed, online
program that can be accessed 24-7.
- Based on cognitive behavior therapy,
developed by UK researchers, used successfully by people all over the world for more than 10 years.
How it helps
- Teaches skills that help you react more
positively and constructively to home and workplace stress.
- Easy, convenient, and confidential
- Helps you focus on success.
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