UPMC Health Plan Latest Updates
The American Rescue Plan Act of 2021 Signed Into Law
Waivers Extended for In-Network Telehealth Visits and Inpatient COVID-19 Treatment
COVID-19 Vaccines at UPMC – Vaccine Information & Updates
UPMC Client Communications – Introducing the UPMC Small Group Help Line
The UPMC Account Management Department has been restructured for groups 1-99.
- New segments have been developed based on group size (1-5, 6-50, 51-99) with a dedicated UPMC Account Manager in each segment.
- Client letters are being mailed by the carrier to introduce the changes.
- For details on how your UPMC Clients’ Account Managers may have changed, contact your NFP-BNGA team.
UPMC COVID-19 Vaccine Information – issued directly to UPMC Employer Group Clients
UPMC has resurfaced their initiative to change how claims are adjudicated for clients that fall under 20 employees (with Medicare deemed Primary). The following resources have been shared by UPMC.
- UPMC Producer update: Medicare Secondary Payer Rules Notice
- UPMC Medicare Secondary Payer Frequently Asked Questions
UPMC Clients with 20 or fewer participants on their UPMC coverage are being contacted by UPMC via email or mail to notify them of their current Medicare Primary status and how it can impact Medicare eligible members. In the communication, clients are provided guidance to attest (via online link) the Medicare Primary status if they have 20+ employees. The attestation is the way to appeal for adjustment to Medicare Secondary Payer status in the system. Be on the lookout for more on this topic from our NFP-BNGA Group & Medicare Team.
UPMC COVID-19 Employer FAQs including Vaccine Details
UPMC extends leniencies due to COVID-19:
- Out-of Pocket Cost Waivers for Telehealth Visits and COVID-19 Treatment through 2/28/2021
- Eligibility Requirements relaxed for furloughed and laid-off employees through 3/31/2021
- Credit Cards Fees and Reinstatement Fees waived through 3/31/2021
UPMC 2021 Underwriting Guidelines have been released and are available for download
- 1-50 Compliance Guidelines (ACA)
- 51+ Underwriting Guidelines
- Dental & Vision 1-50 Underwriting Guidelines
- Dental & Vision 51+ Underwriting Guidelines
- Self-Assure Underwriting Guidelines
UPMC Your Choice & Advantage Choice Formulary Updates effective January 2021
Important Changes to UPMC Health Plan Billing and Administration!
Billing (November 10th onward)
- New Business: UPMC Announced automatic set up into the UPMC Electronic Billing Program. Client Online Account Administrator (OAA) access to Employer OnLine must be created to access first (and subsequent) monthly billing or to take action to opt out for paper invoicing.
- Existing Business: Automatic enrollment of existing clients into the Electronic Billing Program will result upon first access of the Employer Portal ACI billing tab after November 10th. If a group wishes to continue receiving paper statement, they must opt out via the system.
Support (December 1st onward)
- UPMC Account Management will no longer provide ID Rosters upon request. Client Roster details for existing groups will only be accessible through the Employer OnLine Portal
- Client Authorization steps are required for groups that are seeking support from the NFP-BNGA Team via the Employer OnLine system.
We have solutions to assist in navigating the changes above and to provide continued support for you and your clients. Be on the lookout for upcoming outreach from our team to discuss your book of business and how we can help.
Did you miss UPMC’s COVID-19 Surge: The Importance of Behavioral Health Webinar? Watch the recorded version here.
- The Treasury Department and the IRS Announce Deadline Extensions for ACA Reporting Requirements
- UPMC details new distribution method of forms to recipients & Employer Reporting availability
Sam’s Club Pharmacy To Continue Participating in Express Scripts National Network
UPMC Health Plan Further Expands its Sempre Health Partnership to Better Serve Patients with Diabetes
Bonus Info – UPMC Announces the Triple Advantage Bonus Program (eligible for prospects with 51+ enrolling employees) 1/1/2021 through 7/1/2021 Eff. Dates. Note that payouts are available (for a Quoting Component and presenting in tandem with a UPMC Representative) regardless of whether the group ends with a UPMC sale.
UPMC Health Plan is Moving to Electronic Billing – important information announced regarding Electronic billing requirements for new business and eventual requirement for existing clients to enroll in the electronic payment program.
As we await the release of January 2021 Renewals & New Business Rates, guidance for UPMC’s 2021 Plan Portfolios is available in the following:
- UPMC 2021 Small Group Market (2-50 ATNE) Portfolio
- UPMC 2021 Mid Market (51+ ATNE) Portfolio
- UPMC Resource – 2020 to 2021 plan changes
Did you miss UPMC’s Mid Market (51+) Total Advantage Producer Webinar? Watch the recorded version here.
UPMC’s Latest COVID-19 related Resources:
- Getting the Flu Shot Is More Important Than Ever (Resources for Why/How/Where)
- Frequently Asked Questions About the Flu Shot
- UPMC, Pitt Develop Potential Anti-COVID-19 Drug from Antibody Component
- How to Handle Crisis Fatigue
- High-Risk Halloween: Can You Safely Trick-or-Treat During COVID-19?
- 5 Simple Tips to Stay Moving at Home
Extended Eligible Employee Flexibility through December 31, 2020: UPMC Health Plan is continuing to relax their requirement that employees be actively working to be eligible for coverage and will allow groups to continue coverage for temporarily laid-off or furloughed employees. Groups must continue to pay all monthly premiums and this coverage must be offered to impacted employees on a uniform, non-discriminatory basis. Before making plan eligibility changes employers should discuss implications with their tax and benefit advisors.
In addition to relaxed eligibility rules, the following fees will continue to be waived through December 31, 2020:
- Credit Card Payment Fees for Employer Group Monthly Premium
- Reinstatement Fees for clients that are termed for billing purposes with a termination date through 12/31/2020. (Fee waived for Reinstatement action taken within 30 days of the termination)
Listen to the latest UPMC COVID-19 Preparedness Press Briefing (Recorded 9.15.2020) – Pitt and UPMC Experts Share Promising Breakthrough in COVID-19 Drug Development
View UPMC Health Plan Flu Season Resources:
- UPMC Employer Communication – Planning for flu season
- UPMC Workpartners Onsite Flu Clinic Flyer
- UPMC Health Plan Onsite Flu Clinic Request Form
UPMC Announces UPMC Total Advantage (be on the lookout for training webinars coming soon)
UPMC Health System holds Coronavirus Press Conference (6/24/2020) – View the Recorded Press Briefing here
LifeSolutions: UPMC Member EAP Materials Specific to COVID-19. Topics include:
- Canceled by COVID-19: Managing Disappointment
- Managing Anxiety While in Quarantine
- Alcohol & Isolation
- Maximize Your Remote Workforce during COVID-19
- Helping Seniors Navigate COVID-19
- Staying Safe: Intimate Partner Violence during COVID-19
- Tips for Keeping Your Children Safe and Happy at Home
- Self-care Tips during an Illness Outbreak
- How to Handle Social Isolation
- Support for Health Care Workers
- Tips for Working From Home
- Tips for Managing a Remote Workforce
- Get the Support You Need to Successfully Lead Your Team
A message from UPMC Health Plan to our small business clients impacted by COVID-19 – Addresses topics of:
- Premium Payment Options
- Mid-year Benefit Change Requests
- Relief Programs Available & Employer Eligibility Flexibility
January 2020 Your Choice and Advantage Choice formulary updates (1/3/2020) Review changes for 2020 that relate to the Your Choice (for non-ACA products such as grand-mothered groups and experience rated market segments) and Advantage Choice (ACA Group and Individual products)