UPMC Health Plan Latest Updates

Review Adjusted Best Practices surrounding UPMC’s MSP Attestation Submission

UPMC Health Plan Virtual Concierge on Amazon Alexa & Google Home


UPMC Health Plan Extends Members’ Out-Of-Pocket Cost Waivers for In-Network Telehealth Visits, Inpatient COVID-19 Treatment and Monoclonal Treatment (extension in effect through July 20, 2021

UPMC Partner Network Now Available for Groups with 51+ Employees (Beginning with 7/1/2021 Effective Dates)

UPMC Client Communication – UPMC COBRA Subsidies under America Rescue Plan

All Pennsylvanians age 16 and older are now eligible to receive the COVID-19 vaccine. UPMC encourages you to schedule your vaccine today at a UPMC COVID-19 Vaccine Clinic in your region and provides online opportunities for those 18+ to schedule a COVID-19 Vaccine at UPMC. To schedule for a 16 or 17 year old, contact (844)-UPMCVAC (844-876-2822).

UPMC Health Plan has not mailed hard copy 1095B Forms to members covered under fully insured small group plans for the 2020 tax year.  Members have access to their 1095B via their MyHealth Online Member Portal (in the Forms and Guides section) to download for their records.

UPMC Initiates Authentication Process for Producer OnlineRead Two Step Authentication FAQs

UPMC introduces RxWell as a partner for their UPMC Prescription for Wellness portfolio

The American Rescue Plan Act of 2021 Signed Into Law

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 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 Update: Fiscal 2021 Omnibus & COVID-19 Relief Bill (including summary of employer-focused provisions)

UPMC 2021 Underwriting Guidelines have been released and are available for download

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.

UPMC 1095-B and 1095-C Communication:

  • 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:

Did you miss UPMC’s Mid Market (51+) Total Advantage Producer Webinar?  Watch the recorded version here.

UPMC’s Latest COVID-19 related Resources:

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

UPMC Legislative and Regulatory Update (Sept 2020)

View UPMC Health Plan Flu Season Resources:

UPMC Information and Frequently Asked Questions for Patients With Out-of-Network Products

UPMC Health Plan Expands In-Network Access to St. Luke’s Health Network (Eastern & Central PA)

UPMC: Legislative & Regulatory Updates Relating to the Health Care Industry, August 3, 2020

UPMC Network Expansions! Read more about the network additions of UPMC Pinnacle West Shore Hospital and UPMC South Hanover

UPMC: Legislative & Regulatory Updates Relating to the Health Care Industry, July 20, 2020

UPMC Announces UPMC Total Advantage  (be on the lookout for training webinars coming soon)

(Odyssey by UPMC) Getting healthier is easier than ever with this free app from the UPMC Health Plan

UPMC Among Participants in Coronavirus Vaccine Trials

UPMC DentalAdvantage PPE coverage during COVID-19

UPMC Leaders Provide COVID-19 Update (View the 7/9 Recorded Press Briefing)

Telemedicine at the Ready: How Culture of Innovation Helps UPMC Respond to Pandemic

UPMC Health System holds Coronavirus Press Conference (6/24/2020) – View the Recorded Press Briefing here

UPMC Legislative & Regulatory Updates – June 29, 2020

UPMC Health Plan Extends Inpatient In-network COVID-19 Care

2021 Inflation Adjusted Amounts for Health Savings Accounts (HSAs)

UPMC Update: IRS guidance to allow participants to make mid-year cafeteria plan election changes due to the COVID-19 pandemic

UPMC Health Plan: Regulatory Updates – June 2020 Edition

UPMC Extension of Timeframes due to COVID-19 Outbreak

UPMC Extension of No Cost Access to Telehealth Services

LifeSolutions: UPMC Member EAP Materials Specific to COVID-19.  Topics include:

UPMC Health Plan Coverage Enhancements in Response to the CARES Act (Diagnostic testing, Telehealth & COVID-19 related care)

UPMC COVID-19 Testing Updates

UPMC Legislative & Regulatory updates related to the Health Care Industry for May 2020

UPMC Producer Update: Congress passes $484 Billion Coronavirus stimulus package

UPMC April 2020 Legislative & Regulatory Updates

NFP BNGA Producer Guidance – UPMC Health Plan No Cost Premium Deferment

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

UPMC/Huntingdon Bank Webinar 4/7 – What small businesses need to know about federal stimulus loans

University of Pittsburgh School of Medicine’s announces potential SARS-CoV-2 vaccine (watch video or view press conference)

UPMC Health Plan FAQ: Coronavirus (COVID-19) (3/23/2020)

UPMC COVID-19 Guidance for Employer Groups (3/20/2020)

UPMC AnywhereCare Offers Virtual Access to Low Cost Care (3/1/2020)

UPMC Susquehanna Announces Plan for Health Care Services in Sunberry (1/3/2020)

Health Care at your fingertips (1/3/2020)

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)

IRS Announces HSA, FSA, and HDHP contribution and OOP limits for 2020 (1/3/2020)