UPMC Health Plan Carrier Updates

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 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 10^th 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 10^th. If a group wishes to continue receiving paper statement, they must opt out via the system.

Support (December 1^st 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)