UPMC Health Plan Latest Updates
March 2023 Updates:
UPMC announces change in refill of prescription eye drops:
- Pennsylvania State Bill No. 1201 (Act 162 of 2022) permits the early refill of prescription eye drops in certain circumstances
- UPMC allows for early refills of all medications once members have used 75% of their medication
- This new bill allows early refills of prescription eye drops once members have used 70% of their medication
- Change is effective for fully insured groups July 1, 2023
Final reminder: UPMC is shifting all clients to paperless billing effective April 1, 2023:
- Groups will need to access Payments & Billing via Employer OnLine
- Groups will be required to appoint an Online Account Administrator & this individual with register for access to EOL
- Please direct any questions to your NFP BNGA team
February 2023 Updates:
UPMC called renewed attention to the SaveON SP Copay Program:
- This program is for all fully insured groups regardless of group size as of 1/1/23 or at the time of their 2023 renewal
- UPMC has communicated that a small subset of membership is impacted depending on use of specialty medication – please contact your NFP BNGA team for more information
UPMC clients are shifting to paperless billing:
- Change is effective 4/1 – groups will need to access Payments & Billing via Employer OnLine
- Groups will be required to appoint an Online Account Administrator & this individual with register for access to EOL
- Please direct any questions to your NFP BNGA team
UPMC announces compensation increases in the 51+ Market:
- Effective 4/1
- More information to follow regarding how this change effects your General Agency compensation schedules
January 2023 Updates:
- UPMC Active&Fit New Year Special:
- Initial $25 enrollment fee is being waived for new members thru March 2023
- Program provides UPMC Health Plan members over the age of 18, and spouses, the opportunity to use any of their 11,900+ Standard Fitness Centers & over 9,000 digital workout videos
- Please note – effective 4/1/23 the monthly fee for this benefit will be increasing from $25 to $28
- UPMC Active&Fit New Year Special Flyer
- UPMC distributed an Affordable Care Act Quick Reference Guide for 2022 tax year reporting requirements. Helpful links below:
December 2022 Updates:
- UPMC released the 2023 Underwriting Guidelines:
- Note the following changes from 2022:
- 1-50 Compliance Rules:
- Added common ownership statement.
- 51+ UW Guidelines:
- Updated OOA max to 40%
- Removed statement regarding blended rates on exception basis only.
- Added statement that groups with 100 enrolled will automatically be blended (in-area & EXT).
- For 20-99, increased # of plan options allowed from 2 to 3.
- Removed plan rules regarding HealthyU since no longer sold for new business.
- 1-50 Dental/Vision:
- Removed all reference to UPMC Vision Advantage. All future vision plans are under the Vision Care portfolio
- 51+ Dental/Vision:
- Removed all reference to UPMC Vision Advantage. All future vision plans are under the Vision Care portfolio
- Level-Funding (UPMC Self-Assure):
- Updated OOA max to 40%.
- Removed plan rules regarding HealthyU since no longer sold for new business.
- Stop Loss:
- No material changes.
- 1-50 Compliance Rules:
November 2022 Updates:
- UPMC released their 2023 ACA Benefit Plan Summary brochures:
- UPMC 2023 ACA BPS for Groups 2-50
- UPMC 2023 ACA BPS for Groups 51+
- Network maps, Dental/Vision plan information, Self-Funding options
- New UPMC VirtualCare offerings included
- Please reference these brochures for plan selections when submitting Rate Requests thru our team @ nfpbnraterequest@nfp.com
October 2022 Updates:
- UPMC VirtualCare updates:
- Innovative, lower-cost group health plan for employers with 2-50 employees in Allegheny & Erie counties – to be offered with the UPMC Partner Network in 2023.
- Access to convenient, affordable care from virtually enabled in-network providers.
- $0 copay for virtual visits
- Virtual specialist visits for half the copay of in-person
- Video linked here
- Flyer linked here
- UPMC Essential Pharmacy Network:
- Offered to Individuals on and off the Exchange, as well as to small market (2-50) employer groups (excluding MUW) – available upon group’s 2023 renewal date.
- Provides most members access to at least 2 participating pharmacies within 5 miles of their home.
- Network includes more than 19,000 participating pharmacies nationwide & over 1,200 pharmacies in PA.
- Producer training webinar available here
- UPMC encouraging clients to go paperless:
- Increased efficiency / satisfaction & productivity
- Greater protection for information
- Support for sustainability
- Video of the steps an employee can follow to update preferences
- Video of the steps an employee can follow on mobile device to update preferences
September 2022 Updates:
- UPMC hosted a VirtualCare & Essential Pharmacy Network Webinar on 9/27:
- Employer groups are able to schedule On-Site Flue Vaccination Clinics through UPMC:
- Telehealth Awareness Week (9/18 – 9/24) highlighted approved access to quality care on telehealth platforms, such as UPMC AnywhereCare.
- Additional digital health UPMC services available to covered members:
- Exclusive digital health tools and resources, such as MyHealth OnLine and the UPMC Health Plan app.
- RxWell, a cutting-edge app for depression, stress, anxiety, and other health and well-being concerns.
- MyUPMC, which allows members to have a virtual visit with a UPMC physician, view test results, schedule appointments, renew their medications, and pay bills they’ve received from UPMC providers.
- Additional digital health UPMC services available to covered members:
August 2022 Updates:
- Vision Advantage plan changes:
- All Vision Advantage plans are phasing into Vision Care products at upcoming client renewals – please keep in mind as you review renewals with your UPMC clients. They must indicate new Vision plan selection or coverage will terminate effective the last day of month prior to renewal.
July 2022 Updates:
Active&Fit Direct is offering a “Summer Special” through the end of August:
- Waived $25 enrollment fee
- Provides UPMC Health Plan members over the age of 18, & spouses, the opportunity to join A&FD for $25 / month
- Members can use any of their 11,600+ Standard Fitness Centers & over 7,600 digital on demand workouts
- Get started here (UPMC log in required).
June 2022 Updates:
Click the links below to access UPMC commonly used forms:
Click the links below to access UPMC User Guides for Employer OnLine:
- UPMC EOL Online Account Administrator Guide — For the client assigned Online Account Administrator
- UPMC EOL User Guide — For non-OAA users with authorized permissions
UPMC to comply with Transparency in Coverage Final Rule – Machine Readable Files (MRFs) will be available online effective July 1, 2022
May 2022 Updates:
UPMC Health Plan, Express Scripts Inc., and SaveOnSP are pleased to provide the SaveOnSP specialty cost-share assistance service for Health Plan members:
- Begins on July 1, 2022
- Targets specific high-cost specialty medications & leverage funds from manufacturer patient assistance programs to lower cost sharing for members who enroll
- Members will be able to work with UPMC Health Plan’s preferred specialty pharmacies (Chartwell and Accredo) to apply manufacturer assistance to eligible pharmacy claims.
- Visit here to check the SaveOnSP drug list.
Please contact your UPMC account manager with any questions.
UPMC Enrollment Form Step-by-Step
April 2022 Updates:
UPMC Update: Enrollment Contact Form – Moving to Producer OnLine
Important: Vision plan transition for ACA renewals
Recently Archived 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 Online – Read 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 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
