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What's New for 2015

Changes to all UPMC Health Plan options:

  • The Health Incentive Account annual maximum is $250 for self-only enrollment and $500 for self and family.
  • The self and family out-of-pocket maximum must be met by one or more members of the family before benefits will be paid at 100%. One person cannot reach the out-of-pocket maximum themselves.

Changes to Standard Option HMO Plan:

  • The calendar year out-of-pocket maximum is $4,500 for self-only and $7,000 for self and family.

Changes to High Option HMO Plan:

  • The calendar year out-of-pocket maximum is $4,000 for self-only and $6,000 for self and family.

Changes to HDHP Plan:

  • The calendar year out-of-pocket maximum is $4,000 for self-only and $8,000 for self and family for in-network providers.
  • The calendar year out-of-pocket maximum is $8,000 for self-only and $16,000 for self and family for out-of-network providers.

2015 Plan Details

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See the details of the 2015 plans for Federal Employees.

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2015 Plans For Federal Employees

There are three HealthyU plan options available to federal employees:

Standard Option HMO

  • A deductible of $750 for “self-only” and a $1,500 for “self and family.”
  • 20% coinsurance after you reach your deductible for services other than preventive care until your out-of-pocket maximum is reached.
  • An out-of-pocket maximum of $4,500 for an individual and $7,000 for a family.

High Option HMO

  • A deductible of $500 for “self-only” and a $1,000 for “self and family.”
  • 10% coinsurance after you reach your deductible for services other than preventive care until your out-of-pocket maximum is reached.
  • An out-of-pocket maximum of $4,000 for an individual and $6,000 for a family.

High Deductible Health Plan (HDHP)

  • A deductible of $2,000 for “self-only” and a $4,000 for “self and family.”
  • HSA funding by UPMC Health Plan of $83.33 per month for a “self-only” enrollment and $166.67 for a “self and family” enrollment. If you are not eligible for an HSA let us know and we'll establish an HRA for you.
  • 10% coinsurance for participating providers after your reach your deductible for services other than preventive care until your out-of-pocket maximum is reached.
  • An out-of-pocket maximum of $4,000 for “self-only” and $8,000 for “self and family” (in network) or $8,000 for “self-only” and $16,000 for “self and family” (out-of-network).

2015 Plan Details

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See the details of the 2015 plans for Federal Employees.

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2015 Rate Information for UPMC Health Plan

Federal Benefits for that category or contact the agency that maintains your health benefits enrollment.

Postal rates apply to Postal Service employees. They are shown in special Guides published for APWU (including Material Distribution Center and Operating Services) NALC, NPMHU, and NRLCA Career Postal Employees (see RI 70-2A); Information Technology/Accounting Services employees (see RI 70-2IT); Nurses (see RI 70-2N); Postal Service Inspectors and Office of Inspector General (OIG) law enforcement employees and Postal Career Executive Service employees (see RI 70-2IN); and non-career employees (see RI 70-8PS).

Postal Category 1 rates apply to career bargaining unit employees covered by the Postal Police contract.

Postal Category 2 rates apply to career non-bargaining unit, non-executive, non-law enforcement employees, and non-law enforcement Inspection Service and Forensics employees.

For further assistance, Postal Service employees should call:

Human Resources Shared Service Center
1-877-477-3273, option 5
TTY: 1-866-260-7507

Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal employee organization who are not career postal employees. Refer to the applicable Guide to Federal Benefits.

Premiums for Tribal employees are shown under the monthly non-postal column. The amount shown under employee contribution is the maximum you will pay. Your Tribal employer may choose to contribute a higher portion of your premium. Please contact your Tribal Benefits Officer for exact rates.

Type of Enrollment Enrollment Code Non-Postal Premium Postal Premium
Biweekly Monthly Biweekly
Gov't Share Your Share Gov't Share Your Share Category 1 Your Share Category 2 Your Share
High Option Self Only 8W1 $202.01 $103.66 $437.69 $224.60 $89.63 $103.66
High Option Self and Family 8W2 $448.57 $254.44 $971.90 $551.29 $223.29 $254.44
Standard Option Self Only UW4 $188.24 $62.74 $407.84 $135.95 $49.57 $62.74
Standard Option Self and Family UW5 $432.96 $144.32 $938.08 $312.69 $114.01 $144.32
HDHP Option Self Only 8W4 $172.16 $57.39 $373.02 $124.34 $45.34 $57.39
HDHP Option Self and Family 8W5 $388.61 $129.53 $841.98 $280.66 $102.33 $129.53

These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to your special Guide to Federal Benefits. Or contact the agency or tribal employer that maintains your health benefits enrollment.

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Avesis Dental

As a member of UPMC Health Plan, you have access to the Avesis Dental network. Your dental discount program provides full coverage for certain routine procedures and discounts for other dental procedures. These benefits are neither offered nor guaranteed under contract with the FEHB program.

Limited dental coverage is included as part of your UPMC Health Plan enrollment, The following preventative dental services are covered at no cost to you:

  • Most diagnostic X-rays
  • Teeth cleaning
  • Topical fluoride

Discounts are provided for other dental programs.

Note: Select "Federal & Postal Employee Health Benefit" under the "Program" drop-down menu

You may also contact Avesis by calling 1-888-729-7949 for more information. Representatives are available Monday through Friday from 7 a.m. to 8 p,m.

*These benefits are neither offered nor guaranteed under contract with the FEHB program but are made available to all Enrollees and family members who become members of UPMC Health Plan.

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Vision Benefits

Routine vision examination benefits through UPMC Vision Advantage are included as part of your UPMC Health Plan enrollment at no cost to you.

  • Adults are covered for one eye exam every 24 months. Children through age 18 are covered for one eye exam every 12 months.
  • A 20 percent discount for prescription eyewear (excluding contact lenses) is available at participating providers. Dental and vision benefits are neither offered nor guaranteed under contract with the FEHB program, but they are available to all members enrolled with UPMC Health Plan.

To use your eye examination benefit, call us at 1-877-648-9641 to locate a vision care provider or click on the Find a Provider link above.

These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees and family members who become members of UPMC Health Plan.

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Summary of Benefits and Coverage

View the summary of benefits and coverage documents for the 2015 benefit year:

2015 Plans for Federal Employees 2015 Rates Avesis Dental Vision Benefits 2015 Summary of Benefits What's New for 2015 2015 Plans for Federal Employees 2015 Rates Avesis Dental Vision Benefits
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Attention

It is important to know when you enroll in this plan, services are provided through UPMC Health Plan's participating providers as described in UPMC Health Plan's federal brochure, but the continued participation of any one doctor, hospital or other provider cannot be guaranteed.

Continue to upmchealthplan.com