Medical Plan Options

Medical

We understand that employers want to control health care costs while keeping their employees healthy. Our current portfolio offers a variety of plan options to meet the needs of our diverse employer groups.

We offer both fully insured and administrative services only (ASO) contracts. UPMC Health Plan programs and services are customizable for larger employers.

UPMC Small Business Advantage gives all small businesses a robust benefit package to address their employees’ total health and well-being. Included with every plan is an employee assistance program (EAP), online wellness tools, and dental and vision discounts. These are the same value-added benefits available to groups with 51-499 employees. Companies with fewer than 50 employees are eligible for UPMC Small Business Advantage.

UPMC Business Advantage is a diverse portfolio of medical plan options. Several value-added services and benefits may be applied to these plans to further support the health and well-being of employees. UPMC Business Advantage is available to employers with 51 or more employees.

  • Employers with 51 to 499 employees can take advantage of the value-added benefits rider, which includes:
    • EAP services that let employees access three confidential telephone counseling sessions and the Work-Life online resource portal.
    • Unlimited managerial telephone counseling sessions and online education and training for employers.
    • UPMC Dental Advantage Discount Plan with a 20 percent discount on Class I, II and III services when received by a participating dentist.
    • UPMC Vision Care exam with copay, mail order contact lens program, and lens options at a fixed copayment. All other services such as frames and lenses are discounted through NVA EYEESSENTIALS Plan.
  • Employers with 51 or more eligible employees can bundle Dental Advantage and/or Vision Care plans with Medical and receive a discount on the medical premium.

UPMC HealthyU is an innovative plan that rewards members for making healthy choices. By completing healthy activities, subscribers* and their covered spouse or covered domestic partner can earn reward dollars in a health incentive account (HIA) that helps pay for their health care expenses. Dependent children (including adult children) are not eligible to earn reward dollars. UPMC HealthyU recommends healthy activities that are customized to the individual, each with a reward dollar value to help encourage members to focus on what’s most important in understanding and improving their own health. UPMC Health Plan deposits reward dollars into the member’s HIA every time he or she completes a recommended activity. The reward dollars then help pay for out-of-pocket medical expenses, such as deductible, coinsurance, and pharmacy copayments. Employers may choose to offer this plan with claims-based reimbursement or with a debit card.

*A subscriber and their covered spouse or domestic partner (if applicable) can earn reward dollars in their HIA for completing incentivized activities. Dependent children (including adult children) are not eligible to earn reward dollars.

Inside Advantage is a tiered benefit plan offered in Northwest Pennsylvania that provides employees with the same type of coverage as other UPMC Health Plan offerings — but with lower out-of-pocket costs when they receive care at select Level 1 facilities. Level 1 includes all UPMC providers and UPMC-owned facilities along with many community-owned providers and facilities, such as Grove City Medical Center and Warren General Hospital. UPMC facilities in northwest Pennsylvania include UPMC Hamot, UPMC Horizon, UPMC Kane, UPMC Jameson, and UPMC Northwest. At Level 2, out-of-pock costs may increase. Level 2 includes many UPMC-contracted facilities and the services affiliated with those contracted facilities, such as lab, x-ray, MRI therapy, and more. It is available to employer groups with two or more employees in the following counties: Clarion, Crawford, Elk, Erie, Forest, McKean, Mercer, Potter, Venango, and Warren.

Employers with two or more employees in these counties are eligible: Clarion, Crawford, Elk, Erie, Forest, McKean, Mercer, Potter, Venango, and Warren.

UPMC MyCare Advantage is a tiered benefit plan that focuses on patient-centered care to improve the health outcomes of its members. It offers the same type of coverage as other UPMC Health Plan products but maximizes in-network savings with lower cost sharing when members receive care from Level 1 hospitals and facilities, which include all UPMC-owned physician practices, hospitals, and facilities. Level 1 providers also include these valued community-based partners: Butler Memorial Hospital; Excela – Frick, Latrobe, and Westmoreland Hospitals; Grove City Medical Center; Heritage Valley Health System–Heritage Valley, Beaver, and Sewickley; Monongahela Valley Hospital; St. Clair Hospital; Uniontown Hospital; Washington Health System Greene; and Washington Hospital. UPMC MyCare Advantage is available to employers with 51 or more employees located in Allegheny, Beaver, Bedford, Berks, Blair, Butler, Fayette, Lawrence, Lycoming, Tioga, Washington, and Westmoreland counties. Employers with 2 to 50 employees must be located in Allegheny, Beaver, Bedford, Blair, Butler, Fayette, Lawrence, Washington, or Westmoreland counties.

UPMC Consumer Advantage offers many plan options for groups looking to add spending accounts to round out their employee benefits. All the spending accounts can be stacked on a multi-purpose debit card for easy access to funds.

A qualified high–deductible plan (QHDHP) must be in place in order to offer members a health savings account (HSA). This account helps members pay for current and future health care expenses. Both employer and employee may contribute to the HSA, and because this account is member owned, the employee can take the funds along when changing employers or at retirement.

Dependent care accounts (DCA) help with dependent day care expenses. Annual IRS limits for this pre-tax account allow employees to offset dependent care expenses.

Flexible spending accounts (FSA) are established by the employer for their employees to use pre-tax money for predictable plan year healthcare expenses. Unlike HSAs, these accounts are not portable and have guidelines with respect to rollover options and grace period for fund usage.

Qualified transportation accounts (QTA) are transportation and parking pre-tax accounts that are limited by IRS guidelines. They are pre-tax accounts that employers can offer to employees to pay for commuter expenses.

For more information on our plans, call 1-888-383-8762.

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