Women's Health Care
Reproductive Care
Women's Health Care
Panther Gold Plan
You may use your primary care physician (PCP) for women's health care. However, you have the option to separately identify an ob-gyn from the UPMC Health Plan network of physicians and you have direct access without a referral for general women's health care. If your routine check-up by the ob-gyn discloses a medical condition that requires further treatment, your ob-gyn can arrange for these services directly, you are not required to go back to your PCP for authorization for further treatment.
Panther PPO and Panther Basic
These plans do not require the designation of either a PCP or an ob-gyn. However, you have the option to separately identify either a PCP or ob-gyn from the UPMC Health Plan network of physicians.
You have direct access without a referral for women's health care. If your routine check-up by the ob-gyn discloses a medical condition that requires further treatment, your ob-gyn can arrange for these services directly.
You also have direct access to an ob-gyn who is not in the UPMC Health Plan Network; however, the coverage would be according to the out-of-network provision.
Women's Health and Cancer Rights Acts
(HR4328, Public Law 105-277)
As required by law, listed below is a notice that must be distributed to all employees, retirees, and COBRA participants.
Under the University of Pittsburgh's health plans, coverage will be provided to a member who is receiving benefits for medically necessary mastectomy and who elects breast reconstruction after the mastectomy for:
- Reconstruction of the breast on which a mastectomy has been performed
- Surgery and reconstruction of the other breast to produce a symmetrical appearance
- Prostheses
- Treatment of physical complications of all stages of mastectomy, including lymphomas
This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same co-insurance and any applicable annual deductibles that apply for the mastectomy.
Assisted Fertilization
UPMC Health Plan members experiencing fertility complications may be able to obtain infertility treatment based upon the provisions of their employer’s health plan. Infertility is defined as services provided to achieve pregnancy, including monitoring and evaluation of the treatment plan. Individuals must use participating physicians to obtain coverage under the "Infertility Benefit Program."
Additional details about the list of authorized medications and benefits level are below. If you have questions about your level of infertility coverage or participating physicians, please contact UPMC Health Plan Member Services at 1-888-876-2756.
| Fertility Testing Benefits Level | |
|---|---|
| Diagnosis and treatment up to diagnosis of infertility | Covered in full |
| Assisted fertilization procedures |
$250 copayment (medical procedures) $10,000 medical procedure lifetime benefit |
| Infertility prescriptions (Prescriptions must be dispensed from a participating pharmacy) |
$10,000 prescription lifetime benefits 20% coinsurance on prescriptions Authorized prescription drug list
|
Parents-to-Be and New Parents
Family Preparation
Choosing the right ob-gyn is an important decision. Even for those of us who enjoy good health, we rely upon our ob-gyn’s to see us through some of our most emotional transitions: contraception, conception and childbirth to name a few. You should meet with your ob-gyn when considering becoming pregnant for a preconception counseling visit and as early as possible in a pregnancy. Here are some questions to ask yourself to help identify the best gynecologist for you:
- How important is “bedside manner” or personality to you?
- Is the doctor’s gender important to you?
Search for a participating ob-gyn in the UPMC Health Plan network. You will need to select ob-gyn from the drop-down menu under “Type of Provider” when searching “by medical profile.”
Preventive-related benefits are covered at 100 percent without the need to make a copayment or meet a deductible including but not limited to:
- Wellness visits to your PCP
- Wellness-related blood panels
- Annual and prenatal OB/GYN visits
- Flu vaccinations
- Adult and pediatric immunizations
Some tests may not be covered at 100%, check your plan for details.
Individuals experiencing fertility complications may be able to obtain infertility treatment through the University’s medical plans. Learn more about what services are covered by reviewing the Certificates of Coverage for both the HMO and the PPO plans.
Smoking is a difficult habit to break. The University supports members trying to quit smoking by covering:
- Smoking cessation prescription medication*
- Smoking cessation counseling
- In person through LifeSolutions
*Copayments may be reimbursed if members complete a UPMC Health Plan counseling program available through one of the following sources:
- Online
- By telephone
Through the University’s UPMC Health Plan insurance coverage, nutritional counseling is available at no cost to you. The University provides free telephonic nutrition education/counseling with a UPMC Health Plan-registered dietician up to six times a year. A dietitian may be able to help with:
- Meal planning.
- Suggestions to stick with a diet.
- Helpful hints to avoid unhealthy snacks.
If you have Gestational Diabetes please consult with your doctor. However, UPMC Health Plan offers counseling with a registered nurse.
To set up an appointment, contact UPMC Health Plan at 1-800-807-0751 (TTY: 711). Monday through Friday from 8 a.m. to 6 p.m.
When You Are Expecting
- Prenatal visits are billed as an “all inclusive” charge, not by each individual visit; therefore members are not charged a copayment for each visit.
- Childbirth or delivery charges vary depending on the plan. The Panther Gold plans have a copayment for maternity inpatient admissions – this copayment is only applied to the mother for a standard maternity admission. Please note that if you work at the Oakland, Johnstown, or Titusville campus, you must use an Advantage Network facility for this copayment to apply. A copayment would only apply to the baby if he/she had some other medical complications and therefore needed to be admitted as a separate patient. The standard deductibles and co-insurance apply under the Panther PPO and Panther Basic plans.
- Prenatal classes (Lamaze, Lamaze Refresher, breastfeeding, and prepared childbirth) are a covered benefit and are reimbursed up to $65. The member can print a copy of the reimbursement form or call UPMC Health Plan Member Services at 1-888-499-6885 (TTY: 711) to request the reimbursement form. Classes are available through several participating hospitals. Lamaze 2 is not a covered benefit.
UPMC Health Plan offers a maternity program to all pregnant members whereby the member can speak with a health coach/case manager throughout the course of her pregnancy. View the brochure for additional information. There is also a Maternal Wellness Program that is free to all, regardless of your insurance plan.
LifeSolutions, the University’s Faculty and Staff Assistance Program, offers you many tools and resources that are available for use during your pregnancy as well as after you give birth. Please visit the LifeSolutions page for more information.
Choosing the right pediatrician for your child is an important decision. It is best to choose a pediatrician before delivering your baby. From the moment that your baby is born, he or she will be seen by a pediatrician at the hospital in which you deliver. It is typically recommended by most pediatricians that you schedule your baby for his or her first well baby checkup within the first couple of days of being discharged from the hospital. Here are some questions to ask a pediatrician that you are considering:
- Do you have evening and/or Saturday hours?
- If you share a practice, will I always see you?
- Do you have a triage staff to handle sick calls?
- How are sick calls handled after business hours?
- Where do you have admitting privileges (for example, Children’s Hospital, etc.)?
- Does a pediatric nurse practitioner (PNP) work in your office?
- What is the wait time from when I check in until my child is seen by the doctor?
- Do you have a separate waiting room for sick visits?
Search for a participating pediatrician in the UPMC Health Plan network. You will need to select Pediatrics from the “Medical Specialty” drop-down menu when searching “by medical profile.”
Your Newborn
- First 31 days: Your newborn is automatically covered by Pennsylvania state law for the first 31 days of life under the mother’s medical insurance plan.
*If you live outside of Pennsylvania, please refer to your state’s newborn policy.
- After 31 days: To continue coverage after these 31 days, you MUST submit a life event (qualified status change) to add your newborn onto a University-sponsored medical insurance plan.
*A life event must be submitted to the Benefits Department within 60-days of the birth.
You can make changes to your benefits elections if you experience a life event (Qualified Status Change). A life event is an IRS-qualified event that allows you to make a change in your enrollment elections during the plan year (outside of the open enrollment period). Learn how to report a life event.
- Well-baby visits and pediatric immunizations are covered at 100 percent without the need to make a copayment or meet a deductible. View Page 4 of this PDF to see a full listing of covered pediatric immunizations.
- Breast pumps are covered as a wellness benefit with a physician’s prescription. Members should call UPMC Health Plan Member Services at 1-888-499-6885 for more information and to request instructions on how to obtain a covered breast pump. You must follow the exact instructions provided to you by UPMC Health Plan for the pump to be covered. There is only one specific brand of breast pumps that they will cover.
Breast pumps other than the brand covered by UPMC Health Plan are considered an eligible expense under a health care flexible spending (FSA) account. Please visit the Flexible Spending Accounts page for additional information on FSA’s.
LifeSolutions, the University’s Faculty and Staff Assistance Program, offers a broad range of tools and services that are available to new parents. Please visit the LifeSolutions page for more information.
According to WebMD, postpartum depression can occur in women shortly after giving birth. The symptoms for postpartum depression include “sadness and hopelessness over and above the normal baby blues.” It can be treated with counseling and/or antidepressants. For assistance with managing postpartum depression, please contact LifeSolutions 24-hours a day at 1-866-647-3432 (TTY: 711) and/or your PCP. You can also receive postpartum support through UPMC’s free Maternal Wellness Program by UPMC.
Childcare
The University’s Faculty an Staff Assistance Program, LifeSolutions, can help with looking for childcare vacancies. Please visit their website for additional information.
Offsetting the cost of childcare by participating in a dependent care flexible spending account (FSA)
The dependent care flexible spending account (FSA) reimburses dependent daycare expenses incurred while you (and your spouse, if you are married) are working full-time or attending school full-time.
The dependent care FSA program provides an opportunity to reduce your federal and Social Security taxable income by funding an account on a pretax basis. You may obtain reimbursement by submitting documentation of qualified out-of-pocket expenses related to the account (for example, an invoice from the day center).
Review Flexible Spending Accounts for additional information on how participating in a dependent care FSA may benefit you. The list of eligible expenses may also be found on this page.
Wellness and Nutritional Counseling
The University, through UPMC Health Plan, provides health coaching and nutritional counseling to members with University health plan coverage.Health coaches can provide needed support to stayon track with a diet, develop and maintain a regular exerciseprogram, and come up with a plan to manage chronic conditions.
To set up an appointment, contact UPMC Health Plan at 1-800-807-0751 (TTY: 711). Monday through Friday from 8 a.m. to 6 p.m.
The School of Education’s Wellness Program provides wellness education, exercise, and dietary programs that promote physiological benefits. It is open to all faculty and staff. For additional information, visit the School of Education’s website. Pitt employees enrolled in the UPMC Health Plan can also receive free support through the Maternal Wellness Program.