How the Plan Works

HealthyU provides a complete spectrum of coverage including doctor and hospital visits, prescription drugs, and more. Preventive care is always covered at 100 percent even if you haven’t met the deductible.

All three plan options include a health incentive account (HIA) that enables you to earn up to $250 for Self Only coverage and up to $500 for Self Plus One and Self and Family coverage. UPMC Health Plan automatically applies any HIA dollars you have accumulated toward the plan cost-sharing.

The HDHP option includes a health savings account (HSA) in addition to the HIA. With this option, your HIA funds are not available until after the deductible has been met. You have the option to use HSA funds (or pay out-of-pocket instead) to cover eligible medical expenses prior to meeting your deductible.

With the HDHP option, prescription drug expenses are subject to the deductible. This means you will pay the full discounted rate for your prescriptions until you have met the deductible. In this example, your HSA funds will help pay these expenses. After the deductible is met, copayments apply to prescriptions.

Depending on the option you select, you will pay 15 or 20 percent coinsurance. However, once again, your HIA funds will help with this!

The deductible, coinsurance, and copayments apply to your out-of-pocket maximum. The out-of-pocket maximum is the most you'll have to pay in one plan year. At that point HealthyU pays 100 percent of your eligible medical expenses, including prescriptions and copayments.

High and Standard Option HMO:

  • Eligible prescription drugs only require a copayment. There's no need to meet the deductible first.
  • Most preventive care, such as screenings, immunizations, and health exams, is covered at 100 percent with no deductible applied.
  • For services that apply to your deductible, the annual deductible must be met before the plan pays benefits.
  • The deductible for any one person will be the individual deductible.
  • If you enroll more than one family member, a family deductible caps the amount of deductible applied for the entire family.
  • Remember that your HIA can be used toward the deductible, coinsurance, and prescription drug copayments.
  • HIA funds cannot be used toward office visit copayments.

HDHP:

  • Most preventive care, such as screenings, immunizations, and health exams, is covered at 100 percent with no deductible applied.
  • The annual deductible must be met before the plan pays benefits.
  • There are separate deductible amounts for a Self Only enrollment versus a Self Plus One or Self and Family enrollment.
  • Remember that your HIA can be used toward your coinsurance and prescription drug copayments after your deductible has been met.

Benefits of HealthyU

The ability to earn reward dollars that can be used to pay for your out-of-pocket medical expenses is certainly what makes HealthyU such a unique health plan. But there are many benefits that come with HealthyU.

HealthyU offers:

  • Preventive care at no cost to you.
  • Access to a broad network of care providers and pharmacies including the top-ranked doctors and hospitals of UPMC.
  • Award-winning customer service from UPMC Health Plan’s Health Care Concierge team.*
  • All the resources of MyHealth — the acclaimed health and wellness program developed by UPMC.
  • Online tools and resources on our secure member-only website: MyHealth OnLine. Log in to learn more about your health plan benefits, get personalized information about your doctors, and track your personal health information. You can even review your prescriptions and receive important reminders for preventive screenings.
  • On-the-go access to your member ID card, status of claims, and more if you download the UPMC Health Plan mobile app.
  • Self-guided programs and expert health coaches to help you manage a chronic condition or make lifestyle changes.
  • Discounts and savings at gyms, spas, and sporting goods and health food stores.

Earning Reward Dollars

You can earn reward dollars in your health incentive account (HIA) by participating in healthy activities.

Your list of incentivized activities is completely customized for your unique needs. These activities have been specially designed by our team of doctors, nurses, nutritionists, exercise physiologists, and behavioral health experts. Your activities are based on your MyHealth Questionnaire responses, plus pharmacy and medical use. They will alert you to potential health issues and provide tools to help you address those issues. Here are some of the most important healthy activities that may be incentivized for you:

  • MyHealth Questionnaire — The confidential health risk assessment, powered by WebMD®, is the first (and easiest) activity to complete. You take a 20-minute online survey once a year. The results can help you understand your health status and suggest ways to make improvements. You can log in to MyHealth OnLine and complete your MyHealth Questionnaire as soon as you receive your member ID card.
  • Biometric screening — This health screening measures your total cholesterol level and glucose level. Your doctor will also check your blood pressure, height, weight, and body mass index (BMI). It is a simple assessment that can be done at your doctor’s office, a lab, or some convenience care clinics.
  • Condition or lifestyle management coaching — A health coach will help you manage a chronic condition, so you can live your healthiest life possible. Chronic conditions include heart disease, diabetes, asthma, COPD, and depression. Lifestyle programs include smoking cessation, stress management, physical activity, weight management, and nutrition.

We are committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all members. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us at 1-855-395-8762, and we will work with you and your doctor to find a wellness program with the same reward that is right for you in light of your health status.

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Frequently Asked Questions

  • How many reward dollars can I earn in my HIA in a plan year?
  • The most you can earn in one plan year is $250 for Self Only coverage or $500 for Self Plus One or Self and Family coverage.
  • Do my reward dollars in my health incentive account carry over year to year?
  • Yes. Any unused reward dollars — at a value up to two times your annual deductible — automatically roll over to the next year.
  • When can I use my reward dollars?
  • On the HMO options, you can use them toward deductible, coinsurance, and prescription drug copayments, regardless of if your deductible has been met. On the HDHP pption, you must first meet your deductible, then you can use your reward dollars on coinsurance and prescription drug copayments.
  • Do I have to complete healthy activities with my HealthyU plan?
  • No, but if you choose not to, you'll miss out on savings toward your out-of-pocket medical expenses.
  • Can my reward dollars be used before my deductible is met?
  • It depends on which HealthyU plan option you have. If you are enrolled in the standard or high option HMO plan, the reward dollars in your health incentive account are automatically applied toward your deductible if it has not been met. If you are enrolled in the HDHP option, the reward dollars in your health incentive account only apply after your deductible has been met.
  • Do my reward dollars in my health incentive account carry over if I change plan options within UPMC Health Plan?
  • Yes. Any reward dollars you have earned will automatically roll over to the plan option you select within UPMC Health Plan.
  • Do I have to pay for the healthy activities that are considered preventive care?
  • No, preventive care is covered at 100 percent even if your deductible has not been met, so they are at no additional cost. Learn about our preventive health services.
Benefits of HealthyU Earning Reward Dollars FAQ Enrolling In The Plan How the Plan Works Benefits of HealthyU Earning Reward Dollars
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Attention

It is important to know that 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.

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