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What's New for 2017

For all UPMC Health Plan options:

  • Retail generic prescription drug copayment will be $15 for a 30-day supply.
  • Mail-order generic prescription drug copayment will be $30 for a 90-day supply.
  • Hearing aids are no longer covered for members under the age of 21.
  • Acupuncture coverage limited to 12 visits per benefit period.

High and Standard HMO Options:

  • Eligible prescription drugs now only require a copayment. There's no need to meet the deductible first.
  • Copayments now apply for the following:
    Service Copayment (no deductible applies)
    High Option Standard Option
    Physician virtual visit $8 $10
    PCP office visit $15 $20
    Physical, speech, occupational, or habilitative services visit $15 $20
    Chiropractic office visit $15 $20
    Specialist office visit $40 $50
    Urgent care visit $75 $75
    Emergency room $150 $150

    *Copayment waived if admitted, deductible and coinsurance then apply.
    †HIA funds cannot be used for medical services copayments.

High Deductible Health Plan

  • In-network coinsurance is 15 percent. This means that you pay 15 percent of the allowable expense and the plan pays 85 percent. Coinsurance is paid after the plan deductible has been met.
  • UPMC Consumer Advantage is now the Health Savings Account (HSA) administrator and custodian.
  • Prescription drug copayment only applies after the deductible has been met.

HealthyU. Live Healthy. Earn Rewards.

HealthyU is an innovative plan that rewards you for making healthy choices. HealthyU offers a personalized approach that will help keep you focused on healthy activities that are important to helping you understand and improve your health. You can now choose from a customized list of healthy activities that are important for your specific health and wellness goals, in addition to choosing from a standard list of healthy activities.

How easy is it to earn rewards?
Activity HealthyU reward dollars
Complete MyHealth Questionnaire (online health assessment) $50*
Preventive Lab Screening $25
Preventive Screening (mammogram or colonoscopy) $50
Well Visit $50

*Completing the MyHealth Questionnaire is worth $50 if completed in the first 90 days of the benefit year (or your effective date if you join the plan later) and $25 after that.

The reward dollars you earn automatically help pay certain out-of-pocket medical expenses — deductible, coinsurance, and prescription drug copayments under the HMO options, coinsurance and prescription drug copayments under the HDHP option. In each plan year, you can earn up to $250 for Self-Only coverage or $500 for Self Plus One and Self and Family coverage. Any unused reward dollars — at a value up to two times your annual deductible — automatically roll over to the next year.

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.

2017 Plan Details

See the details of the 2017 plans for Federal Employees.

 

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2017 Plans for Federal Employees

There are three HealthyU plan options available to federal employees:

Standard Option HMO

  • A deductible of $800 for Self-Only or $1,600 for Self Plus One and Self and Family.
  • Twenty percent coinsurance after you reach your deductible for services that go toward your deductible until your out-of-pocket maximum is reached.
  • An out-of-pocket maximum of $5,000 for an individual or $10,000 for Self Plus One and Self and Family.

High Option HMO

  • A deductible of $650 for Self-Only and a $1,300 for Self Plus One and Self and Family.
  • Fifteen percent coinsurance after you reach your deductible for services that go toward your deductible until your out-of-pocket maximum is reached.
  • An out-of-pocket maximum of $4,000 for an individual and $8,000 for Self Plus One and Self and Family.

High Deductible Health Plan (HDHP)

  • A deductible of $2,000 for Self-Only or $4,000 for Self Plus One and Self and Family.
  • For the health savings account (HSA), members receive $83.33 per month for Self-Only coverage or $166.67 for Self Plus One and Self and Family enrollment. These funds can be used toward your deductible.
  • Fifteen percent 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 $5,000 for Self-Only and $10,000 for Self Plus One and Self and Family (in-network); or $8,000 for Self-Only and $16,000 for Self Plus One and Self and Family (out-of-network).

2017 Plan Details

Watch the video to see the details of the 2017 plans for Federal employees. Log in to MyHealth OnLine and watch the full 2016 video to receive $15 in your health incentive account.

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2017 Rate Information for UPMC Health Plan

Non-postal rates apply to most non-postal employees. If you are in a special enrollment category, 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.

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 $221.67 $133.59 $480.29 $289.44 $124.36 $121.28
High Option Self Plus One 8W3 $475.79 $323.54 $1030.88 $701.00 $303.71 $303.71
High Option Self and Family 8W2 $505.22 $329.61 $1094.64 $714.16 $308.55 $301.54
Standard Option Self Only UW4 $207.63 $69.21 $449.87 $149.95 $60.21 $57.44
Standard Option Self Plus One UW6 $467.18 $155.72 $1012.22 $337.40 $135.48 $129.25
Standard Option Self and Family UW5 $487.91 $162.64 $1057.15 $352.38 $141.49 $134.99
HDHP Option Self Only 8W4 $177.22 $59.07 $383.97 $127.99 $51.39 $49.03
HDHP Option Self Plus One 8W6 $390.93 $130.31 $847.01 $282.34 $113.37 $108.16
HDHP Option Self and Family 8W5 $405.94 $135.31 $879.53 $293.18 $117.72 $112.31

These rates do not apply to all enrollees. If you are in a special enrollment category, refer to your special FEHB guide or contact the agency that maintains your medical benefits enrollment.

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Dental Benefits

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

  • Most diagnostic x-rays
  • Two oral exams per year
  • Two teeth cleanings per year
  • Topical fluoride

Discounts are provided for other dental services.

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

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

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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 18 years old and younger 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 benefits and the discount for prescription eyewear 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 2017 benefit year:

2017 Plans for Federal Employees 2017 Rates Dental Benefits Vision Benefits 2017 Summary of Benefits What's New for 2017 2017 Plans for Federal Employees 2017 Rates Dental Benefits 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