University Times

Certain Pitt employees who subscribed to Highmark Blue Cross/Blue Shield health plans last year would be able to continue using designated Highmark physicians under a proposed, one-time exception.

Those employees also would have an opportunity to re-select enrollment among the three UPMC Health Plan options.

Potentially, about 1,000 people (Pitt employees and their covered dependents) are affected, according to Ron Frisch, associate vice chancellor for Human Resources. He said, "These folks will be notified in their homes of the re-selection process as soon as the final agreement is worked out," which could be as early as this week.

Employees will be eligible to re-select a health care plan only if they were patients of certain designated Highmark doctors between July 1, 1999, and June 30, 2000.

Only doctors in Highmark's Alliance/Ventures Inc. (AVI) and Premier Medical Associates — about 120 physicians in all — will be part of the agreement, Frisch said.

Highmark officials verbally agreed with UPMC Health Plan officials this month to allow Pitt patients and their covered dependents to continue seeing Highmark physicians in the two medical associate groups.

Pitt's contract with Highmark expired June 30, and on July 1 a three-year, sole-provider deal with UPMC Health Plan went into effect.

The current contract limited Pitt health care subscriber options to three UPMC Health Plan selections: enhanced HMO, point-of-service and comprehensive (deductible). Employees also could waive the UPMC options by certifying that they had alternate coverage.

"We now have a verbal agreement between the two insurers, Highmark and UPMC," Frisch said. "We also have in writing UPMC's agreement and a letter of intent from Highmark. We haven't completely worked out the process, and I'm waiting for that to get cleaned up before we send out information to the affected employees. I want to make sure, for example, we have in writing that this will be in effect for the life of the contract and not pulled off the table in six months."

Frisch said that along with a letter detailing the re-selection process, Human Resources will be sending eligible employees a list of the AVI and Premium doctors included in the agreement. "We'll also send a re-selection form with a strict deadline for returning and a return envelope. This will be a one-time shot," he said.

About three of every four Pitt employees were covered by Highmark plans before the exclusive contract with UPMC Health Plan went into effect July 1. Last year, about 1,000 employees opted out of the Pitt health plans, a figure that rose to about 1,300 this year.

Frisch acknowledged that some employees, informed that their physicians were not in the UPMC Health Plan network, had selected either a point of service or comprehensive option to retain the physicians, costing them more.

"This is really mostly for those who had an HMO plan and chose a higher priced option or opted out [of Pitt's selections] because they wanted to keep their PCP, gynecologist or pediatrician," Frisch said. "This agreement means that some of them can re-enroll their doctor and still select the enhanced HMO." Following the one-time selection period, the Highmark doctors will remain classified as out of the network for the duration of the three-year deal, Frisch said. However, those who choose to re-select a designated Highmark doctor during the one-time exception period may keep that doctor for the life of the contract.

"This is a problem we knew about the whole time: There were going to be people who had to change doctors. Would I like to have seen this deal done by the time the contract went into effect? Certainly. But at least it looks like we're getting it done now. This is really an agreement between two insurers, with Pitt employees benefiting."

About 12,000 employees are covered through Pitt's health plan options, including the four regional campuses and employees covered by collective bargaining agreements.

This year, about 77 percent of Pitt participants are subscribers in the UPMC enhanced HMO plan; 20 percent opted for point of service, and 3 percent for the comprehensive plan, according to HR officials.

Features of the tentative agreement include:

* Employees may switch UPMC Health Plan options if they were patients of the designated Highmark doctors from July 1, 1999, to June 30, 2000, but only during this one-time re-selection process.

* Employees who waived Pitt health insurance may, during the one-time exception period, re-select a Pitt option only if their doctor in the year before July 1, 2000, was among the designated Highmark doctors.

* Eligible participants need only fill out a form themselves; no doctor's signature will be required.

* Employees may remain with the selection they made in last spring's open enrollment period by doing nothing.

* The option to re-select will be limited to this one-time only opportunity (although there will be the normal open enrollment period next spring for choosing among the UPMC Health Plan options for next fiscal year). However, all AVI and Premium doctors will continue to be considered out of network during the next open enrollment.

* Under the terms of the UPMC Health Plan contract, employees may change health care options under exceptional circumstances, such as a change in family status.

For more information, call UPMC Health Plan member services at 1-888/499-6885 or visit the UPMC Health Plan customer service representative, 2nd floor Craig Hall, 11 a.m.-2 p.m. Tuesdays, Wednesdays or Thursdays.

–Peter Hart