University Times

Pitt's exclusive contract with UPMC Health Plan prompted about three-quarters of participating employees to change health care plans this year.

Under a three-year deal announced last March, all Pitt employees were required to enroll in one of three UPMC Health Plan options, or certify that they had alternate health benefits coverage.

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

Some three out of four Pitt participating employees had subscribed to a Highmark Blue Cross/Blue Shield option a year ago, according to Jim Edgerton, assistant vice chancellor for compensation and benefits. The other 25 percent of those who enrolled in Pitt's options chose the UPMC Health Plan enhanced HMO.

About 1,300 employees have opted out of Pitt's health care plans this year, he said. That's up from about 1,000 the previous year.

Figures for this year indicate 77 percent of participating employees enrolled in the UPMC Health Plan enhanced HMO; 20 percent in the point of service plan, and 3 percent in the comprehensive (deductible) plan option, Edgerton said. The latter two options were not available last year.

Pitt paid about $26 million in employee health care coverage last fiscal year.

"We're pretty happy with our situation here," Edgerton said. "There will be no raises of the costs for the HMO and point-of-service plans for five years," he said, referring to the last two years and the three years of the current contract. "Counting last year, it also will be four consecutive years of the same co-payment amount for prescription drugs, even though nationally they're going up by double digits."

Health care participants' welcoming kits are expected to be mailed to employees' homes in mid October, said Nancy Gilkes, benefits manager.

The informational packet includes a member's handbook describing features of the participant's plan and a certificate of coverage. "This welcoming kit gives an explanation in detail of what services are covered, broken down into categories," Edgerton said.

Gilkes added, "In general, all legal, non-experimental and non-cosmetic procedures, treatments and medicines, if approved by a regulatory agency like the FDA, are covered [in all the plans]."

The kits also include a brochure describing the prescription drug plan; which drugs are covered; and information about ordering drugs, including mail-order envelopes for ordering drugs in 90-day quantities with one co-payment. Two sites on campus offer the 90-day drug supply service, Falk Clinic and Student Health Services in the Medical Arts building.

Participants also will receive instructions for surgery pre-notification for those participating in the comprehensive or point-of-service's self-referred options. Members must alert the UPMC customer service group of any scheduled surgeries. "This is not for approval of any procedures," Gilkes stressed. "This is to ensure the billing will go smoothly, if an out-of-network doctor is involved." Gilkes said failure to pre-notify presents no risk to the patient, "but pre-notification alerts the health plan and the insurance company and the hospital how much the health plan should be billed for."

As an added customer service, a UPMC Health Plan representative now is on the Pittsburgh campus, every Tuesday, Wednesday and Thursday, 11 a.m.-2 p.m., on the 2nd floor, Craig Hall.

"We had the dedicated hotline set up, but we said to UPMC Health Plan that we need additional customer service," Edgerton said. "They were very responsive and cooperative. So, on a trial basis, we have an on-site customer service rep who can answer questions face to face."

The service is scheduled indefinitely, and will be assessed after a few months, Edgerton said. Meetings are confidential; no appointment is necessary. (The toll-free UPMC Health Plan member services hotline number is 1-888/499-6885.)

Human Resources also is happy with the dental and vision plan enrollment, Edgerton said. "We're up to nearly 50 percent of eligibles who participate. For any employee self-pay plan, this is very high participation."

Part of the increase in participation, Edgerton surmised, was due to the same rate payment for the dental plan and the slight decrease in cost for the vision plan compared to last year.

He said there is about 18 percent participation in the flexible spending tax plan, up from about 14 percent last year. The tax plan allows participants to set aside money for certain types of predictable expenses not covered by insurance, such as dependent day care charges. The withheld funds are not subject to federal income or Social Security taxes.

–Peter Hart