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May 2, 2013

New health plan option available

Pitt employees who use University health plan benefits can expect higher co-pays and increased monthly premiums in the coming fiscal year as health care costs are increasing 6.7 percent.

Pitt’s health insurance costs for active faculty and staff are projected to be $120 million, up $13 million from fiscal year 2013. The University continues to pick up 80 percent of the health insurance costs.

“In this era of tight budgets, it certainly wasn’t news we wanted,” John Kozar, assistant vice chancellor of Human Resources, said of the cost increase, of which approximately $1 million is attributed to a per-participant reinsurance fee health plans must pay as part of national health-care reform.

Cost increases

As of July 1, participants in the University’s health plans will see their contributions increase $7-$9 per month.

Prescription co-pays are increasing to $14 for generics (up $2), $40 for preferred brands (up $4), $80 for non-preferred brands (up $8) and $90 for specialty medications (up $10).

And Panther Gold HMO plan co-pays for common services are increasing $5, rising to $25 for primary care and behavioral health visits and to $40 for specialist visits. Co-pays for other services also are increasing.

Kozar labeled the cost increases “fairly modest” for the Panther Gold HMO, the most popular of the University’s health plan offerings. About 90 percent of those insured under University plans participate in the HMO, with the rest choosing among PPO plans.

Other benefits

There are no changes in Davis Vision vision plan benefits and rates. Likewise the Flex I and Flex II dental benefits and rates will remain the same in the 2013-14 plan year.

Dental plan rates for the Concordia Plus DHMO will increase 6.2 percent in the upcoming plan year, but will not rise in the 2014-15 plan year.

Flexible spending accounts

No changes in flexible spending accounts are in store this year. However, this year, users will have separate cards for their medical plan ID and flexible spending account, rather than a single card. The change is attributed to an issue with the vendor, Kozar said.

New PPO offering

A new Panther Advocate PPO plan is being added to medical plan options in the coming year — the first new plan in a decade, Kozar said. Panther Advocate features a wellness component in which participants can reduce their deductible by completing wellness-related incentives.

“It’s always a balancing act between bumping up the cost of premiums versus raising co-pays,” Kozar said, adding that there was “healthy debate” among the faculty and staff who serve on the medical advisory committee, which makes recommendations on benefits plans and costs.

Kozar said about 2 percent of the members in Pitt’s health plans account for 37.5 percent of all claims. While some costs are due to bad luck, “a fair percentage of our claims are lifestyle related,” he said, adding that motivating members to use wellness services is a goal. “Our participation rates exceed the national averages already,” he said but there’s room for improvement as long as some people aren’t using the available preventive care services.

Pitt has a roughly 1:1 ratio for wellness services usage, with about 1,000 services used per 1,000 members. However, the numbers can be skewed upwards — for instance, by babies who may have multiple wellness visits for scheduled immunizations. Kozar said there is a subset of people who don’t take advantage of preventive care services.

University Senate President Thomas C. Smitherman, a member of the medical advisory committee, said there was extensive discussion about how to maintain a good menu of benefits plans amid sharply increased costs.  “Pitt’s benefits historically are among the best and there was a desire to keep them that way,” he said, adding that he is pleased that the University is offering an option “encouraging people to be responsible — getting engaged in their own health care and doing the right thing.”

Participation in Pitt’s medical benefits plans has been on the rise in recent years, climbing each year since the economic downturn in 2008, Kozar said. Currently, approximately 28,000 people — employees, their partners and dependents — are covered under Pitt plans, an increase of 2.6 percent over last year, he said.


Kozar noted that while thinking about benefits, it is a good time to review life insurance and retirement plan beneficiaries. Beneficiary forms are online, he said. From www., log into PRISM, then select PHR Employee Self-Service.

—Kimberly K. Barlow

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