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April 19, 2007

SAC focuses on benefits questions

Benefits were the hot topic at the Staff Association Council’s (SAC) April 11 meeting.

SAC President Rich Colwell, who is a member of the University-wide medical advisory committee, reported on the three most prominent changes in the UPMC Health Plan, set to go into effect July 1.

The biggest changes, Colwell said, are higher premiums for most health plan options, higher co-payments for emergency-room services and higher co-pays for non-generic prescription drugs.

(For details on the UPMC Health Plan changes, see related story this issue.)

A portion of the meeting was taken up with complaints about Pitt’s vision care plan, Davis Vision. Some SAC members complained that their regular eye care professionals, who had been enrolled in the network of Pitt’s former vision care provider, Blue Shield OptiChoice, are not participating in Davis Vision, the University’s current vision coverage provider. This is true even when the eye professionals are affiliated with UPMC, SAC members noted.

According to Ron Frisch, associate vice chancellor for Human Resources who attended the April 11 meeting, the choice to enroll in the Davis Vision network is up to the individual eye care professional. For example, he said, “it was UPMC’s Eye Clinic that opted not to participate in the Davis Vision plan. Davis and the University have worked hard to include the Eye Clinic into the Pitt vision plan; we do hope that this will happen someday, but the decision is the choice of the Eye Clinic management.”

Pitt has more than 7,500 subscribers to the vision coverage plan, Frisch pointed out. While Pitt is in its second year of a two-year contract, employees may opt in or out of the plan during the open enrollment period, he noted.

“When we converted to Davis a year ago it was because Highmark would not write the former plan for us anymore. They’re essentially getting out of OptiChoice,” Frisch said. “As those plans come to the end of their term, they are no longer writing new ones. Highmark purchased Davis several years ago as a subsidiary, and they are slowly but surely converting all new contracts to the Davis operation.”

Davis was chosen by Pitt because it provides the best rates and the best total coverage compared with competing vendors, Frisch maintained. “Davis provides choice, just like most existing labs. However, they deal in volume which allows them to contain their costs and maintain a significant inventory,” he said.

“I, too, was one of those folks who had to change eye doctors, and I wasn’t too happy about it,” Frisch said. “My eye doctor, who also provides frames and so forth, said, ‘No, I don’t want to [join] with them because their discounts are [not the same as] OptiChoice’s were. If they’re not going to give me the same discounts as OptiChoice, I’m not going to [join] them.’ It’s 100 percent their decision not to participate in Davis, not the University’s decision to exclude them.”

He said director of Benefits John Kozar has approached numerous eye care professionals who were formerly in OptiChoice to urge them to enroll with Davis. Kozar told the University Times, “Of all the providers with any type of membership, we were down to six that did not elect to continue under Davis.”

Frisch said, “As more and more companies sign on with Davis and the OptiChoice plans fade away, we’d hope that they’ll come around. Until that time comes, like any physician group or optical place or dental office, they do not operate as a University center, they operate as a stand-alone. It’s their choice to pick whatever insurance plan they want to go with.”

(Vision providers in the Davis Vision plan can be located online at From that web site click on “Find a Provider.” Use client code 4228. There are 100 Davis network providers within a 50-mile radius of the 15213 area, according to the Davis web site.)

SAC benefits committee chair Steve Zupcic asked for clarification “on the interplay regarding insurance between a dental visit and dental surgery. Which is covered by the [UPMC] health plan and which by the dental coverage provider?” Zupcic asked.

Frisch replied, “There is not a clean answer to this. I can say that the rule of thumb is that if a procedure is medically necessary, it is covered by your [Pitt] insurance. But we recommend that you call United Concordia (Pitt’s dental coverage provider) directly to ask about this,” he said. “It’s still wise to call and ask beforehand or risk being charged.”

Vendors have a procedure-coding system that governs which procedures are covered by what insurance, Frisch added.

In response to a question on whether a staff member who leaves the University involuntarily due to an elimination of a position is eligible to recoup his or her flexible spending account (FSA) money, Frisch said, “You should be able to get that money assuming the expenses were incurred prior to termination. The IRS regulations clearly indicate that when employment stops so does an individual’s flexible spending account. We encourage people to spend down their accounts when they know that they are leaving.”

The “use it or lose it” rule goes into effect at the time that a contract is terminated, he added. “An individual does have six months following termination to re-coup their expenses, as long as those expenses were incurred during the active stage of the flexible spending contract.”

According to Kozar, terminated employees who have not incurred enough expenses to spend down their accounts have the option of continuing the FSA for health care under Cobra laws. “They pay 2 percent more but it opens the window to incur claims after termination,” Kozar told the University Times.

In other SAC developments:

• Brittany Guthrie, who serves as a staff representative on the University-wide parking and transportation committee, reported that renovations to parking garages in Posvar Hall, Soldiers & Sailors and O’Hara Street will begin April 30. She said that Pitt parking lease holders are not expected to be affected, but that non-permit patrons will have fewer spaces available to them during the summer months.

Guthrie also reported that the Port Authority of Allegheny County has sent a request to meet with Pitt officials about renegotiating the contract that allows Pittsburgh campus I.D. holders free access to Port Authority vehicles in exchange for annual Pitt payments. The contract year expires July 31. A clause in the contract says that either side can request a re-negotiation. The meeting has not been scheduled yet, Guthrie said.

• Anita Sorrells was elected co-chair of the marketing and communications committee, and Michele Aldrich, who was co-chair, was elected chair. The committee vacancy resulted from a SAC member’s resignation. Aldrich will assume the editor’s role for the SAC newsletter.

According to Zupcic, the newsletter will be introducing a new regular column, tentatively called “Know your benefits,” to “assist staff members in demanding the services they deserve from vendors and providers from outside the University.

“This is not about benefits policy,” Zupcic said. “It’s about making sure staff are aware of their current benefits, and to ensure that they are receiving them in a timely and correct fashion. We’re so large a population, with more than 20,000 subscribers to the UPMC Health Plan, that getting such competent services, such as correct hospital billing services, should be something that we as a group demand, nothing more, nothing less.”

• SAC discussed chronic unexcused absences by members at monthly and committee meetings. “At the end of the fiscal year, we will remove these members from the SAC roster,” said Ann Ostroski, chair of the governance committee.

“If a SAC member in good standing decides to resign because of work responsibilities or family responsibilities, they can come back and join SAC. But we don’t want staff in SAC who don’t even tell us that they’re not coming to meetings.”

—Peter Hart

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