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Q. If I want the same elections as I have now, do I have to re-enroll? A. No, if you do not want to change your elections, you do not have to re-enroll to maintain your current coverage.
Q. When is open enrollment? A. Open enrollment begins Monday April 21, 2008 and ends on Wednesday May 14, 2008.
Q. I have not received/lost my packet. Where can I get a new one? A. If you have not received a packet or have lost yours, please contact Benefits at (412) 624-8160.
Q. What are the Benefits Department’s hours during open enrollment? A. Our business hours are Monday through Friday, 8 a.m. to 5 p.m. Eastern Standard Time.
Q. What is the effective date of the elections that I choose during open enrollment? A. Coverage will take effect July 1, 2008.
Q. How long do my open enrollment elections remain in effect? A. Coverage will remain in effect until June 30, 2009.
Q. Can I make changes to my benefit elections during the plan year? A. You can only make changes during the plan year if you have a qualified change in status. Examples include marriage, divorce, newborn baby, your dependent is no longer a full-time student or a change in your spouse’s employment. You must make the change within 60 days following the event. Paperwork is due in the Benefits Office by the last working day of the month prior to the effective date.
Q. If my spouse’s open enrollment is in January 2009, can I make changes to my enrollment at that time? A. If there is a significant change in plan design or coverage, you can change your enrollment at that time.
Q. When will a confirmation statement for my open enrollment elections be mailed to my home? A. If you enroll through online self service, you will receive a confirmation page at the end that you can print out and keep for your records. Confirmation statements will be produced and mailed at the end of Open Enrollment.
Q. Will I receive new cards? A. You and your covered dependents will receive new medical cards by the end of June. You will only receive new cards for vision and/or dental if you change or add plans. If you would like new cards, you can request them by contacting the vendors directly. UPMC Health Plan (medical) - 1-888-499-6885 United Concordia (dental) – 1-877-215-3616 Davis Vision – 1-800-999-5431 Client code: 4228
Q. What is online self service? A. Online self service operates in the PRISM (Oracle) system. PRISM is the operating system that runs all the Financial and Human Resource applications for the University community.
Q. How do I access online self service? A. To access self service, you will need a User Name (found on the Summary of Current Benefit Elections sheet that was included in your open enrollment packet) and a password (directions for deriving your password if you are a first time PRISM user, are also found in the open enrollment packet).
Q. I lost my password, can I get a new one? A.
If you have forgotten your PRISM Username or you need
your PRISM password reset, please take the following action:
Call the Technology Help Desk at 412-624-HELP (4357). Tell them that you are having problems logging in to Prism when you call. Be prepared to provide: 1.) Your full name (as it appears on your paycheck), 2.) The last four (4) digits of your social security number, and 3.) Your date of birth. Your password will be reset within one (1) business day to the original password that you derived (first two (2) characters of your User Name and last six (6) digits of your SSN). Q. Do I need to go through all of the screens in the self service system, even if I don’t want to change everything? A. Yes, it is very important that you complete the self service process even if you do not want to change everything. The system saves your information on every screen, so it is important that you complete the entire open enrollment process.
Q. I clicked the “Back” button at the top of the page and it took me out of the self service application. What happened? A. You need to make sure that if you have to go back to a previous page that you click the “Back” button at the BOTTOM OF THE PAGE. Using your browser “Back” button at the top of the page may take you out of the application.
Q. There are people listed on the Family Members and Others page who are not on my coverage. Why are they listed there? A. These are individuals who at one time or another were a contact of yours. For record keeping purposes, they can not be deleted. Even though they are listed as contacts, it does not mean that they are currently covered by your insurance. On a later screen, you will be able to designate dependents for the purpose of insurance coverage. Q. Why is the benefit credit an election? Do I need to do anything? A. The Benefit Credit is listed because that is a part of your flexible benefit program. We can not prevent that from appearing on the Self Service screens. You will only need to do something if the box next to “Benefit Credit Waive” is checked. Otherwise, you can just move on to the next section.
Q. Why is the $50 benefit credit reflected in the medical rates? A. The medical rates list the $50 benefit credit because the medical rates work in conjunction with the benefit credit. Q. I have already submitted my changes through online self service and I want to make another change. How can I make these changes? A. You can go into the online self service as many times as you like during the open enrollment period (April 21, 2008 through May 14, 2008). Each time you make a change, a confirmation page will be available for you to print out and you will also receive a confirmation statement at the end of Open Enrollment.
Q. Why does it say $0 next to the benefit credit? Since the benefit credit is an earning and not a cost, the $50 does not show on the Benefit Selections screen. You will see the $50 on the confirmation page
Q. My dependent(s) does not show up on my Summary of Benefit Elections sheet. Why? A. If an employee’s dependent does not have a Social Security Number in PRISM they will not show up on your Summary of Benefit Elections. They may, however, show up when you go into Self Service. To ensure that your dependent(s) show up on your Summary sheet next year, you should update the social security numbers in Self Service
Q. Do I need to designate my primary care physician (PCP) to complete the online enrollment/enrollment form? A. No, you do not have to restate your PCP if and your dependents (if any) are currently enrolled the Panther Gold plan. You will only need to designate a PCP if you and/or your dependent(s) are enrolling for the first time. If you are currently enrolled in the Panther Gold and would like to change your doctor, you must contact UPMC Health Plan directly at 1-888-499-6885. PCP’s are not needed for the Panther Premier, Plus, or Basic plan.
Q. How do I locate participating PCP’s in the Panther Gold plan? A. PCPs, pediatricians, OB/GYNs, and specialists in the Panther Gold plan can be located by visiting UPMC’s Web site at www.upmchealthplan.com. From that Web site click on “Provider Search.” Next click the link under “Provider Search.” You can then search by provider type and name, city or zip. Once you find a provider, click on the provider’s name and write down the four (4) digit Practice number.
Q. In previous years I had to designate my OB/GYN on the enrollment form. I don’t see a place for the code on the online enrollment form. Do I need to designate an OB/GYN for open enrollment? A. No, you do not need to designate an OB/GYN for online enrollment or on the paper form. As long as your OB/GYN participates in the Panther Gold plan, you will still have coverage. It will no longer print on your insurance card either. This will not be a problem when you go to your OB/GYN provided they participate in the Panther Gold plan.
Q. Can I change PCP’s during the plan year? A. Yes, you can change PCP’s at any time during the plan year. Please contact UPMC directly at 1-888-499-6885 to change your PCP.
Q. What is the Advantage Network? A. Advantage Network refers to the specific network of UPMC owned hospitals and facilities. The advantage network applies to the Panther Gold plan only. If services are provided at an Advantage Network Facility, you will have 100% benefit coverage. For a listing of Advantage Network facilities, click here.
Q. My PCP or specialist does not have admitting privileges to a UPMC advantage network facility. What are my options? A. Under the Gold Plan, if you want the highest benefit level, your doctor can refer you to a specialist who has admitting privileges to an advantage network facility. If you decide to go to a UPMC Health Plan network facility that is NOT an Advantage Network facility, but is part of the UPMC Health Plan network, you will be subject to a deductible and 20% coinsurance.
Q. What is a deductible? A. A deductible is the initial amount that you must pay each plan year for covered services before the plan begins to provide benefits.
Q. What is coinsurance? A. Coinsurance is the percentage of the cost of medical services shared by UPMC Health Plan and you.
Q. What is the out-of-pocket maximum? A. The out-of-pocket maximum is the most you have to pay each plan year before the plan begins to pay 100% of reasonable and customary covered expenses. Out-of-pocket maximums exclude deductibles, copayments, prescription drug expenses, precertification penalties and amounts over reasonable and customary charges.
Q. Do I have coverage if I am traveling? A. Under all four plans, you have coverage worldwide if you have a life threatening emergency. In medical emergency situations: Seek care immediately from the nearest emergency care facility. If you are in the Gold plan, contact your PCP within 24-48 hours. If you are in one of the PPO plans, contact UPMC Member Services within 24-48 hours.
Q. How does the copayment for the diagnostic services work? A. The copayment applies for your first four services per plan year. After that, UPMC pays 100%.
Q. What is Generic First? A. For new prescriptions dispensed after July 1, 2004, when a generic equivalent of a brand drug is available, a pharmacist will dispense the generic equivalent. If you choose not to accept the generic equivalent and elect a brand name drug, you will be responsible for the preferred brand copayment PLUS the cost difference between the generic and brand drugs.
Q. How does Generic First work? A. If you are currently taking a brand name drug that has a generic equivalent available, you do not have to do anything. If you choose, you can continue taking the brand name drug at the preferred brand copayment. If your doctor writes a new prescription for you that is not listed in the Your Choice Pharmacy brochure, your pharmacist will automatically dispense the generic equivalent. If it does not work, your doctor will need to complete a prior authorization for the brand name drug.
Q. What if I can’t take a generic? A. If there is a medical reason why you cannot take a generic equivalent of a brand drug, your physician can request a medical exception from UPMC Health Plan.
Q. What if I have a new prescription for a non-sedating antihistamine? A. You will have to try over-the-counter version first. If it does not work, your doctor will need to complete a prior authorization for the brand name drug.
Q. Where can I get a list of the preferred and non-preferred brands? A. This listing is found in the Your Choice Pharmacy brochure. Please click here.
Q. What if my medication is not listed in the Your Choice drug table? A. The medications listed in this table are the most common drug categories. If you medication is not listed in the table, you pay the generic or preferred brand copayment.
Q. What are the differences among the Your Choice copayment levels? A. The drugs listed in the first column are examples of generic prescription drugs. These drugs have the same active ingredients as their brand name counterparts. The drugs listed in the second and third columns are examples of preferred brand drugs that do not have a generic equivalent available. The fourth column lists examples of lifestyle drugs, cosmetic drugs and other medications that are not covered.
Q. Do I need to restate my Primary Dental Office (PDO) to complete the online enrollment/enrollment form? A. No, you do not have to restate your PDO in the Concordia Plus plan. You will only need to designate a PDO if you and/or your dependent(s) are enrolling for the first time. If you are currently enrolled in the Plus plan and want to change your PDO, contact United Concordia directly at 1-877-215-3616. PDOs are not needed for the Concordia Flex I and Flex II plans.
Q. How do I locate participating dentists in the Concordia Plus plan? A. To find a participating dentist, go to www.ucci.com and click on “Find a Dentist.” Select the DHMO Concordia Plus option and you can then search by city, name, zip or distance. Once you find a dentist, write down the last six (6) digits of the Provider ID.
Q. What is a participating provider? A. A participating provider is a provider that participates in the Concordia Advantage network, which is separate and distinct network and should not be confused with the managed care network of Concordia Plus. For a list of participating providers, visit United Concordia’s Web site, www.ucci.com.
Q. What is the advantage of choosing a participating provider? A. An advantage is that participating providers have agreed accept United Concordia’s Maximum Allowable Charge (MAC) as payment in full. These providers also will file claims on your behalf. A non-participating provider is under no obligation to accept these payments as payments in full and may bill you for amounts in excess of the MAC.
Q. Can I change my dentist during the plan year? A. Yes, you can change PDOs at any time during the plan year. Please contact United Concordia directly at 1-877-215-3616 to change your PDO.
Q. What does the $5 copay apply to? A. The $5 office visit copay applies to Diagnostic and Preventive Services under the Concordia Plus plan. This copay applies to services provided only at the University Dental Health Services (Provider Number 608061).
Q. If I am going to cover two children, can I elect the Individual plus spouse or child option? A. No, you must elect the Family coverage option. Individual plus spouse or child refers to you and one member of your family.
Q. How do I locate participating vision provider in the Davis Vision plan? A. Vision providers in the Davis Vision plan can be located by visiting Davis’s Web site at www.davisvision.com. From that Web site click on “Find a Provider.” Use client code 4228.
Q. I just had an eye exam in March. Can I get another one in July since it is the start of the new plan year? A. No, current participants that will continue with the program will have to wait one year from the date that services were last obtained. So if you had an eye exam in March 2008, you will not be eligible for another one until March 2009.
Q. If I am going to cover two children, can I elect the Individual plus spouse or child option? A. No, you must elect the Family coverage option. Individual plus spouse or child refers to you and one member of your family.
Q. What is the Health Care Spending Account? A. A Health Care Spending Account allows you to put aside pre-tax dollars to pay for predictable health care expenses.
Q. How much can I contribute to the Health Care flexible spending account? A. The minimum contribution is $10 per month and the maximum contribution is $416.67 per month ($5000 per plan year). If you are a faculty member on a less than annual contract, you can contribute a maximum of $625 per month.
Q. What types of expenses are covered under my flexible spending health care account? A. A
few examples include deductibles, copayments and over-the-counter
medication. For a more complete listing, please
see our list of eligible expenses for flexible spending accounts. Q. Can I change my contributions? A. You cannot increase or decrease your contributions during the plan year unless you experience a qualified change in status. This is why it is very important to plan your contributions carefully.
Q. Can I cancel my participation in the program? A. No, you would be able to cancel your participation if you experience a qualified change in status.
Q. What if I don’t use all of my contributions? A. The Health Care Spending account has a “use it or lose it” provision. Any funds that are not used for services and expenses incurred during the Plan Year and are not claimed by the end of the grace period, are forfeited.
Q. How long is the grace period? A. You have 6 months (December 31, 2009) from the end of the Plan Year to claim funds.
Q. What happens to the funds that are not claimed? A. These funds are forfeited and remain in trust to be used only for the operating costs of the flexible spending program.
Q. Can I elect it if I did not elect the medical, vision and/or dental insurance? A. Yes, you can elect a health care spending account even if you did not elect medical, vision and/or dental insurance.
Q. Can I use it for my spouse and/or dependents health care expenses? A. Yes, you can use the health care spending account for your spouse and/or dependents’ health care expenses.
Dependent Day Care Flexible Spending
Q. What is the Dependent Day Care Spending Account? A. The Dependent Day Care account reimburses dependent day care expenses necessary while you (and your spouse, if you are married) are working on a full-time basis.
Q. How much can I contribute to the Dependent Day Care Spending account? A. The minimum contribution is $10 per month and the maximum contribution is $416.67 per month ($5000 per plan year). If you are a faculty member on a less than annual contract, you can contribute a maximum of $625 per month.
Q. What types of expenses are covered under my flexible spending health care account? A. A
few examples include day care and summer day camp. For a more
complete listing, please
see our list of eligible expenses for flexible spending accounts. Q. Can I change my contributions? A. You cannot increase or decrease your contributions during the plan year unless you experience a qualified change in status. This is why it is very important to plan your contributions carefully
Q. Can I cancel my participation in the program? A. No, you would be able to cancel your participation if you experience a qualified change in status.
Q. What if I don’t use all of my contributions? A. The Health Care Spending account has a “use it or lose it” provision. Any funds that are not used for services and expenses incurred during the Plan Year and are not claimed by the end of the grace period, are forfeited.
Q. How long is the grace period? A. You have 6 months (December 31, 2009) from the end of the Plan Year to claim funds.
Q. What happens to the funds that are not claimed? A. These funds are forfeited and remain in trust to be used only for the operating costs of the flexible spending program.
Qualified Commuter Reimbursement Account
Q. What is the Qualified Commuter Reimbursement Account? A. The Qualified Commuter Reimbursement Account is a benefit that allows you to pay for certain commuting expenses with tax-free dollars through a payroll deduction.
Q. Who is eligible to participate in the program? A. Full-time Faculty Full- and Part-time Staff
Q. Who administers the Qualified Commuter Reimbursement Account? A. Employee Benefit Data Services (EBDS) administers the program. EBDS is the same company that administers the University’s Health Care and Dependent Day Care Flexible Spending Accounts.
Q. What kind of Qualified Commuter Reimbursement Accounts are there? A. There are two types of accounts: The Qualified Parking expense account, and The Qualified Mass Transit account. You can choose to contribute to one or both of these accounts.
Q. How much can I contribute to the Commuter account? A. For the Parking account Minimum monthly contribution is $25 Maximum monthly contribution is $220 For the Mass Transit account Minimum monthly contribution is $25 Maximum monthly contribution is $115
Q. How do I enroll in the program? A. You should carefully estimate the commuting expenses that you are likely to incur on a monthly basis during the plan year. Then indicate this amount either on the paper enrollment form or through online self service. A pre-tax deduction will be made from your paycheck to the elected Parking and/or Mass Transit Account(s). If you have a University parking lease and you are paying for this parking through a payroll deduction, then there is nothing you need to do. This deduction is automatically taken on a pre-tax basis.
Q. How do I get reimbursed?
A. Effective January 1, 2007, the University of Pittsburgh is offering a simpler, faster reimbursement method for all
Spending Accounts through a new product called MedSave®. Medsave, administered by eBDS, is an Online Claims Entry system
that applies to all University of Pittsburgh Flex Accounts (Healthcare, Dependent Day Care, Qualified Commuter).
Q. Can I change my contributions? A. You can make changes to your contributions at any time, but requests must be submitted by the last business day of the month prior to the effective date. Example: If you know that you are going on vacation in August and need to reduce your deduction for parking, you must submit a request by July 30. Requests received after that day, will not take effect until September 1.
Q. Can I cancel my participation in the program? A. You can cancel your participation in the program if you have a qualified change in status. Examples include attainment of a University parking lease or a change in your mode of transportation (switching from driving to taking the bus). You may submit claims for services provided prior to your cancellation in the program, however any unused account balance, for which a claim cannot be filed, will be forfeited.
Q. Can I combine my parking and mass transit accounts? A. No, you cannot combine the qualified parking account and the mass transit account into one account. However, if you incur both types of expenses, you can elect to participate in both types of accounts.
Q. I have a University lease; can I participate in the program? A. All full-time faculty and full- and part-time staff are eligible to participate in the program. However if you have a University lease, you would not be eligible for reimbursement because the lease is already taken out of your paycheck on a pre-tax basis.
Q. Why are public transportation expenses only eligible for outside of Allegheny County? A. This expense is not eligible because individuals with a University ID can ride the buses, trolleys and inclines within Allegheny County for free so there is no reason why you would pay for public transportation expenses within Allegheny County.
Q. What happens if I do not use the entire amount? A. Unused dollars roll over from month to month and plan year to plan year. This means that any portion of your monthly contribution to the account that is not reimbursed during a particular month will roll over to subsequent months until you submit an eligible claim.
Q. What happens if I incur expenses in a particular month but forget to submit claims until a few months later? A. Since unused funds roll over from month to month and plan year to plan year, reimbursements may be made for claims incurred in more than one month, provided the reimbursement for each month is calculated separately and does not exceed the statutory limits for any month. However claims incurred during the plan year which are not submitted within 90 days after the end of the plan year are forfeited.
Q. I pay for my parking lease at the beginning of the month. When would I be reimbursed? A. Claims will be reimbursed after the expense is incurred, not after it is paid for. Example: If you pay for your July parking lease on June 30 and submit your claim on July 5, you will not receive reimbursement until August because you must use the service first.
Q. What happens if I leave the University? A. Once you leave the University you will no longer be able to participate in the Commuter account. You may submit claims for services provided prior to the termination date within 90 days after you termination. Any claims received after 90 days are forfeited.
Q. Can I use the Commuter Account to pay for my spouse’s and/or dependent’s mass transit or parking expense? A. No. This account is only for employee work related commuter expenses.
Q. I park in a UPMC garage and get an employee monthly sticker, but the parking attendants cannot give me a receipt and all that I have is a cancelled check. If I sign of the Parking Flexible Spending Account, how can I get reimbursed? A. In this situation you can submit a copy of the sticker and a completed claim form.
Q. What is the difference between Life Insurance and AD&D (Accidental Death & Dismemberment)? A. Life insurance is insurance for death due to natural causes (e.g. heart attack, stroke), whereas AD&D is insurance for death due to accidents (e.g. car accident).
Q. Does the University provide Life Insurance and Accidental Death and Dismemberment to its employees? A. Yes, the University provides basic Life Insurance and Accidental Death and Dismemberment to its employees. This is free of charge to the employees. The basic coverage is 1x your salary up to the maximum of $50,000. If 1x your salary happens to be more than $50,000, your basic life insurance and AD&D is capped off at that amount.
Q. Can I elect optional life insurance and/or AD&D? A. You can elect optional life insurance and/or AD&D during open enrollment or if you have a Change in Status. It is possible that you will have to complete an Evidence of Insurability (EOI) to be approved for optional life insurance by Aetna. An EOI does not need to be completed for additional AD&D.
Q. I am currently not participating in optional life. Can I elect it now? A. You can elect optional life insurance now, but you will be required to fill out Evidence of Insurability. Note: If you are currently a participant, you can increase an additional one times base pay each open enrollment without EOI.
Q. I know that I can elect optional life and/or AD&D, but how much is it going to cost me? A. The optional life insurance is age-graded, meaning the older you are, the more it is going to cost you. Please keep in mind that you may need to complete an Evidence of Insurability (EOI) before you are approved for optional life insurance. The AD&D is not age-graded. The cost for optional AD&D is .018/$1000. An employee can elect between 1x-6x their salary for optional life insurance and/or AD&D. The equation to determine the cost of the optional life insurance is as follows: An employee who is age 42 has an annual salary of $25,000 and would like to have a total of $75, 000 in optional life insurance, which would be 3x his/her salary. You will need to locate your age-graded rate from the following chart.* 25,000 X 3 = 75, 000 75,000/1000 = 75 75 X .128* = $9.60/month For optional AD&D using the same example, replace the age-graded rate with .018. 75 X .018 = $1.35/month You can also visit our life insurance calculator to determine your monthly cost.
Q. What is Dependent Life Insurance? A. Dependent Life Insurance is insurance to cover your dependents (spouse and children). If your dependent(s) were to pass away, you as the employee would be the beneficiary.
Q. I am currently not participating in Dependent Life Insurance. Can I elect it now? A. You can elect dependent life now, however you will be required to fill out Evidence of Insurability. Note: If you are currently a participant, you can increase an additional one times base pay each open enrollment without EOI, however, option 4 ALWAYS requires Evidence of Insurability.
Q. Can I only make changes to my retirement contributions during open enrollment? A. No, you can change the amount that is being deducted from your paycheck, as well as the allocation between investment companies on a monthly basis. Please note: due to IRS regulations as well as University policies, the online changes are ALWAYS due in our office the month prior to when you want to make the change for. For example, if you would like to make a change for 6/1, the changes are due in our office by 5/31. You will see the change reflected in your 6/30 paycheck. You can change the funds that you are invested in on a daily basis directly with the investment companies.
Q. How can I change the amount that is deducted from my paycheck for retirement, start a supplemental account (SRA), or change allocation between investment companies? A. All changes must be made through the University Web Portal at my.pitt.edu. For questions on how to get started please contact the Benefits department at 412-624-8160.
Q. How can I change the funds within the investment company? A. You will need to call the investment company directly to make fund changes. TIAA-CREF: 1-800-842-2776 Vanguard: 1-800-523-1188
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