Summary Guide - Human Resources - University of Pittsburgh

hr.pitt.edu

Summary Guide - Human Resources - University of Pittsburgh

2013-2014

SUMMARY GUIDE

UNIVERSITY OF PITTSBURGH

Eligible faculty and staff

Summary Guide to

Benefits

July 1, 2013–June 30, 2014

Office of Human Resources

Benefits Department

320 Craig Hall

200 South Craig Street

Pittsburgh, PA 15260

412-624-8160

fax: 412-624-3485

www.hr.pitt.edu/benefits


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Table of Contents

Enrollment and Status Changes.....................................................................................................................3

Vendor Contact Information..........................................................................................................................3

Medical Plans..............................................................................................................................................4–7

Medical Plan Premiums.................................................................................................................................8

Prescription Drug Program...........................................................................................................................8

Emergency Services and Assist America........................................................................................................9

LifeSolutions (Faculty and Staff Assistance Program)...................................................................................9

Fitness for Life..............................................................................................................................................10

Vision Plans and Monthly Premiums..........................................................................................................11

Dental Plans and Monthly Premiums..........................................................................................................12

Life Insurance and Monthly Premiums.......................................................................................................13

Flexible Spending Accounts...................................................................................................................14–15

Retirement Income Plans.............................................................................................................................16

Additional Benefits (Education, Paid Time Off, Income Protection/Leaves of Absence,

Employee Discount Services, Long Term Care Insurance, Parking and Transportation Services)............17

Retiree Benefits Program.......................................................................................................................18–19

Policies and Notices.....................................................................................................................................20

Disclosure

The information presented in this Summary Guide to Benefits is intended to provide a general overview and discussion of the plans. Descriptive

literature is available from the carriers and the Office of Human Resources. Additional details of the benefits presented here also may be found at

www.hr.pitt.edu/benefits. The rights and obligations of employees and those of the University are governed by the terms of each benefit plan and

in some cases by contracts with the insurance companies. The plans are based on current federal and state laws and are regulated by those laws. If

there is a conflict between the enrollment guide and the plan/contracts, then the plan and contracts will control. Benefits may be modified from

time to time as required by applicable laws, and benefits may be modified or terminated as deemed necessary or appropriate by the University.

Staff covered under collective bargaining agreements are governed by the terms of those agreements.

Enrollment and Status Changes

Outside of Open Enrollment

Eligibility

Participation is open to:

»»

Full-time regular faculty, librarians, research associates,

and post doctoral associates

»»

Part-time regular, tenured/tenure stream faculty at not less

than 50% effort

»»

Part-time regular librarians designated with expectations

of continued employment at not less than 50% effort

Full-time regular staff

Part-time regular staff

»»

The aforementioned may include their spouse, children,

and domestic partner

Enrollment

All of the benefits outlined in this Summary Guide to Benefits

brochure remain in effect from July 1, 2013, to June 30, 2014.

The plans and level of coverage for a particular plan (i.e., those

individuals covered under a particular plan) in which you are

enrolled can only be changed during the annual open enrollment

period. You may only make changes to your benefit elections

outside of the open enrollment period if you have a qualified

status change. Additionally, if you are declining enrollment

for yourself or your dependents (including your spouse/domestic

partner) because of other health insurance coverage, you may

in the future be able to enroll yourself or your dependents in

the University’s coverage because of a qualified status change.

Examples of status changes are listed below.

Qualified Status Changes

»»

Marriage or divorce

»

» Birth, adoption, or custody of a stepchild who will reside

in your household

»»

Spouse/domestic partner’s gain or loss of employment,

or obtaining or losing coverage

»»

A significant change in coverage occurring with a spouse/

domestic partner’s plan

»»

Death of a spouse/domestic partner or child

»»

Child attains age 26

»»

Loss of Medicaid or CHIP coverage or become eligible for

the premium assistance subsidy

You must make your election within 60 days of when the status

change occurs. Please note that primary care physicians and

primary dental offices may be changed at any time during the

year directly through the respective insurance carrier, not just

at open enrollment or because of a status change.

Coverage for Dependent Children

Under the University of Pittsburgh’s insurance plans,

children, up to the age of 26, are eligible for medical, dental,

and vision coverage under their parent’s insurance.

Refer to www.hr.pitt.edu/benefits/act-4 for additional

details on eligibility requirements for covering children

under the University’s health insurances.

Important Vendor Contact Information

Vendor

Benefits Plan

Phone

Number

Web Site

Medical 1-888-499-6885 www.upmchealthplan.com

Prescription drug program: retail 1-800-396-4139

www.upmchealthplan.com/pharmacy/

index.html

UPMC Health Plan

Prescription drug program: mail order 1-877-787-6279 www.expressscripts.com

Travel medical emergency services 1-800-872-1414 www.assistamerica.com

MyHealth Advice Line 1-866-918-1591

Flexible spending accounts 1-888-499-6885 www.upmchealthplan.com/myflex

Davis Vision

Vision: prior to enrollment 1-877-923-2847

www.davisvision.com (refer to page 9

for more details)

Vision: current participants 1-800-999-5431

www.davisvision.com (refer to page 9

for more details)

United Concordia Dental 1-877-215-3616 www.ucci.com

Aetna Life Insurance Company Life, AD&D, and dependent life 1-888-584-2983 www.aetna.com/group/upitt

UNUM Long term care insurance 1-800-227-4165 http://w3.unum.com/enroll/upitt

TIAA-CREF Retirement income plans 1-800-682-9139 www.tiaa-cref.org/pitt

Vanguard Retirement income plans 1-800-523-1188 www.vanguard.com

LifeSolutions Faculty and Staff Assistance Program 1-866-647-3432 www.hr.pitt.edu/lifesolutions


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Upmc Medical Plans

Physician, Emergency Room, and Other Services

Medical Insurance Plans Comparative Summary of Key Provisions

How the Plan Works

Basic Plan Features

and Explanations

Deductible

(member responsibility before insurance

pays for services)

Coinsurance

(member responsibility for services after

deductible has been paid)

Plan Responsibility

(amount insurance pays for services after

member pays deductible and before out

of pocket max is reached)

Out of Pocket Max -INCLUDES

Deductible and Coinsurance

Amounts

(total member responsibility before

insurance pays for services at 100%)

Copayment

(member responsibility at time of

service; amounts do not apply

towards any deductibles, coinsurance

or out of pocket maximums)

Panther Gold with Advantage

Network (HMO)

Panther Advocate

(New PPO/HIA)

Panther Premier (PPO) Panther Plus (PPO) Panther Basic (PPO)

Requires selection of a network doctor—

primary care physician (PCP) a May select any doctor b May select any doctor b May select any doctor b May select any doctor b

No coverage provided outside the UPMC Health Plan

network, except in the case of an emergency

FULL UPMC

IN NETWORK

n/a

OUT OF

NETWORK

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

$750 / $1,500 $1,500 / $3,000 $500 / $1,000 $1,000 / $2,000 $750 / $1,500 $1,500 / $3,000 $1,000 / $2,000 $2,000 / $4,000

10% 30% 10% 30% 20% 40% 30% 50%

100% 90% 70% 90% 70% 80% 60% 70% 50%

n/a No coverage $1,250 / $2,500 $2,500 / $5,000 $1,500 / $3,000 $3,000 / $6,000 $2,250 / $4,500 $4,500 / $9,000 $5,000 / $10,000 $10,000 / $20,000

Copayments for various

services are listed below

n/a

n/a

Health Incentive Account (HIA)

$500 / $1,000

Earning Maximum

n/a n/a n/a n/a n/a n/a

Reduced Deductible if

100% HIA Earned Before

$250 / $500 $1,000 / $2,000

n/a

Claims are Incurred

Reduced Out of Pocket Max

if 100% HIA Earned Before

n/a $750 / $1,500 $2,000 / $4,000

Claims are Incurred †

Health Plan Payments for Services are Noted Below; Copayments for the HMO and Deductibles and Coinsurance for PPO the Plans Apply as Stated Above

Adult and Pediatric Wellness

and Preventive Services

(e.g., adult physical and annual ob/gyn

visit, pneumonia vaccine, well-baby

visits, pediatric immunizations)

Doctor Office Visit

(for illness or injury)

Specialist Office Visit

(e.g., cardiologist, dermatologist)

Outpatient Behavioral Health

(e.g., therapist)

Chiropractic Services

(limit of 25 visits per plan year)

Maternity Services

(e.g., prenatal visits)

Convenient Care Clinics c

(e.g., ear infections, strep throat)

Urgent Care Services c

(same services as Convenient Care plus

x-rays, setting broken bones, stitches)

Emergency Room Services

(refer to page 9 for Global Emergency

Services)

100%

100% after

$25 copayment

100% after

$40 copayment

100% after

$25 copayment

100% after

Copayment per visit:

Initial $40 / Others $25

100%

100% after

$25 copayment

100% after

$60 copayment

No coverage

$75 copayment (children up to age 18)/$125 (adult 19+)

(copay waived if admitted)

100%

(deductible does

not apply)

70%

(deductible does

not apply to pediatric

immunizations

and preventive

mammographies)

100%

(deductible does

not apply)

70%

(deductible does

not apply to pediatric

immunizations

and preventive

mammographies)

100%

(deductible does

not apply)

60%

(deductible does

not apply to pediatric

immunizations

and preventive

mammographies)

100%

(deductible does

not apply)

50%

(deductible does

not apply to pediatric

immunizations

and preventive

mammographies)

90% 70% 90% 70% 80% 60% 70% 50%

90%

(after in-network deductible)

90%

(after in-network deductible)

90%

(after in-network deductible)

90%

(after in-network deductible)

Member services: 1-888-499-6885

www.upmchealthplan.com

80%

(after in-network deductible)

80%

(after in-network deductible)

70%

(after in-network deductible)

70%

(after in-network deductible)

a b

To locate participating physicians and

facilities in the UPMC network if you reside in

Western Pennsylvania:

1. Go to www.upmchealthplan.com

2. Click on “Find a Doctor”

»»

To locate physicians for the Panther Gold plan, click on

“UPMC Advantage”

»»

To locate physicians for any of the PPO plans, click on

“UPMC Health Plan PPO”

b

To locate physicians and facilities if you reside

outside of Western Pennsylvania:

1. Go to www.upmchealthplan.com

2. Click on “Find a Doctor”

3. Click on “Out of Area Members Find a Doctor” to locate other

contracted networks of UPMC Health Plan

For Ohio residents, click on “The Ohio Portion of the Map”

»»

For all others, click on “The Out-of-Area Portion of the Map”

c

To locate convenient care clinics and urgent

care centers:

3. Go to www.upmchealthplan.com

4. Click on “Find a Doctor”

5. Click on “Find a Convenient Care or Urgent Care Clinic”

»»

To locate these clinics for the Panther Gold plan, click on

“UPMC Health Plan HMO”

»»

To locate these clinics for any of the PPO plans, click on

“UPMC Health Plan PPO”

† HIA credits automatically apply to prescription copays at the pharmacy,

however copays are not counted toward the Out of Pocket maximum.

Credits will be used toward the coinsurance and out-of-pocket maximum

if they are earned after the deductible has been met.

*The Summary of Benefits and Coverage (SBC) and uniform glossary

of terms, developed by UPMC Health Plan as mandated by the Patient

Protection and Affordable Care Act (PPACA) are available online at

www.hr.pitt.edu/benefits. Hard copies are also available by contacting

the Benefits Department at 412-624-8160.


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Upmc Medical Plans (continued)

Inpatient and Outpatient Facility Services

Member services: 1-888-499-6885

www.upmchealthplan.com

Medical Insurance Plans Comparative Summary of Key Provisions

How the Plan Works

Basic Plan Features

and Explanations

Panther Gold with Advantage

Network (HMO)

Panther Advocate

(New PPO/HIA)

Panther Premier (PPO) Panther Plus (PPO) Panther Basic (PPO)

Requires selection of a network doctor—

primary care physician (PCP) a May select any doctor b May select any doctor b May select any doctor b May select any doctor b

No coverage provided outside the UPMC Health

Plan network, except in the case of an emergency

UPMC

Advantage

Network:

Higher Benefit–UPMC

Owned Facilities c

UPMC

Affiliated

Network:

Lower Benefit–No

Out of Network

Benefit Coverage d

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

Provides coverage to any

doctor or hospital

FULL UPMC

IN NETWORK

OUT OF

NETWORK

Deductible n/a $300/$600 $750 / $1,500 $1,500 / $3,000 $500 / $1,000 $1,000 / $2,000 $750 / $1,500 $1,500 / $3,000 $1,000 / $2,000 $2,000 / $4,000

Coinsurance n/a 20% 10% 30% 10% 30% 20% 40% 30% 50%

Plan Responsibility 100% 80% 90% 70% 90% 70% 80% 60% 70% 50%

Out of Pocket Max -INCLUDES

Deductible and Coinsurance

Amounts

Copayment

n/a $1,800 / $3,600 $1,250 / $2,500 $2,500 / $5,000 $1,500 / $3,000 $3,000 / $6,000 $2,250 / $4,500 $4,500 / $9,000 $5,000 / $10,000 $10,000 / $20,000

Copayments for various

services are listed below

n/a

n/a

Health Incentive Account (HIA)

$500 / $1,000

Earning Maximum

Reduced Deductible if

n/a

n/a n/a n/a n/a n/a n/a

100% HIA Earned Before Claims

$250 / $500 $1,000 / $2,000

n/a

are Incurred

Reduced Out of Pocket Max

if 100% HIA Earned Before

$750 / $1,500 $2,000 / $4,000

Claims are Incurred †

Health Plan Payments for Services are Noted Below; Copayments for the HMO and Deductibles and Coinsurance for PPO the Plans Apply as Stated Above

Inpatient Hospital Services

max. of 2 copayments per plan year

Outpatient Facility Services

and Observations

(e.g., same day surgery)

max. of 4 copayments per plan year

100% after

$500 copayment

100% after

$200 copayment

a b

To locate participating physicians and

facilities in the UPMC network if you reside in

Western Pennsylvania:

1. Go to www.upmchealthplan.com

2. Click on “Find a Doctor”

»»

To locate physicians for the Panther Gold plan, click on

“UPMC Advantage”

»»

To locate physicians for any of the PPO plans, click on

“UPMC Health Plan PPO”

b

To locate physicians and facilities if you reside

outside of Western Pennsylvania:

1. Go to www.upmchealthplan.com

2. Click on “Find a Doctor”

3. Click on “Out of Area Members Find a Doctor” to locate other

contracted networks of UPMC Health Plan

For Ohio residents, click on “The Ohio Portion of the Map”

»»

For all others, click on “The Out-of-Area Portion of the Map”

c

UPMC Advantage Network

Listed below is a sampling of the Advantage Network hospitals. To locate the full

listing of Advantage Network hospitals, please refer to the instructions above.

»»

Children’s Hospital of

UPMC Northwest

Pittsburgh of UPMC

UPMC Presbyterian

»»

Conemaugh Valley »»

UPMC Shadyside

Memorial Hospital

»»

Magee-Womens Hospital

of UPMC

»»

Memorial Medical Center

Downtown (Johnstown)

»»

Western Psychiatric

Institute and Clinic

»»

Windber Medical Center

d

Other Affiliated UPMC Facilities

Listed below is a sampling of the other affiliated UPMC facilities. To locate the full

listing of facilities, please refer to the instructions above.

Butler Memorial Hospital »»

St. Clair Memorial

»»

Jefferson Regional

Medical Center

Hospital

»»

The Washington Hospital

† HIA credits automatically apply to prescription copays at the pharmacy

however copays are not counted toward the Out of Pocket maximum.

Diagnostic Services:

Basic (e.g., x-ray, sonograms)

max. of 4 copayments per plan year

High-tech (e.g., MRI, CT, PET)

max. of 4 copayments per plan year

Medical Therapy Services

(e.g., dialysis, radiation, chemo)

100% after

$20 copayment

100% after

$80 copayment

100%

80% 90% 70% 90% 70% 80% 60% 70% 50%

*The Summary of Benefits and Coverage (SBC) and uniform glossary

of terms, developed by UPMC Health Plan as mandated by the Patient

Protection and Affordable Care Act (PPACA) are available online at

www.hr.pitt.edu/benefits. Hard copies are also available by contacting

the Benefits Department at 412-624-8160.

Physical, Speech, and

Occupational Therapy

(Limit 60 visits/plan year all therapies

combined)

100% after

$25 copayment


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Medical Insurance Plans Monthly Rates: July 1, 2013–June 30, 2014

Premium Summary

Plans

Total Monthly Rate

Monthly University

Contribution Including

Benefit Credit

PANTHER GOLD with Advantage Network (HMO)

Individual $ $ 455 $

Parent/Child(ren) $ $ 1006 $

Two Adults $ $ 1138 $

Family $ $ 1259 $

Panther Advocate (New PPO/HIA)

Individual $ $ 445 $

Parent/Child(ren) $ $ 983 $

Two Adults $ $ 1113 $

Family $ $ 1231 $

PANTHER PREMIER (PPO)

Individual $ $ 451 $

Parent/Child(ren) $ $ 995 $

Two Adults $ $ 1124 $

Family $ $ 1244 $

PANTHER PLUS (PPO)

Individual $ $ 406 $

Parent/Child(ren) $ $ 885 $

Two Adults $ $ 1006 $

Family $ $ 1117 $

PANTHER BASIC (PPO)

Individual $ $ 385 $

Parent/Child(ren) $ $ 842 $

Two Adults $ $ 924 $

Family $ $ 970 $

Prescription Drug Program

(applies to all medical plans)

30 Day Supply available through:

Retail and Independent Pharmacies

UPMC Pharmacy Services 1-800-396-4139

»»

$14 copayment generic

»»

$40 copayment preferred brand

»»

$80 copayment nonpreferred brand

»»

$90 copayment speciality medication

Monthly Employee

Contribution

$ 385 $ $ 70

$ 842 $ $ 164

$ 901 $ $ 237

$ 934 $ $ 325

$ 385 $ $ 60

$ 842 $ $ 141

$ 901 $ $ 212

$ 934 $ $ 297

$ 385 $ $ 66

$ 842 $ $ 153

$ 901 $ $ 223

$ 934 $ $ 310

$ 385 $ $ 21

$ 842 $ $ 43

$ 901 $ $ 105

$ 934 $ $ 183

$ 385 $ $ 0

$ 842 $ $ 0

$ 901 $ $ 23

$ 934 $ $ 36

90 Day Supply available through:

Mail Order through Express Scripts 1-877-787-6279:

Falk Clinic Pharmacy 412-623-6222 (Oakland campus

office delivery available)

Student Health Service Pharmacy 412-383-1850

»»

$28 copayment generic

»»

$80 copayment preferred brand

»»

$160 copayment nonpreferred brand

Please note that the prescription drug formulary is subject to change periodically based upon the decisions of the UPMC Pharmacy and

Therapeutics Committee. Examples include introduction of new medications, changes in tier level (i.e., brand name to generic), etc.

Members may obtain a 90-day supply of medication at any participating retail pharmacy but, three copayments will apply. Members may

obtain a 90 day supply at a discounted price through mail order, Falk Pharmacy, and Student Health Service Pharmacy. As an example, at

Student Health Service Pharmacy members pay $28 for a 90-day supply of generic medication, while the cost is $42 at a retail pharmacy

($14 x 3). Specialty medication is not available at the discount price.

Assist America - Global Emergency Services

1-800-872-1414 or www.assistamerica.com

If you encounter a medical emergency while traveling, you have

the comfort of knowing that you are protected worldwide. Keep

in mind, during a medical emergency situation you should:

»»

Seek care immediately from the nearest emergency facility.

»»

Notify your primary care physician (if applicable), or

contact UPMC Health Plan Member Services at 1-888-

499-6885 within 24–48 hours of an emergency or hospital

admission.

»»

Have claims processed through UPMC Health Plan

before making payment to providers outside the network.

As part of your UPMC health plan you have the powerful global

emergency assistance services provided by Assist America if you

encounter a medical or personal emergency while traveling 100

miles or more away from home, or in another country. Assist

America provides emergency medical and personal assistance

services such as doctor referrals, prescription assistance, emergency

evacuation, return of mortal remains and more.

LifeSolutions

1-866-647-3432 or www.hr.pitt.edu/lifesolutions

As Faculty and Staff of the University, you are continually asked

to juggle your own workload, and your life at home. Balancing

can be much easier with direct access to supportive resources and

personal attention. LifeSolutions, your University faculty and

staff assistance program, provides WorkLife services including

no-cost personalized consultations and referrals, for a wide range

of daily needs.

The goal of WorkLife services is to help with the time consuming

leg work associated with daily needs, so a person can remain

focused on his or her job duties. Some of the WorkLife services

offered include:

»»

Elder Care: Help with locating an assisted living facility

for an elderly parent who can no longer live independently.

»»

Financial consultation: Support with budgeting, retirement

planning, debt management, and similar issues.

»»

Child care assistance: Choosing a summer camp, preschool,

day care facility, or other resource(s).

»»

Legal consultation: Estate planning, wills, divorce or

marriage issues, or contract issues. The initial 30 minute

legal consultation is free and subsequent legal support will

be offered at a discounted rate.

LifeSolutions continues to provide in person and telephonic

coaching and counseling services. Faculty, staff, and their

To obtain a brochure with attached ID card, you can call member

services or print out a card by:

1. Log into UPMC Health Plan member portal at

www.upmchealthplan.com.

2. Select “Coverage and Benefits”

3. Select “Your Benefits”

4. Click on “My Town Square” at the bottom

5. Select “Travel”

Assist America is available 24 hours a day, 365 days a year,

anywhere in the world. Assist America arranges and pays for the

services and cannot reimburse members for services arranged

independently.

household members can receive up to six sessions per issue per

year at no cost. These services are completely private and confidential.

Our clinicians are all Ph.D. or Master’s level trained

with broad experience in mental health and addiction issues.

LifeSolutions helps people with stressors such as family conflict

and relationship issues, as well as more serious psychiatric or

substance use disorders. LifeSolutions responds to calls 24 hours

a day, seven days a week. Our services are conveniently located

near all five University of Pittsburgh campuses.

LifeSolutions also provides training and education programs

which can be customized to meet a department or school’s needs:

»»

Examples include Financial Wellness, Stress Management:

a Path to Wellbeing, and Maintaining a Respectful

Workplace, to name a few.

»»

Deans, managers, and supervisors receive management

consultation services regarding challenging workplace

issues, including how to safely and tactfully approach a

troubled employee or sensitive situation.

LifeSolutions is a no cost resource available to University faculty,

staff, and their household members that can help pave the way

to a happier, healthier, and more productive life at work and at

home. You can reach LifeSolutions by phone at 1-866-647-3432

or online at www.hr.pitt.edu/lifesolutions.


10 // july 1, 2013–june 30, 2014 july 1, 2013–june 30, 2014 \\ 11

Fitness for Life

www.hr.pitt.edu/fitness

The University’s Fitness for Life program focuses

on proactive health care management. As part of this

program, services are offered to you and your family

members to promote a healthy lifestyle. The benefit

coverage and activities sponsored by the University help

Preventive Care Coverage

Preventive-related benefits are covered at 100 percent without

the need to make a copayment or meet a deductible including

but not limited to:

»»

Wellness visits to your primary care physician

»»

Wellness-related blood panels

»»

Mammograms

»»

Prostate screenings

»»

Colonoscopies

»»

Flu and pneumonia vaccinations

»»

Shingles vaccination (Zostavax)

»»

Adult immunizations

»»

Pediatric immunizations

The adult and pediatric preventative guidelines are posted at:

www.hr.pitt.edu/fitness. Click on “Prevention Guidelines.”

Smoking Cessation

Smoking is a difficult habit to break. The University supports

members trying to quit smoking by covering:

»»

Smoking cessation prescription medication

»»

Smoking cessation counseling

Copayments may be reimbursed if members complete a counseling

program that is available:

»»

Online

»»

By telephone

»»

In person through LifeSolutions

Exercise

A well-balanced diet and exercise are key components of a

healthy lifestyle. The availability of exercise facilities will vary by

campus. In Oakland, Trees Hall and Bellefield Hall are available

for use at no cost to faculty and staff. Regional campus information

is available through the local Human Resources office.

The University Club is also open to faculty and staff.

Membership and general information are available on its Web

site: www.uc.pitt.edu.

support each member in the development of a healthy

lifestyle and awareness of the benefits of reducing

healthcare cost escalation.

Benefits Coverage, Wellness Related Programs and Activities

The University’s Health and Physical Activity department

provides wellness education, exercise, and dietary programs that

promote physiological benefits. It is open to all faculty and staff.

Additional information is available on its Web site:

www.education.pitt.edu/wellness.

Activities on Campus

Throughout the year, the Benefits Department, UPMC Health

Plan, and many engaged departments sponsor wellness-related

activities on campus. Some of the programs include:

»»

Access to weight watchers “At work” meetings on campus

»»

Exercise campaigns

»»

Wellness fairs

These programs are generally announced through flyers, campus

mailings, and posters.

Nutrition Counseling

Through the University’s UPMC Health Plan insurance

coverage, nutritional counseling is available at no cost to you.

The University provides free telephonic nutrition

education/counseling with a UPMC Health Plan registered

dietician up to six times per year.

A dietician may be able to help with:

»»

Meal planning

»»

Suggestions to comply with a diet

»»

Helpful hints to avoid unhealthy snacks

To set up an appointment contact UPMC Health Plan at

1-800-807-0751.

Health Coaching

The University, through UPMC Health Plan, provides

health coaching to members with University health plan

coverage. Health coaches can provide needed support to stay

on track with a diet, develop and maintain a regular exercise

program, and support management of chronic conditions.

To set up an appointment contact UPMC Health Plan at

1-800-807-0751.

Vision Plans and Monthly Premiums

Davis Vision: Prior to enrollment: 1-877-923-2983 (client code 4228 for the Fashion Excellence Plan

and 4583 for the Designer Gold Plan)

Current participants: 1-800-999-5431 or www.davisvision.com (client code 4228 for the Fashion Excellence Plan

and 4583 for the Designer Gold Plan)

How the

Plan Works

Feature

**To locate participating providers

in the Davis Vision network:

1. Go to www.davisvision.com

2. Click on “Members”

3. Under the box “Open enrollment” enter the

client code 4228 for the Fashion Excellence Plan

and 4583 for the Designer Gold Plan and click

submit

4. Select “Find a Provider”

Vision Insurance Plans—Summary of Key Provisions

All participants, regardless of age, are eligible for a comprehensive eye examination and one pair of eyeglass lenses and frames OR a

contact lens evaluation and fitting and contact lenses once every 12 months.

Note: For current participants who will continue in the program, eligibility for exams, lenses, and frames will be one year from the

date that services were last obtained.

“In-Network”: requires utilization of providers in the Davis Vision network*

“Out-of-Network”: may utilize providers outside the Davis Vision network

Participants who utilize an out-of-network provider are responsible for paying all billed charges and will be reimbursed subsequently (after

submitting claim forms to the carrier) up to the specified out-of-network schedule allowance as stated below.

Fashion Excellence Plan

Copayments and Coverage Options

Coverage Level

Designer Gold Plan

Copayments and Coverage Options

In-Network Out-of-Network In-Network Out-of-Network

Eye Examination Covered in Full Up to $32 Covered in Full Up to $32

Spectacle Lenses

Frame

Contacts

(in lieu of eyeglasses)

Covered in Full

Up to $60 retail allowance

towards provider-supplied frame

or

Any Fashion frame from Davis

Vision’s exclusive Collection*

(with retail values up to $125)

Covered in Full

or

Any Designer frame from Davis

Vision’s exclusive Collection*

(with retail values up to $175)

after $20 copayment

or

Any Premier frame from Davis

Vision’s exclusive Collection*

(with retail values up to $225)

after $40 copayment

Contact lenses, evaluation and

fitting fees, Covered in Full

$75 allowance towards providersupplied

contacts or one pair of

daily wear (in lieu of allowance)

or

Medically necessary with prior

approval, Covered in Full

Single Vision $25

Bifocal $36

Trifocal $46

Lenticular $72

Up to $30

Evaluation and fitting fee:

Daily wear, up to $20

Extended wear, up to $30

Standard Daily Wear,

up to $48

or

Elective, up to $75

or

Medically Necessary,

up to $225

Covered in Full

$130 retail allowance towards

provider-supplied frame

plus 20% off overage 1

or

Any Fashion or Designer

frame from Davis Vision’s

exclusive Collection* (with

retail values up to $175)

Covered in Full

or

Any Premier frame from

Davis Vision’s exclusive

Collection* (with retail values

up to $225) after

$25 copayment

Contact lenses, evaluation

and fitting fees,

Covered in Full

$130 allowance towards

provider-supplied contacts

plus 15% off overage 1

or

Medically necessary

with prior approval,

Covered in Full

MONTHLY RATES

Davis Vision

Fashion Excellence Plan

Single Vision $25

Bifocal $36

Trifocal $46

Lenticular $72

Up to $30

Evaluation and fitting fee:

Daily wear, up to $20

Extended wear, up to $30

Elective, up to $75

or

Medically Necessary,

up to $225

Davis Vision

Designer Gold Plan

Individual $6.03 $8.43

Individual Plus

One Adult or One Child

$10.83 $15.14

Family $14.74 $20.61

*For more information on the Davis Vision Collection, call Davis Vision at the number listed above

1

Additional discounts not available at Walmart locations


12 // july 1, 2013–june 30, 2014 july 1, 2013–june 30, 2014 \\ 13

Dental Plans and Monthly Premiums

United Concordia: 1-877-215-3616 or www.ucci.com

Life Insurance and Ad&d

Aetna Life Insurance Company: 1-888-584-2983 or www.aetna.com/group/upitt

To report a death or to check on a claim, call 1-800-523-5065

Dental Insurance Plans

Summary of Key Provisions

Managed Care

Standard Care Plans

Concordia PLUS Concordia FLEX I Concordia FLEX II

Life insurance and accidental death and dismemberment (AD&D) insurance help provide financial protection in the event of your death

or that of a spouse/domestic partner or dependent.

How the Plan Works

Annual Deductible

Requires selection of a network

primary dental office (PDO)*

Plan payment accepted by PDO, or for

certain services patient responsible for

fixed-dollar copayment.

To determine your copayment

responsibility, refer to www.hr.pitt.

edu/benefits/health-and-welfare/

dental-plans and click on “Schedule of

Benefits.”

None

May select any dentist*

Plan payment accepted, or for certain

services patient responsible for coinsurance

as percent of maximum allowable

charge (MAC).

MAC accepted as payment in full by

participating provider (Concordia

Advantage dentist); nonparticipating

provider may issue a balance bill*.

$50/individual, $100/individual plus

one adult or child, $150/family

May select any dentist*

Plan payment accepted, or for certain

services patient responsible for coinsurance

as percent of maximum allowable

charge (MAC).

MAC accepted as payment in full by

participating provider (Concordia

Advantage dentist); nonparticipating

provider may issue a balance bill*.

Same—Waived for preventive, diagnostic,

and orthodontics

Basic Coverage

Group Life

AD&D

The University provides group term life insurance coverage in the amount of one times your

salary, rounded up to the next thousand capped at the plan maximum of $50,000. AD&D coverage

also is provided in the amount of one times your salary, rounded up to the next thousand capped at

the plan maximum of $50,000. There is no cost to you.

Optional Coverage and Monthly Rates

Group Life

Optional group term coverage is available to you at your choice of one to six times your annual salary,

rounded up to the next thousand capped at the plan maximum of $2 million. This is a fully employeepaid,

after-tax benefit that does not reduce federal and state taxes. New hires may elect the lesser of

two times base pay or $500,000 in optional life insurance without evidence of insurability (EOI).

Exam/Cleaning Frequency One in any consecutive six months** One in any consecutive six months One in any consecutive six months

Preventive Services

(e.g., x-rays)

Basic Services

(e.g., cavity fillings)

Major Services

(e.g., crowns)

Orthodontics

Eligible dependents to age 19

Annual Plan Year

Maximum

*To locate participating providers

in the United Concordia network:

1. Go to www.ucci.com

2. Click on “find a dentist”

3. For the Concordia PLUS plan, select

“DHMO Concordia Plus General

Dentist” from the “My Network Is” drop

down menu

4. For the Concordia FLEX I and II plans,

select “Concordia Advantage” from

the “My Network Is” drop down menu

Insurance pays 100%** Insurance pays 100% of MAC Insurance pays 100% of MAC

Insurance pays 100% Insurance pays 50% of MAC Insurance pays 80% of MAC

Insurance pays approximately 60% Insurance pays 50% of MAC Insurance pays 50% of MAC

Insurance pays approximately

40%–50% up to scheduled allowance

MONTHLY RATES

Coverage Level Concordia Plus Concordia FLEX I Concordia FLEX II

Individual $17.86 $18.18 $26.89

Individual Plus

One Adult or One

Child

Not covered

Insurance pays approximately

50% up to scheduled allowance;

$1,500 lifetime maximum

None $500/covered person $1,000/covered person

**A $5 office visit copayment applies for these services only at University Dental Health Services Inc.

$36.23 $34.37 $52.71

Family $59.11 $56.14 $102.45

AD&D

Dependent Life

Cost is age-graded rate times each $1,000 of coverage.

Less than 30 years.................... $.051

30–34 years.............................. $.068

35–39 years.............................. $.077

40–44 years.............................. $.085

45–49 years.............................. $.150

50–54 years.............................. $.214

55–59 years.............................. $.367

60–64 years.............................. $.589

65–69 years............................ $1.083

70–74 years............................ $1.756

74 plus.................................... $1.756

To calculate your life insurance cost:

Salary × additional coverage value (1–6) = total coverage

Employees age 42 with $35,000 salary electing to have

coverage of three times their salary have a total coverage

of $105,000.

Total coverage ÷ 1,000 × age rate = cost per month

$105,000 ÷ 1,000 × .085 = $8.93

Employee cost per month = $8.93

Coverage is available at your choice of one to six times your annual salary, rounded up to the

next thousand capped at the maximum of $2 million.

Cost is not age-graded and is a constant rate times each $1,000 of coverage ($.015/$1,000).

Subject to evidence of insurability. Cost is not age-graded and is constant regardless of the

number of eligible family members covered.

COVERAGE OF SPOUSE/ COVERAGE OF EACH

DOMESTIC PARTNER DEPENDENT CHILD

Option 1 $1.58.............................. $10,000....................................$5,000

Option 2 $3.12.............................. $15,000..................................$10,000

Option 3 $3.43.............................. $20,000..................................$10,000

Option 4 $8.54.............................. $50,000..................................$10,000

Option 5* $11.57.............................. $75,000..................................$10,000

Option 6* $15.41.............................. $100,000................................$10,000

*Proof of good health, also called evidence of insurability, is required for some types of coverage. Evidence of insurability (EOI) is

an application process in which you provide information on the condition of your health or your dependent’s health in order to be

approved for coverage. Aetna Life Insurance provides 90 days to submit the EOI application for approval or denial of coverage.

Business Travel

Accident

Insurance

The University provides business travel accident (BTA) coverage for all full-time employees.

BTA insurance coverage provides a benefit for loss of life and certain injuries resulting from a

covered accident while traveling on authorized University business.


14 // july 1, 2013–june 30, 2014 july 1, 2013–june 30, 2014 \\ 15

Flexible Spending Accounts

UPMC Health Plan:

1-888-499-6885 or

www.upmchealthplan.com/myflex

A flexible spending account program provides an opportunity to

reduce your federal and Social Security taxable income through

funding an account(s) on a pretax basis. You may obtain reimbursement

through the submission of qualified out-of-pocket

expenses relating to that particular account.

Flexible spending accounts are intended to be used for

predictable expenses only. Please review the plan details of

each flexible spending account prior to enrollment to determine

if a flexible spending account is right for you.

You may learn more about the flexible spending accounts in greater

detail, including eligible expenses, claim submission deadlines,

and claim submission procedures, by visiting the University of

Pittsburgh’s Benefits Department Web site at www.hr.pitt.edu/

benefits/health-and-wellness/flexible-spending, or by contacting

the University’s flexible spending account administrator, UPMC

Health Plan, at 1-888-499-6885

Flexible spending account participants may enjoy the following

benefits of UPMC Health Plan’s MyFlex Advantage flexible

spending administration:

»»

The MyFlex Advantage MasterCard for Health Care FSA

members provides the benefit of swiping your card to pay

for health care FSA-eligible items, such as doctors office

copays, deductibles, coinsurance, prescription drugs, and

other qualified medical expenses.

»»

UPMC Health Plan’s online claims submission (OCS)

allows participants to submit claims and download receipts

by following a few easy steps. Utilizing OCS starts the

review process of claims much faster than traditional claim

submission methods, and reduces the need to fax or mail

personal health information. The OSC Tool is both safe

and secure.

»»

Participants are able to obtain their flexible spending

account for health care and dependent day care over the

phone by calling 1-888-499-6885 and following a series of

prompts.

“Use It or Lose It” Rule for Plan Year

2014: July 1, 2013-June 30, 2014

The “Use it or Lose it” rule applies to all four spending

account types. Other than the exception listed below for

health care and dependent care, all claims must be incurred

prior to July 1, 2014. Participants must submit those

expenses for reimbursement by December 31, 2014. If

your coverage ends prior to June 30, 2014, claims must be

incurred prior to your last day of coverage. If your coverage

ends prior to the end of the plan year, you have 180 days to

submit expenses after the last day of coverage. Careful planning

is required. Any remaining funds in your account at

the end of the plan year will be forfeited and used to offset

the general plan expenses.

2 ½ Month Health Care and

Dependent Day Care Flexible

Spending Account Extension

The U.S. Treasury Department granted a 2 ½ month

extension for health care and dependent day care flexible

spending accounts. Participants have until September 15

to incur an expense and use any contributions remaining

in their health care and/or dependent day care flexible

spending accounts. During this grace period, card transactions

will automatically pull from the previous plan year

to exhaust funds before it pulls from the current plan year

funds. Expenses incurred during this period still must be

submitted to UPMC Health Plan, the University’s flexible

spending account administrator, for reimbursement no later

than December 31, 2014.

Incomplete Participation in Plan Year

Unused funds will be forfeited if not claimed within 180

days of the following status changes:

»»

End of the plan year

»»

Termination

»»

Change in status which makes you ineligible for

the plan

In case of termination or ineligibility during the plan year,

claims can be submitted for expenses incurred prior to

the termination/ineligibility date. Expenses and services

incurred after the termination/ineligibility date are not

eligible for reimbursement.

Flexible Spending Accounts Offered

Account Type

Examples of Eligible Expenses

Monthly

Minimum

Monthly

Maximum

Annual

Maximum

Claims

Incurred

Incurring Extension

Available?

Filing

Deadline

Does the “Use it or

Lose it” rule apply?

Eligible to use

the MyFlex Advantage card

to cover expenses?

Health Care

Deductible(s), copayments, prescription drugs,

prescription glasses, and orthodontics for you and/

or your dependents.

$10 $208.33 $2,500

Yes - Through

September 15, 2014

Yes

Dependent

Day Care

Parking

Day care providers, after school care or extended

day care, au pair, nanny, elder care, and summer

day camp expenses incurred due to working

outside the home.

The cost of parking in a non-University lot (leases

or pay by the day) that is located near your place

of employment or cost of parking in a University

lot if you pay by the day.

$10 $416.67 $5,000

$25 $240.00 $2,880

July 1, 2013 -

June 30, 2014

Yes - Through

September 15, 2014

No

December 31, 2014

Yes

No

No

Mass Transit

Vanpooling expenses or cost of a transit pass to

travel to your place of employment from outside

of Allegheny County.

$25 $125.00 $1,500

No

No


16 // july 1, 2013–june 30, 2014 july 1, 2013–june 30, 2014 \\ 17

Retirement Income Plans

Eligible faculty and staff are offered a choice between two

options to establish a continuation of an income stream upon

retirement. The two options are listed below. Details, including

plan documents, may be found on the Benefits Department Web

site at www.hr.pitt.edu/benefits/retirement-benefits. The Plan

Years are Calendar Years and are not subject to an annual open

enrollment. Elections or changes may be made online throughout

the year by following the steps in the box below:

Log into the University’s Web portal at www.my.pitt.edu.

Click on the “My Resources” tab on the “My Pitt” portal home

page, and select “Human Resources” from the drop-down list.

Select Retirement Plan Access – Manage your Retirement

Plan Elections.

The online system is available 7 days a week, 24 hours a day.

Changes must be made by the end of the month prior to when the

change is to take effect.

One important term referred to frequently in the plans is vesting.

Under the Defined Contribution Plan, once you have fulfilled

the three-year vesting schedule, you have a non-forfeitable right

to the University match when you retire from the University

or leave employment with the University. Under the Defined

Contribution Plan, you always have the right to your contributions

and earnings upon retirement or leaving. Under the

Defined Benefit Pension Plan, the vesting schedule is five years.

Defined Contribution Plan

Within the Defined Contribution Plan, participants contribute

a percentage of base pay which is placed into investments of

personal choice through either TIAA-CREF and/or Vanguard.

Participant contributions may be made on a pre-tax basis or

through the Roth 403(b) after-tax deduction.

Eligible faculty and staff become vested after having completed

1,000 hours of participation in three consecutive calendar years.

Once vested, the participant has ownership of the contributions

which are matched by the University. You are always 100%

vested in your pre-tax or after tax contributions.

Between the ages of 52 and 65, once vested, you have the option

of joining the Accelerated Option. This option ends after

making the election: up to 120 months or to age 65, whichever

occurs first. The University match ceases once participation in

the Accelerated Option ends.

Upon retirement, faculty and staff may continue to invest

savings through TIAA-CREF and/or Vanguard. As needed

upon retirement, retirement income streams may be established

from among the options available through TIAA-CREF and/or

Vanguard.

Defined Benefit Pension Plan

The Defined Benefit Pension Plan is a non-contributory

program. In other words, you do not contribute. Only the

University is responsible for funding the plan.

Benefits are based upon a formula, not upon contributions or the

plan’s investment earnings. A participant who is terminated or

retired in a vested status and meets the criteria is eligible for an

annuity (fixed income stream).

For each year of vested participation, a participant accrues a

benefit equal to 2.1% of their compensation not to exceed the

Social Security Wage Base. The benefit is calculated for all

participants as a single life annuity , although it may be converted

to a joint and 100% survivor annuity for a married participant.

The vesting period under the Noncontributory Defined Benefit

Pension Plan is five years counted as 1,000 or more hours of

service in each calendar year:

»»

Full-time faculty are credited with 1,000 hours of service

in a calendar year. (If part time, service credits are based

on the academic credit load of teaching and if applicable

computation of the academic credit equivalencies of other

academic assignments.)

»»

Full-time staff are credited with 1,950 hours for a 37.5

hour work or 2,080 hours for a 40 hour work week. (To

accumulate 1,000 hours, the status of the staff position

must be at least 60% effort.)

If you are covered by the Defined Benefit Pension Plan and

have never been enrolled in the Defined Contribution Program,

you may be eligible to take advantage of the Once in Career

Change option:

»»

Elect enrollment in the Defined Contribution Program,

according to the online steps described in the above box.

»»

Re-enrollment in the Defined Benefit Pension Plan is not

permitted.

Employee-Only Tax Deferral

Contributions

Faculty and staff may elect to make supplemental tax-deferred

contributions without a University matching contribution, but

within the limits permitted by tax regulations.

Employees who are not eligible for the University matching

contribution may make elective tax-deferred contributions within

the limits permitted by tax regulations.

DEFINED contribution PLAN schedule

Faculty and Staff University Total

Minimum Maximum Dollar Maximum Match in Maximum

Contribution Contribution Contribution Contribution Dollars Deferral with Match

Non-vested 3% 8% $1.00 8% $1.00 16%

Vested 3% 8% $1.00 12% $1.50 20%

Accelerated Option 3% 8% $1.00 14.5% $1.810 22.5%

Additional Benefits

Additional benefits are available to eligible faculty and staff. All of

the additional benefit offerings that are outlined in the remaining

pages of this Summary Guide to Benefits brochure do not operate

on an annual open enrollment schedule or the same plan

year. For benefits requiring an enrollment, the guidelines for

enrollment are stated below.

Education

The University offers tuition remission to staff and faculty, as

well as their spouse/domestic partner and dependent children.

For more information on staff education benefits, refer to the

Office of Human Resources Benefits Department Web site at

www.hr.pitt.edu/benefits/education.

For more information on faculty education benefits, refer to the

online Faculty Handbook at www.provost.pitt.edu/handbook/

handbook.html (Section V: Faculty Compen sation and Benefits).

Paid Time Off from Work

The University provides faculty and staff with 10 paid holidays

per calendar year.

Additionally, full-time faculty members with an annual contract

are entitled to a one-month vacation each year. For more information

on paid time off for faculty, refer to the online Faculty

Handbook at www.provost.pitt.edu/handbook/handbook.html

(Section II: Faculty Policies).

Staff members accrue vacation and sick days each month.

They also receive personal day(s) and may receive winter

recess (Christmas Eve to the first working day of the year) off.

For more information on paid time off for staff, refer to the

Office of Human Resources Benefits Department Web site at

www.hr.pitt.edu/benefits/time.

Income Protection/Leaves of Absence

The University provides long term disability insurance for

faculty and staff. The long term disability benefit program

provides partial income replacement and continuation of certain

University benefits in the event eligible staff or faculty become

“disabled.” For more information on long term disability refer

to the Office of Human Resources Benefits Department Web site

at www.hr.pitt.edu/node/476.

For information on faculty leaves of absence, refer to the

online Faculty Handbook at www.provost.pitt.edu/handbook/

handbook.html (Section II: Faculty Policies and Section V:

Faculty Compensation and Benefits).

For information about staff leaves of absence, refer to the

Office of Human Resources Benefits Department Web site

at http://hr.pitt.edu/benefits/medical_leave

Employee Discount Services

A variety of discounts are available to faculty and staff members

and, in many cases, their dependents, through different departments

of the University and companies that are affiliated with the

University. Discounts also are offered to faculty and staff, as well as

their dependents, who carry UPMC Health Plan medical coverage.

For a listing of all of the available discounts through these

various locations, please visit www.hr.pitt.edu/worklife-balance/

employee-discounts.

Long Term Care Insurance

The University of Pittsburgh is committed to providing benefit

solutions that will help you plan for a future of financial stability

and security. This commitment to providing valuable benefits

extends to your future by the University’s offering of Long Term

Care Insurance at a group rate.

Long term care is the type of care received, either at home or

in a facility, when someone needs assistance with activities of

daily living because of an accident, illness, or advancing age.

Long Term Care Insurance provides benefits to help pay for this

needed care.

The national average cost for care in a long term care facility

is $81,000 per year. Home-based costs vary depending on the

type and frequency of care required. For most of us, this expense

would have a significant impact on our financial security. The

need for long term care and the impact it can have on a family’s

financial security has become an issue of national concern. The

University appreciates the seriousness of this issue and is taking

steps to help our faculty and staff understand and protect against

the financial risks associated with long term care.

Long Term Care Insurance is an employee-paid benefit available

at a group rate to faculty and staff, as well as their family

members. Please contact the University’s Long Term Care

Insurance carrier, Unum, for specific plan details and coverage,

rates and downloadable enrollment forms at 1-800-227-4165, or

http://w3.unum.com/enroll/upitt.

Parking and Transportation Services

For more than 30 years, the University has promoted carpooling,

vanpooling, and bicycle programs through incentives from

Parking and Transportation Services.

Incentives for registered carpoolers include:

»»

Reduced monthly parking permit fees

»»

Pretax payroll deduction (not to be used in conjunction

with Qualified Commuter Expense Accounts)

»»

Free ride matching

»»

Courtesy parking

»»

Access to the region’s Emergency Ride Home program

The registered vanpools receive free parking in designated areas,

as well as other incentives offered to carpoolers.

The Bicycle Program provides bicycle parking conveniently

located throughout campus, and bicycle lockers are available for

a nominal fee.

Please visit the Parking and Transportation Services Web site for

more information about the programs described above at www.

pts.pitt.edu/commuting.


18 // july 1, 2013–june 30, 2014 july 1, 2013–june 30, 2014 \\ 19

Retiree Benefits Program

www.hr.pitt.edu/retirees

Eligibility

University of Pittsburgh faculty and staff receive official recognized

retiree status if they meet the following requirements:

»»

Recognized Pitt start date prior to July 1, 2004: Must be

age 62

»»

Recognized Pitt start date on or after July 1, 2004: Must

be age 62 and have age and service equal to 85 or greater

Defined Dollar

Benefit Program

The Defined Dollar Benefit (DDB) program provides “credits”

that may be used to offset the cost of retiree medical coverage.

Between the ages of 62 and 65, retirees have the option to elect

pre-65 retiree medical coverage, by enrolling at the cost share or

for the credits.

At age 65, retirees and eligible spouses/partners are enrolled in

the DDB program.

Credits may be used for the following:

»»

Purchase of University-sponsored post-65 coverage

»»

Purchase of post-65 coverage obtained independently

»»

Retained in an account for future use toward a retiree

medical plan premium

Each month the University will deposit credits (dollars) into an

account in your name and that of your eligible spouse/partner.

Unused credits roll over month to month and year to year.

Pre-65 Benefit Plan Coverage

Retirees and qualified spouses/partners* between the ages of 62

and 65 have the options to:

»»

Continue the same medical, dental, and vision coverage

available to active faculty and staff. The cost share remains

the same as well.

»»

Elect “credits” under the Defined Dollar Benefit (DDB)

program instead of paying for the cost share of University

medical coverage.

• Pre-65 retirees typically elect to take DDB credits if

they have medical coverage through a spouse/partner or

through another employer. Credits (available only for

retiree coverage) may be “banked” or saved for future

use or reimbursement of retiree medical coverage.

• Please refer to the Defined Dollar Benefit program

section of the Benefits Department Web site: http://

retiree.hr.pitt.edu/ddb.htm.

Post-65 Benefit

Plan Coverage

Prior to the beginning of the month in which you turn 65, you

will be provided with the opportunity to enroll in post-65 benefit

coverages sponsored by the University of Pittsburgh (medical,

dental, vision).

Medical

The University of Pittsburgh offers several medical plan options.

Equally as important, the University sponsors prescription

drug coverage that generally exceeds the standard plans offered

directly by Medicare and insurance carriers.

The University sponsors the following Post-65 medical plans:

»»

UPMC for Life HMO (requires residency in a

Pennsylvania service area)

»»

UPMC for Life PPO–Standard (requires residency in a

Pennsylvania service area)

»»

UPMC for Life PPO–Basic (requires residency in a

Pennsylvania service area)

»»

Highmark Freedom Blue PPO–Standard

»»

Highmark Freedom Blue PPO–Basic

»»

UPMC National Complementary Program with PDP

»»

Highmark Signature 65 with Blue Rx

The DDB credits may cover the full cost of the HMO and PPOs.

The national plans, which provide a greater level of flexibility,

may require a retiree contribution.

Each of the University-sponsored plans for post-65 retirees

coordinates coverage with Medicare Parts A and B. You should

begin the Medicare Part B enrollment process three months

prior to the month in which you need your Medicare Part B to

be effective. The forms for a University-sponsored plan must

be signed and dated prior to the month in which you need

your Medicare Part B to be effective; but not earlier than three

months in advance.

Dental

Coverage is available through the United Concordia Access

program, a Highmark BCBS company.

Vision

Davis Vision, also a Highmark BCBS company, provides a valueadded

vision program.

*NOTE: An eligible spouse/partner is the individual

designated as approved on University records at the

time of retirement.

Benefits For Pre-65 and

Post-65 Retirees

Life Insurance

The University provides life insurance, based on eligibility as an

active employee, equal to $1,500 for each year of service up to a

maximum of $15,000. If you have additional life insurance needs,

the University offers both conversion and portability provisions

for basic and optional coverages, respectively, that were in force

immediately prior to your retirement.

Long-term Care

Long-term care may be continued into retirement. Upon retirement,

the University will notify the insurance carrier, Unum, to

offer you conversion information. Premiums do not increase due

to age or retiree status and will be paid directly to Unum.

Education Benefits

Staff should refer to University Policy 07-11-02, or call the

Benefits Department at 412-624-8160.

Faculty should refer to University Policy 02-07-02, or call

Faculty Records at 412-624-4232.

Retirement Income Plan

You should begin to review your TIAA-CREF and/or Vanguard

retirement accounts or Defined Benefit Pension Plan participation

prior to retirement. Licensed financial counselors from

TIAA-CREF and Vanguard are available for one-on-one

appointments to review your accounts and discuss potential

investment strategies, income options, inflation and taxes, planning

tools, and resources for services.

TIAA-CREF

General Web Site: www.tiaa-cref.org/pitt

Telephone Counseling: 1-800-682-9139

Personal Appointment: 1-877-209-3136

Appointment Web Site: www.tiaa-cref.org/moc

The Vanguard Group

General Web Site: www.vanguard.com

Telephone Counseling: 1-800-523-1188

Personal Appointment: 1-800-662-0106 ext. 14500

Appointment Web Site: www.meetvanguard.com

Noncontributory Defined Benefit

Pension Plan

Participants in this plan should contact the University of

Pittsburgh Pension Administration Center at 1-866-283-0208 to

review the following:

»»

Participation

»»

Vesting status

»»

Eligibility for payments upon retirement

»»

Benefit begin date

»»

Benefit amounts

Benefits Service Center

The University of Pittsburgh partners with a benefits service

center to handle retiree benefit administration:

»»

The University remains responsible for the overall

management of the program.

»»

The center handles general program administration

and the day-to-day operations of the University’s retiree

benefits program, including billing.

After the decision to retire is made and officially processes, the

center will send the enrollment packet to your home address.

What Should I Do If I Want

To Retire?

Contact the Benefits Department to set up a one-on-one session

for you and your spouse/partner if you are considering retiring

and would like to discuss the topics mentioned in this brochure.

»»

Your department requires advance notification of a retirement.

The length of time your department needs varies by

department.

»»

Your department will then begin the processing of your

employee record. Once the processing is complete, the

benefits service center will mail a benefits enrollment

packet to your home address.

»»

The enrollment packet includes all of the forms necessary

to enroll in the retiree coverages. This packet will need to

be completed and sent back to the benefits service center

to the address indicated.

»»

The Benefits Department will complete verification forms

required by TIAA-CREF and/or the Vanguard Group as

well as forms for Medicare Part B obtained from the Social

Security Administration.


20 // july 1, 2013–june 30, 2014

Policies and Notices

Children’s Health Insurance Program

Reauthorization Act of 2009 (CHIPRA)

CHIRPA requires employers offering group health plans to

notify employees of their potential rights to receive premium

assistance under a state’s Medicaid or CHIP program.

CHIPRA has added two different rules that could benefit of

certain employees of the University. First CHIPRA added a new

premium assistance program for participants who are eligible for

a Medicaid or a state CHIP program If you are such an individual

and you are eligible for health coverage from the University

but are unable to afford the premiums, the state CHIP program

may help you pay for coverage under the University health plans.

If you or your dependents are already enrolled in Medicaid or

CHIP, you can contact your state Medicaid or CHIP office to

find out if premium assistance is available. Second, CHIPRA has

added two new Qualified Status Change events. The Qualified

Status Changes events occur either when an eligible employee’s

enrollment ends in Medicaid or a state’s CHIP program or when

an eligible employee becomes eligible for the premium subsidy

and can then enroll in the University’s coverage. If either of

those two events occur, the employee must request coverage

from the University within 60 days of the event.

Women’s Health and Cancer Rights

Acts (HR4328, Public Law 105-277)

Under the University of Pittsburgh’s health plans, coverage will

be provided to a member who is receiving benefits for medically

necessary mastectomy and who elects breast reconstruction after

the mastectomy for:

1. Reconstruction of the breast on which a mastectomy has

been performed

2. Surgery and reconstruction of other breast to produce a

symmetrical appearance

3. Prostheses

4. Treatment of physical complications of all stages of

mastectomy, including lymphomas

This coverage will be provided in consultation with the attending

physician and the patient and will be subject to the same

coinsurance and any applicable annual deductibles that apply for

the mastectomy.

Prescription Drug Notice of

Creditable Coverage (Medicare

Part D Notice)

Group medical plans with prescription drug coverage sponsored

by the University for active faculty and staff, pre-age 65 retirees,

and post‐age 65 retirees meet the standards for creditable coverage

required by federal regulations and guidelines.

Summaries of Benefits and Coverage

Summaries of Benefits and Coverage (SBC) provide applicants,

enrollees, and policyholders with government mandated

comparable information about health plan benefits and coverage

options to help you evaluate choices when comparing the

University of Pittsburgh’s plans to other plans. For the most

cost-accurate information to compare between the University of

Pittsburgh’s group of plans, and customized information about

your medical options, please go to www.hr.pitt.edu/benefits.

In addition to accessing and/or printing copies of the

electronic SPDs and SBCs, you also have the right to

request and receive, free of charge, paper copies of these

documents.

Request a printed Health and Welfare SPD and/or

Summary of Benefits and Coverage (SBC) on the Benefits

website or by calling the University’s Benefits Department

at 412-624-8160

Certificates of Creditable Coverage

Pursuant to the Health Insurance Portability and Accountability

Act of 1996, you will receive certification of your coverage under

UPMC Health Plan should you, your spouse, and/or your dependents

lose group health coverage. You may need this certification

in the event that you become covered by a new plan under a different

employer, or under an individual policy, to possibly reduce any

pre-existing condition or coverage delay limitations.

The following policies and notices can be found on the Benefits

Department’s Web site at www.hr.pitt.edu/benefits:

»»

Newborns’ And Mothers’ Health Protection Act

»»

Qualified Medical Child Support Orders

»»

Personal Health Information

»»

Military Leave under USERRA and NDAA

»»

Claims Review and Appeal Procedures

»»

Genetic Information Nondiscrimination Act Compliance

»»

Loss of Coverage/Termination of Employment

Office of Human Resources

The University of Pittsburgh is an affirmative action, equal opportunity institution.

Published in cooperation with the Department of University Marketing Communications.

UMC89781-0413

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