UPMC Health Plan’s network is expanding!

Effective July 1, 2018, the UPMC Health Plan premium network will expand across northeastern Pennsylvania. The new counties are: Bradford, Clinton, Columbia, Lackawanna, Luzerne, Snyder, and Wyoming. Here is a map of the new premium network service area.

What this means for your clients
Businesses and organizations who have employees residing in the expansion counties and have an out-of-area PPO established for these employees can move these employees to the in-network plans upon renewal after July 1, 2018. Members seeking care in these counties will also move from using Private HealthCare Systems (PHCS)-MultiPlan contracted providers to direct contracted providers on July 1, 2018.

UPMC Health Plan will change from using PHCS-MultiPlan contracted providers to direct contracted providers in the expansion counties as of July 1, 2018. We have been working diligently over the past year to direct contract with the PHCS-MultiPlan providers in the expansion counties. However, there are some providers who chose not to contract with UPMC Health Plan. To allow the affected members sufficient time to find a participating provider, we notified them by mail the week of April 30, 2018. In addition, our Health Care Concierge team will reach out to these members by phone to assist them in locating participating providers in their area. A transition of care period will be available for members who apply and qualify for the extension.

If you require a zip code listing of the expanded premium network service area, please contact your account manager.

If you find that your client no longer has a need for the out-of-area PPO as of July 1, 2018, please notify your account manager and we will terminate the out-of-area subgroups.

If your client offers UPMC Health Plan EPO or PPO as an option to other insurance carriers in our service area, the client may expand the offering to employees in the expansion counties at their next renewal date after July 1, 2018. If the group is fully insured, expansion may impact its fully insured rates depending on the number of employees that reside in the expansion counties. The account manager will discuss this with you and/or your client upon their next renewal.

UPMC Health Plan’s online provider directory was updated to reflect the expanded service area.

UPMC Health Plan is pleased to be growing our footprint across Pennsylvania. We appreciate your business and your support. If you have questions about this change, contact your account manager.