AGENT AND AGENCY TALKING POINTS  

Key Messages:

• We are committed to doing what is best for our members.
• Our Security Blue HMO and Freedom Blue PPO members will have in-network access to all UPMC hospitals including those in Pittsburgh and Erie through Dec. 31, 2018, and do not need to take any action at this time.
• There is no change for Highmark’s Community Blue Medicare HMO and PPO or Medigap Blue members. Highmark's Medigap supplemental insurance has no network. All Medicare Part B participating providers must bill and accept Medigap insurance products for their Medicare patients.
• We have a long history of offering a broad range of products for our Medicare members including both in-network and out-of-network benefits to meet their unique needs.
• We will continue to work on developing new options to help ensure access to local health care providers and while traveling.
• We welcome members to contact us directly during the Medicare Annual Enrollment Period for further details on new and enhanced benefits and options for 2019.

1. How does this ruling impact Highmark’s Medicare Advantage Security Blue HMO and Freedom Blue PPO members?
There is no change for Highmark’s Medicare Advantage Security Blue HMO and Freedom Blue PPO members in 2018. Members will continue to have in-network access to all UPMC hospitals including those in Pittsburgh and Erie through Dec. 31, 2018, and do not need to take any action at this time.

While some UPMC facilities will be out of network in 2019, we are committed to ensuring access to high-quality care for every member. In order to support a smooth transition, Highmark’s Medicare Advantage members will continue to be able to access all UPMC facilities through a run-out period that ends June 30, 2019.
 
Additionally, Highmark has a long history of offering a broad range of products for our Medicare members including both in-network and out-of-network benefits to meet their unique needs. We will continue to work on developing new options to help ensure access to local health care providers and while traveling.
 
We welcome members to contact us directly during the Medicare Annual Enrollment Period for further details on new and enhanced benefits and options for 2019.
 
In the meantime, members who have questions about their current Medicare Advantage plan should call 866-871-7710.

2. What about UPMC doctors?
UPMC has not terminated any physician contracts at this time.
 
3. Can Highmark Security Blue HMO and Freedom Blue PPO members keep their plan in 2019?
Yes, we look forward to continuing to serve our Security Blue HMO and Freedom Blue PPO members in the same plans that they have loved for years.  While we expect most members will want to stay in their current plans, Highmark has a wide range of product options to meet every member’s unique needs.  We have Medicare Advantage products that offer out-of-network benefits as well as Medigap Blue products that do not have any network requirements.  During the Medicare Annual Enrollment Period that occurs October through December, members can elect Highmark products for the coming year. Members who want to learn more about Highmark’s products should reach out to 866-871-7710.
 
4. What happens on January 1, 2019 for members who are actively in treatment at a Pittsburgh or Erie UPMC facility?
We will work closely with members in an active course of treatment to ensure they continue to receive high-quality care without any disruption.  Medicare Advantage members are protected even if they are treated by an out-of-network provider. Highmark members will only pay the stated member cost sharing (i.e., copay) as providers are prohibited from balance billing Medicare members.
 
5. How does this ruling impact Highmark’s Medicare Advantage members in Central or Northeastern Pennsylvania?
There is no change for Highmark’s Medicare Advantage members in Central or Northeastern Pennsylvania. Members do not need to take any action since the contracts with UPMC Susquehanna and UPMC Pinnacle will remain in force. 

6. How does this ruling impact Highmark’s Community Blue Medicare members?
There is no change for Highmark’s Community Blue Medicare HMO and PPO members in 2018 or 2019. There are nearly 25,000 members who are already enjoying Medicare Advantage products that have a broad range of physicians and hospitals but exclude UPMC. These members find value in the large provider network that includes Allegheny Health Network and local partner hospitals for care close to home. 

7. How does this ruling impact Highmark’s Medigap Blue members?
There is no change for Highmark’s Medigap Blue members. Highmark's Medigap supplemental insurance has no network. All Medicare Part B participating providers must bill and accept Medigap insurance products for their Medicare patients.

8. How many Security Blue HMO and Freedom Blue PPO members will this decision impact?
Highmark has more than 134,000 members in its Security Blue HMO and Freedom Blue PPO products in Western Pennsylvania. We think it’s important that all of our members understand the decision even if they are not directly impacted.

9. Does Highmark anticipate a significant loss of membership when in-network access to UPMC hospitals in Pittsburgh and Erie ends? How much membership will you lose?
We look forward to continuing to serve our members in the same plans that they have loved for years. While we expect most members will want to stay in their current plans, Highmark has a wide range of product options to meet members’ unique needs. We have Medicare Advantage products that offer out-of-network benefits as well as Medigap Blue products that do not have any network requirements.
 
In Western Pennsylvania, we have seen significant enrollment growth in our Community Blue Medicare HMO and PPO Medicare Advantage products. There are nearly 25,000 members who are already enjoying Medicare Advantage products that have a broad range of physicians and hospitals but exclude UPMC. These members find value in the large provider network that includes Allegheny Health Network and local partner hospitals for care close to home.

10. Which UPMC hospitals will be out-of-network for 2019? 

• Magee-Womens Hospital of UPMC
• UPMC East
• UPMC Hamot
• UPMC Horizon
• UPMC McKeesport
• UPMC Mercy
• UPMC Passavant
• UPMC Presbyterian Shadyside
• UPMC St. Margaret

11. Which UPMC hospitals will be in-network for 2019?

• Western Psychiatric Institute and Clinic
• UPMC Bedford
• UPMC Northwest
• UPMC Altoona
• UPMC Jameson
• UPMC Kane Hospital
• UPMC Pinnacle Carlisle
• UPMC Pinnacle Lancaster
• UPMC Pinnacle Lititz
• UPMC Pinnacle Hanover
• UPMC Pinnacle Memorial
• UPMC Susquehanna Williamsport Regional Medical Center
• UPMC Susquehanna Divine Providence Hospital
• UPMC Susquehanna Muncy Valley Hospital
• UPMC Susquehanna Soldier & Sailors Memorial Hospital
• UPMC Susquehanna Sunbury
• UPMC Susquehanna Lock Haven