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Health Plan Options

Individual Advantage Updates

Subscriber Swaps
Pennie, (Pennsylvania's new marketplace for individual health insurance coverage), requires the primary tax filer to be listed as the subscriber on all individual/family policies.  If the primary tax filer was already listed as the subscriber, they were not affected.  If the primary tax filer was listed as the spouse in 2020, they have been switched to the subscriber for 2021 and the old subscriber will now be listed as the spouse. 

What does this mean for your affected clients?
  • New ID numbers for 2021
    • Members will need to provide their new ID number to doctors and pharmacies.
    • Members will need to create a new MyHealth OnLine account using their new 2021 ID number.
  • Payments
    • Members are required to pay their January premium (initial binder payment) on or before January 1st.
    • If your client pays their premium electronically through their bank’s online bill payment system, they will need to update their ID number to be sure funds are applied to the correct account.
    • If your client currently has auto pay set up through UPMC Health Plan, they will need to set up auto pay under their new ID number for 2021.
  • Medical and pharmacy authorization
    • All prior authorizations will transfer to the new member ID.
Pennie Data Migration after 9/9/20
If your client made changes to their FFM application on or after September 9, 2020, those changes may not transfer to their 2021 application through Pennie. These changes include household size, income, and home address.  Your clients must update their household information through Pennie by December 15, 2020. If your client completed a new FFM application on or after September 9, 2020, the enrollments may not transfer to Pennie, causing your client’s coverage to terminate December 31,2020.  A new application must be completed through Pennie by December 15, 2020, for your client to have continuous coverage.   
Pennie Guide
A Pennie Guide has been added to the UPMC Health Plan Producer Portal under the Training & Guide section.
The guide reviews the following information:
  • How to navigate the agent dashboard
  • How to navigate the agency manager dashboard
  • How to navigate the member dashboard
  • How to start a new Pennie application
  • How to use access codes for existing Pennie members
  • How members can add a broker to their account
  • How to shop for a renewing member
  • Fast pathway to calling the Pennie broker assistance line
  • How payments work on Pennie
If you have any additional questions, please contact your UPMC Health Plan representative.
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