Client Name

Table of Content

  1. Header
  2. Overview
    1. Open Enrollment
    2. Eligibility
    3. How to Enroll
    4. How to Enroll
    5. Your Benefit Options
    6. Understanding Your Benefits
    7. Understanding Your Benefits Continued
    8. Terms to Know
  3. Medical
    1. Highmark
    2. Virtual Visits
    3. Added Benefits from Highmark
    4. Health and Wellness Programs
    5. UPMC Health Plan
    6. Benefit Summaries
    7. Virtual Visits
    8. Added Benefits from UPMC
    9. LifeSolutions
    10. UnitedHealthcare
    11. Benefit Summaries
    12. Virtual Visits
    13. Wellness and Rewards Programs
    14. Health Savings Account
    15. Flexible Spending Account
    16. Health Reimbursement Arrangement
    17. Additional Resources
    18. Medicare Services from NFP
  4. Dental
    1. Benefit Summary
  5. Vision
    1. Benefit Summary
  6. Other Coverage
    1. Life and AD&D
    2. Short-Term Disability
    3. Long-Term Disability
    4. Accident
    5. Critical Illness
  7. Contacts
  8. Footer

Plan Year

December 1, 2025 - November 30, 2026

What is Open Enrollment?

Open Enrollment is the one time of year that you are able to enroll in or modify your employee benefits for the upcoming plan year. Elections you make at this time will remain in effect until the next Open Enrollment period, unless you have a Mid-Year Election Change Event that allows for a plan change.

What is a Mid-Year Election Change Event?

 A Mid-Year Election Change Event (such as marriage, divorce, birth/adoption of a child, or loss of eligibility under another plan) allows you to make plan changes outside of Open Enrollment. If you experience this type of event during the year, you may modify your benefits within 30 days by notifying HR as soon as possible. Learn more.

Who is eligible for benefits?

Full-time employees working 30 or more hours per week, your spouse, and your legal dependents are eligible to participate in the benefit plans.

Who are my legal dependents?

  • Your legal spouse 
  • Your children (up to age 26) including natural, step, legally adopted/placed for adoption, and children for whom you serve as legal guardian
  • Disabled dependent children (any age)

When does my coverage start?

Your coverage becomes effective on the first day of the month following your date of hire.

How to Enroll

To complete your enrollment, please complete the form below and return to NAME/EMAIL by DATE.

Your Benefit Options

Medical

UPMC Health Plan

Dental

UPMC Health Plan

Vision

UPMC Health Plan

Understanding Your Benefits

Covered Health Service: A service could be an office visit, test, prescription, or another medical treatment your health insurance covers. Before seeking care, check to make sure the service is covered.

Claim: The request for payment that's sent to your health insurance company after you receive covered care.

Copay: A fixed fee that you must pay for a covered service as outlined in your plan design, usually at the time you receive the service.

Plan Allowance: The set amount your plan will pay for a health service, even if your provider bills for more.

Deductible: The set amount you pay for a covered health service before your plan will begin to pay. Will be outlined within your plan design.

Coinsurance: The percentage of the cost of your covered health care services, that you must pay after you've met your deductible.

Out-of-Pocket Maximum: The most you'd pay for covered care within the plan period. If you hit this amount, your plan pays 100% after it is reached.

Premium: The monthly amount paid (by your employer, a combination of employer and employee or the employee only if voluntary)


In-Network Provider: A doctor, hospital, or other provider in the plan's network. Network providers accept the plan's payment in full. You pay less when you use an in-network provider. With the exception of care for emergent and urgent conditions, if the plan does not offer out of network coverage, you must seek an in–network provider for all covered services.


Out-of-Network Provider: Provider who does not have a contract with your health insurer to provide services to you at a discount. You will generally pay more to see an out-of-network provider. If you have an EPO or HMO plan, you are not covered for out-of-network services (except for emergency and urgent care services).


Formulary: A list of medications covered by your plan sorted by tier. Lower tiers usually mean lower copays.

UPMC Health Plan

  • EPO $1,000 $15/$30 - Premium Network
  • EPO $2,500 $20/$40 - Premium Network

Did you know? 

  • Preventive services are covered at 100% in-network, and copays and deductibles do not apply.
  • You pay less out of pocket if you receive care from an in-network provider. 
  • You do not need a referral to see a specialist.

Download the UPMC Health Plan app

Find care, check benefits and coverage, access ID cards, view claims, and more.

EPO 1000 Benefit Grid

EPO 1000 Benefit Grid

EPO 1000 SBC

EPO 1000 SBC

EPO 2500 Benefit Grid

EPO 2500 Benefit Grid

EPO 2500 SBC

EPO 2500 SBC

Virtual Visits

As a UPMC Health Plan member, you have access to virtual visits with a provider - right from your computer, tablet, or smartphone.

Using telehealth, you can receive:

  • A rapid response to your health needs
  • Advice on appropriate care
  • Access to providers

Sign up for a MyUPMC account to conveniently manage the care you receive from UPMC providers:

  • Schedule a video or office visit
  • Communicate with your doctor's office via secure messaging
  • Manage your appointments
  • Renew your prescriptions
  • View your test results and medical history
  • Pay your bills

RxWell is a mobile app that's designed to help you address anxiety, depression, weight management issues, or stress with the help of a health coach. The app delivers evidence-based cognitive behavioral therapy techniques that you can access anytime, anywhere.

Answer a few questions, then have a virtual visit with a provider over live video. UPMC AnywhereCare provides access to treatment for a variety of nonemergency conditions:

  • Cold and flu symptoms
  • Sinus and allergy symptoms
  • Bronchitis
  • Sore throats
  • Pink eye
  • Rashes 

If you need a prescription, the provider will send it to your preferred pharmacy. The copayment is generally less than the cost of an urgent care visit and much less than an emergency department visit.

Added Benefits from UPMC

Assist America

As a UPMC Health Plan member, you have access to a unique global emergency travel assistance program - Assist America. You can use this service if you experience an emergency while traveling 100 miles from home (including to another country) for less than 90 days. This service can connect you and your covered family members to doctors, hospitals, pharmacies, and more for no extra cost. 

Active&Fit Direct

As a member, you have access to the Active&Fit Direct program for one low monthly cost.

  • 8,000+ digital workout videos
  • No long-term contract
  • Ability to enroll a spouse/domestic partner 
  • 11,000+ fitness centers and studios nationwide, including:

To get started, log into upmchealthplan.com and see Health and Wellness Discounts. 

LifeSolutions

Our Employee Assistance Programs (EAPs) help your workers balance everyday work-life demands and supports your managers as they address the challenges in today's workplace.


LifeSolutions is an employee assistance program (EAP) and much more. We use our expertise in human behavior in the workplace to help companies thrive. We connect employees to the resources they need so they stay focused and productive. We help managers and leaders face challenges in their day-to-day responsibilities. In short, LifeSolutions can contribute to achieving your company's bottom line goals.


We look forward to partnering with you.

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Medicare Services from NFP

Considering Medicare Coverage?

NFP is proud to support you when it comes to Medicare and understanding your coverage options. As trusted advisors in the individual markets for over 20 years, our team is comprised of experienced and knowledgeable agents specializing in Medicare coverage. We offer independent and individualized consultations to help you to:

  • Understand your coverage options
  • Determine if you are eligible for subsidies to lower your healthcare costs
  • Establish a timeline for applying for coverage
  • Choose a plan that fits both your lifestyle and your budget
  • Find coverage that allows you to access the doctors and hospitals you want most
  • Enroll in the plan that works best for you

The best part is - there is never a fee for our services.

Dental

Premium 100/80/50/$0/$1,500/Ortho/$1,500

Did you know? 

Oral health is more than just healthy teeth. Oral refers to the mouth, which includes the teeth, gums, and supporting tissues. Most oral health conditions are largely preventable and can be treated in their early stages. 

Dental Benefit Summary

Dental Benefit Summary

Vision

Premier Plus with Copay

Did you know?

Eyes can give doctors a clear picture of overall wellness. A comprehensive eye exam can detect early signs of serious health problems, such as:

  • Diabetes
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Glaucoma and cataracts

Vision Benefits Summary

Vision Benefits Summary

Contacts

You have dedicated agents ready to handle any situation in a discreet and confidential manner. Contact us for questions and needs such as:

  • Understanding your benefit coverage
  • Help finding in-network providers
  • Assistance with prescription or pharmacy issues
  • Questions regarding bills you receive from your doctor, specialist, hospital, or lab  
  • Claims you believe haven’t been paid properly

ContactImage

Erica Jones

Account Executive

erica.jones@nfp.com

724-940-9466

ContactImage

John Mueller

Producer / Sales Consultant

john.mueller@nfp.com

724-940-9406

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