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FAQs: UPMC-Highmark contract announcement

Will this new agreement change the way UPMC Health Plan does business?
No. UPMC Health Plan will continue to develop innovative, high-quality insurance products for consumers in western Pennsylvania and across the Commonwealth. We remain committed to providing exceptional service and full in-network access to all of UPMC’s hospitals and providers, as well as many community hospitals and providers.

Does the new agreement impact UPMC Health Plan members?
The UPMC-Highmark agreement does not have any impact on UPMC Health Plan members. UPMC Health Plan members will continue to enjoy the same exceptional service and full in-network access to the physicians and hospitals that they have always had, including all UPMC hospitals and providers.

Does the new agreement impact UPMC Health Plan members’ access to AHN hospitals or providers?
No. UPMC Health Plan members will continue to have access to all AHN primary care physicians and specialists. AHN hospitals accessible to commercial product members is dependent upon the commercial product design selected by the employer. Members of our Individual plan do not have access to AHN Hospitals. Those AHN hospitals that were out of network before this announcement will remain out of network. (See Table for detail.)

Will UPMC for You members have access to AHN hospitals or providers?
UPMC for You members have access to all AHN primary care physicians and specialists. UPMC for You products have access to the majority of AHN facilities including West Penn Hospital, Forbes Hospital, Jefferson Hospital and St. Vincent Hospital. (See Table for detail.)

Will UPMC for Life Medicare Advantage members have access to AHN?
UPMC for Life Medicare Advantage members will continue to have the access to AHN hospitals that they have always had under their selected plan. UPMC for Life Medicare Advantage members have full in-network access to AHN primary care physicians and specialists, as well as the AHN hospitals shown in the table below. UPMC Premier Rx members do not have access to AHN hospitals or physicians. (See table for detail.)

In light of this announcement, will there be a special enrollment period for Medicare members?
No.

Was UPMC forced to contract with Highmark?
No. UPMC approached the Attorney General expressing a willingness to talk with Highmark even before the Supreme Court’s decision in its favor.

This table provides information on products. Please check the members specific product for additional detail.

  UPMC for You UPMC for Kids UPMC for Life UPMC for Life SNP CHC Commercial*
Allegheny General Hospital NO NO NO NO NO NO
Alle-Kiski NO NO NO NO NO NO
Canonsburg NO NO NO NO NO NO
Forbes YES NO NO YES YES NO
Jefferson YES YES YES YES YES YES
St. Vincent YES YES YES YES NO YES
West Penn YES NO NO YES YES NO

 

*Commercial Product depends on product design network used.
Standard network does not have AHN Physicians or Hospitals.