Claims administered by Highmark Blue Cross Blue Shield
If you are a member of the union and eligible for Base A B C, your medical/pharmacy plans will be changing slightly. Please look out for further communication regarding these changes.
Please be reminded that Highmark and UPMC signed a 10-year agreement in July 2019 giving all UPMC facilities and physicians full in-network access to the Highmark Plans.
You have three medical plan options to choose from: Silver, Gold and Platinum. Please click here to learn more!
- The Silver Plan is a Qualified High Deductible Plan. This means the plan will include a $2,500 deductible and 20% coinsurance to an additional $2,500 for an individual. For family coverage, the deductible is $5,000 with 20% coinsurance to an additional $5,000.
- The Gold Plan is a Highmark PPO plan with a $1,500 deductible and 20% co-insurance for an additional $2,500. Office visits are a $30 co-pay for PCP, a $60 co-pay for a specialist visit, a $75 co-pay for urgent care, and a $250 co-pay for an emergency visit. For family coverage, the deductible is $3,000 with 20% coinsurance to an additional $2,000.
- The Platinum Plan is a Highmark PPO plan with a $500 deductible and no co-insurance. Office visits are a $25 co-pay for a PCP, a $50 co-pay for a specialist, a $75 co-pay for urgent care, and a $150 co-pay for an emergency visit. For family coverage, the deductible is $1,000 with no coinsurance.
The employee contribution increases when moving from the Silver to Gold to Platinum.
Prescription Coverage
Prescription coverage will continue to be provided by the Employers Health PBM program, delivered through CVS Caremark. Pharmacies like Giant Eagle, CVS, Rite-Aid, Walmart, Walgreens, etc., ARE included as an eligible provider. Click here to learn more.
- The Silver Plan: You pay 20% after the deductible is met.
- The Gold Plan: You pay a $15 co-pay for a generic prescription, a $30 co-pay for brand prescription, a $60 co-pay for brand formulary prescription, and 30% coinsurance, up to $150 maximum, for specialty medication.
- The Platinum Plan: You pay a $15 co-pay for generic, a $30 co-pay for brand, a $60 co-pay for brand formulary, and 30% coinsurance, up to $150 maximum, for specialty medication.
CVS Caremark
- Voluntary Maintenance Choice from CVS Caremark helps keep your regular medication as affordable as possible. Start filling medications you take regularly (like medication for asthma or high blood pressure) in 90-day supplies at CVS Pharmacy® or CVS Caremark® Mail Service Pharmacy. Choose the option that works best for you — and change it whenever you like. Click Here to learn more!
- PrudentRx Specialty Program partners with CVS Caremark to help save you money on your specialty prescriptions. CVS Caremark® has collaborated with PrudentRx exclusively for a program that may help save you money on your specialty prescription. This innovative plan design includes all specialty medications on your plan’s specialty drug list, as well as select high-cost specialty limited distribution drugs (LDDs) – outlined in your plan’s PrudentRx program drug list. Click Here to learn more!
Health Savings Account (HSA)
Employees who elect the Silver Medical Plan are also eligible to enroll in a Health Savings Account (HSA).
An HSA is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in an HSA to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs.
Different than a Flexible Spending Account (FSA), once deposited into your account, these funds are yours for paying medical expenses and if you do not spend all of the monies at the end of the year, it stays with you for the future year. Even if you leave employment, these unused funds go with you. As part of this program, your employer will also make a monthly contribution to your HSA to help with your additional out of pocket expenses.
The annual limit on HSA contributions for 2024 will be $4,150 for individuals and $8,300 for families.
Additional Features:
- Contributions to HSAs are not subject to income tax
- Earnings to an HSA from interest and investments are tax-free
- Distributions from an HSA to pay qualified medical expenses are tax-free
Flexible Spending Account (FSA)
Employees who elect the Gold or Platinum Medical Plan are eligible to enroll in Flexible Savings Account (FSA).
An FSA is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in an FSA to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall health care costs. Unfortunately, per IRS regulations, unused FSA dollars are forfeited at the end of each calendar year.
For the 2024 calendar year, an individual can contribute up to $3,200 to an FSA as a reference.
Tobacco Surcharge
You will be required to complete a tobacco use affidavit if you enroll in a Diocese medical plan. If you are a tobacco user, you may complete a tobacco cessation program through Highmark BCBS at no cost to you.
Helpful Tools & Resources:
Health care lingo, translated.
When you're choosing a plan, you're bound to see certain terms over and over. Here's a cheat sheet for a few of the most important ones. (If you want the complete glossary, check your benefit booklet after you enroll.)
- Premium: The monthly amount you or your employer pay so you have health coverage.
- Deductible: The set amount you pay for a health service before your plan starts paying.
- Copay: The set amount you pay for a covered service, for example it could be: $15 for a doctor visit or $6 for a prescription.
- Coinsurance: The percentage you owe after your deductible. For example, if your plan pays 80%, you pay 20%.
- Plan Allowance: The set amount your plan will pay for a health service, even if your provider bills for more.
- In-Network Provider: A doctor or hospital that accepts your plan allowance and cost sharing as full payment. They won't bill you extra, but you could still have to pay your copays.
- Maximum Out-of-Pocket: The most you'd pay for covered care. If you hit this amount, your plan pays 100% after that.
- Formulary: The list of medications covered by your plan, sorted by tier. Lower tiers usually mean lower copays.
- Claim: The request for payment that's sent to your health insurance company after you receive covered care.
Keep in mind you may download your electronic ID card 24/7 at www.highmarkbcbs.com!
