Neishloss& Fleming Inc.

UPMC Health Plan has recently released a new product, UPMC Inside Advantage. UPMC Inside Advantage is available to small, mid, and large groups in the following counties in Western Pennsylvania: Erie, Crawford, Venango, Mercer, McKean, Elk, Forest, Clarion, Potter, and Warren.  UPMC Inside Advantage is a tiered network plan that will provide employees with the same type of coverage as other UPMC Health Plan offerings, but at a lower premium and with lower out-of-pocket costs when they choose hospitals right in their community.  These hospitals include UPMC Hamot, Warren General Hospital, Kane Community Hospital, UPMC Horizon, UPMC Northwest, and all other UPMC-owned facilities.

UPMC Inside Advantage includes a choice of EPO or PPO plans, pharmacy benefits, 24/7 MyHealth advice line, and much more.

UPMC Health Plan is offering a limited time bonus program specifically for the new UPMC Inside Advantage product.  UPMC Health Plan will pay a $65 per member bonus for new UPMC Inside Advantage groups submitted with effective dates of July, August, and September 2012.  (* Payment is at the sole discretion of UPMC Health Plan and is final.  UPMC Health Plan may cancele, amend, terminate, or suspend this program at any time at its sole discretion.)

For more information on UPMC Inside Advantage, see the EPO Benefit Grid and the PPO Benefit Grid.

Should you have any questions, please call Mary Ann Cannon, Patti DeSimone, or Christine Kaercher at 800-562-7733.

UPMC Health Plan has announced that they will be extending the New Business = Big Rewards incentive program through July 1, 2012 effective dates.

To participate in the program, simply sell fully insured commercial UPMC Health Plan medical insurance plans as total replacement with effective dates of June 1 and July 1, 2012.  Agents will earn $50 for each new member.  All group sizes are eligible for this incentive program (see initial terms of the incentive program).

Eligibility and requirements:

• New business must remain in force with UPMC Health Plan for 12 months from the effective date.  UPMC Health Plan reserves the right to recover any or all incentives paid as part of this program is this requirement is not satisfied.
• Payment will be made within 60 days for all effective dates
• Payment of earned incentives under this program is at the sole discretion of UPMC Health Plan and is final.  UPMC Health Plan may cancel, amend, terminate, or suspend the program at any time at its sole discretion.
• Existing business is not eligible.

NOTE: Please remember to include your name on all new business documentation.  This incentive program applies only to writing producers.

Should you have any questions, please call Mary Ann Cannon, Patti DeSimone, or Christine Kaercher at 800-562-7733.

As part of the Patient Protection and Affordable Care Act (PPACA), UPMC Health Plan is required to comply with certain new medical loss ratio (MLR) standards.  In order to meet the requirements, UPMC Health Plan needs your clients’ response to the information included on their Employee Count Form.  This form will be mailed to all clients, whether current or terminated, within the next couple of days.

The information gathered from the form will quantify the average number of people employed in both 2010 and 2011.  After receiving this information, UPMC Health Plan will classify each employer group as a “large employer” or “small employer” in its annual MLR report.

These new MLR standards may also require UPMC Health Plan to issue premium rebates to certain employers and their employees.  In order to determine the amount of any such rebates, UPMC Health Plan must collect accurate employee counts from all employer groups.

Please help to answer any questions that your clients have about this form.  Clients are required to respond within 14 days of the date of the letter.  If UPMC Health Plan does not receive a prompt response, UPMC Health Plan will follow up with your clients.

Should you have any questions, please call Mary Ann Cannon, Patti DeSimone, or Christine Kaercher at 800-562-7733.