An out-of-pocket (OOP) maximum protects you against very high health care costs in any given year. If you reach the OOP maximum, the plan pays 100 percent of eligible expenses for the rest of the plan year.
You will have a choice of two carriers based on your home location. The carrier you choose will determine which providers are considered in-network and out-of-network. Your carrier choice doesn’t change your deductible, out-of-pocket maximum or any other features of the plan you choose. To see whether your preferred doctors and other providers are in a certain network, click the links below.
*Employees in Western Pennsylvania (and other areas impacted by the Highmark/UPMC dispute): In 2014, Highmark and UPMC signed a Consent Decree that provides participants covered by Highmark with limited in-network access to certain UPMC providers. The Consent Decree is scheduled to end June 30, 2019. If you choose Highmark as your medical carrier for 2019, your access to UPMC providers after June 30 will be significantly limited. Visit Highmark's informational website at www.highmarkanswers.com or call My Care Navigator at 888-258-3428 for information about which providers and facilities will be in- and out-of-network and how to transition care. Also, the Office of the Attorney General for the Commonwealth of Pennsylvania has a UPMC/Highmark dedicated helpline at 844-743-2015 (8:30 a.m. to 5 p.m. ET weekdays). Visit the Enrollment Hub for additional information.
To see details on whom you can cover on your PNC health and insurance benefits, please visit pages 5-6 and 24 of the PNC General Plan Information guide.
For details on when and how to change your benefits, see pages 7-8 of the PNC General Plan Information guide.
The PNC Financial Services Group, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Review the full PNC Notice of Non-Discrimination here.
This chart shows in-network benefits under both the Health Choice 1 and Health Choice 2 plans. For information about out-of-network benefits, please refer to the Medical Benefits SPD.
|Health Choice 1||Health Choice 2|
If you cover yourself only: $1,350
If you cover yourself only: $2,500
|Preventive Care Based on federal guidelines||
In-network: 100% covered; deductible does not apply
Out-of-network: After you meet the deductible, plan pays 60% and you pay 40%
In-network: After you meet the deductible, plan pays 80% and you pay 20%
Out-of-network: After you meet the deductible, plan pays 60% and you pay 40%
|Teladoc||Telemedicine service that gives you and your covered family members convenient, affordable access to a board-certified doctor by phone or online. Phone consultations are available 24/7. Video consultations are available from 7 a.m. to 9 p.m. ET every day. You save time and money: regular medical visits are $40, dermatology visits are $75 and behavioral health support is $80 to $160, depending on the service.|
|Well-being Centers (Pittsburgh and Miamisburg)||Available to you and your covered family members age 2 and up for primary care, preventive and urgent care, physical therapy, chronic condition support, immunizations and more. Services are billed the same way as any other health care provider.
To align with other Living Well offerings, Biometric Screenings and flu shots are available at the Well-being Centers for all employees. This means you can take advantage of these services even if you’re not enrolled in a PNC medical option. Health education events are open to all employees as well. There is no cost to you for these services. Note: Family members must be covered under a PNC medical option to use any Well-being Center services.
|Emergency Room (ER) Non-emergency treatment is not covered in the ER.||After you meet the deductible, plan pays 80% and you pay 20%|
|Annual Out-of-Pocket Maximum (includes deductible)||
If you cover yourself only: $3,000 must be met before you’re covered at 100%
If you cover any family members:
If you cover yourself only: $5,000 must be met before you’re covered at 100%
If you cover any family members:
|Health Savings Account (HSA)||If eligible, the HSA lets you set aside pretax dollars to pay for current eligible health care expenses and/or save for future eligible expenses. You choose how much to contribute (up to IRS limits) and can change your contribution at any time. PNC and Living Well also may contribute to your HSA. Learn more.|
|Prescription Drug Coverage***||
Preventive care drugs: Deductible does not apply; you pay 20%
Health Care Reform preventive care drugs: Deductible does not apply; you pay nothing (plan pays 100%)
All other covered drugs: After you meet the deductible, you pay 20%
*In-network providers agree to accept negotiated rates.
**Deductible and coinsurance apply to eligible, medically necessary medical and prescription drug expenses. However, covered in-network preventive care and qualified preventive-care prescription drugs are covered in full without having to meet the deductible or pay coinsurance. If you cover any family members, the full family deductible must be met before expenses are paid for any individual.
***Subject to the terms of the plan. Please see the Prescription Drug Program section in the Medical SPD for additional information.
Go to Pathfinder > Benefits > Health Care > More Coverage Details to see 2018 rates for Health Choice 1 & 2 (and other available benefits). You can also find 2019 contribution rates in the Enrollment Hub on PNC News Online. Your actual cost may be affected by:
When you elect PNC medical benefits, you need to affirm your tobacco-user status. If you don’t indicate your status and/or you use tobacco but don’t agree to an approved cessation program, you’ll pay an extra $30 per pay period ($780 per year). This also applies to your covered spouse/domestic partner.
If your spouse/domestic partner has access to medical coverage through his/her own employer and you cover him/her under PNC’s medical benefits, you’ll pay an extra $125 per month. This amount is deducted from your pay in equal installments throughout the year. In most cases, this contribution will be deducted from your pay on a pretax basis.*
* The Working Spouse Contribution does not apply if you are a part-time employee, or if both you and your spouse/domestic partner work for PNC, your spouse is self-employed, or if your spouse is enrolled in Medicare.
To help keep coverage affordable, full-time, highly paid employees are charged an additional contribution for medical coverage. For 2019, the calculation is based on 2017 W-2 earnings. In most cases, this contribution will be deducted from your pay on a pretax basis.
Note: The tobacco user and working spouse contributions are separate line items in your pay. However, if applicable, the earnings-based contribution is added to your per-pay contribution amount for medical.
With Teladoc, you and your covered family members can visit a doctor without ever leaving home — or your hotel room or wherever you happen to be.* You can use Teladoc for a variety of medical services, including general medical issues, dermatology and behavioral health. Teladoc’s physicians treat most non-emergency conditions including colds, flu, allergies, headaches, urinary tract infections, skin problems and pediatric illnesses. Dermatologists treat issues like psoriasis, eczema and acne. Behavioral health specialists can provide support for anxiety, depression, family issues and more. In many cases, physicians can call in prescriptions or refills.
Phone consultations are available 24/7. Video consultations are available from 7 a.m. to 9 p.m. ET every day. You save time and money: regular medical visits are $40, dermatology visits are $75 and behavioral health support is $80 to $160, depending on the service. All fees are subject to your medical plan deductible, coinsurance and out-of-pocket maximum and can be paid from your HSA. That means you’ll pay the full cost of these services until you’ve met your deductible, then only 20 percent of the regular fee after that until you meet the out-of-pocket maximum.
You can also earn wellness credits for registering and using Teladoc. To register or learn more about Teladoc’s services, including the Teladoc app, visit Teladoc.com/pnc or call 800-Teladoc (835-2362).
*Note: The following states have special provisions for telehealth: Idaho consultations can be done by video only; Texas consultations can be done by phone only; Georgia prescriptions require a three-day fill limit.
PNC medical plan participants and their family members age 2 and up are welcome to use our onsite Well-being Centers. Conveniently located at work sites in Pittsburgh and Miamisburg, our Well-being Centers offer high-quality primary care, preventive and urgent care, physical therapy, chronic condition support, immunizations and more. Services are billed the same way as any other health care provider. Walk in or call for an appointment.
To align with other Living Well offerings, biometric screenings and flu shots are available at the Well-being Centers for all employees. This means you can take advantage of these services even if you’re not enrolled in a PNC medical option. Health education events are open to all employees as well. There is no cost to you for these services. Note: Family members must be covered under a PNC medical option to use any Well-being Center services.
PNC’s advocacy service is there when you need help with complex health and retirement benefits issues, locating doctors and medical facilities, coordinating PNC’s benefits with Medicare, and managing claims issues. This service is available to all employees; you don’t have to be enrolled in a PNC medical option to use it. Call the HR Service Center at 877-968-7762, option 1, then say “advocacy” when prompted.
What does being a “good health care consumer” mean? It means taking advantage of tools and resources, making informed decisions about your care and comparing the cost and quality of what’s available. Here are six ways to make the most of your health and health care dollars.
Take advantage of eligible in-network preventive care at no cost to you. Free preventive care can often help you detect potential issues before they become bigger concerns.
Use in-network providers — they typically cost you less. Use “Find a provider” or a similar tool on your medical carrier’s website to find participating doctors.
Compare costs when you can. Use the cost comparison tools (if available) on your medical carrier’s website, or call the customer service number on your medical plan ID card.
Try Teladoc. You and your eligible family members can speak with a board-certified doctor by phone or video for non-emergency issues.
Use the Well-being Centers in Pittsburgh and Miamisburg. These centers are provided to offer employees and their covered family members accessible, high-quality and convenient health and wellness care right at the workplace.
Get help managing diabetes. If you’re enrolled in a PNC medical option and you and/or your covered family members have diabetes, you’ll have access to CVS Caremark's Transform Diabetes Care Program. It provides personalized health coaching and support from certified diabetes educators, plus a digital glucometer and test strips at no cost through Livongo. You don’t need to take any action during annual enrollment. If eligible, you can expect to receive more information from CVS Caremark in 2019.
At the PNC Well-being Centers, covered employees and covered family members age 2 and up can also meet with a nurse practitioner for an evaluation and diabetes or pre-diabetes coaching and referral to a specialist, as appropriate.
Maximize your wellness credits from Living Well. If you’re enrolled in a PNC medical option with a PNC BeneFit Plus Health Savings Account (HSA), you can earn wellness credits that will be deposited into your HSA. Simply complete eligible wellness incentive activities throughout the year and record them in the incentive tracker online to earn up to $600, plus up to an additional $400 if your covered spouse/domestic partner (if applicable) participates. Aren’t enrolled in a PNC medical option or don’t have an associated HSA? You can still earn up to $100 cash. Check out the Wellness Incentive Program Checklist to learn more. (Note: The wellness incentive activities and credits outlined in the 2018 Wellness Incentive Checklist will apply for 2019 as well.)
Take advantage of your HSA. Not only will you save on taxes when you make pre-tax contributions to your HSA, but you can then use the funds in your account to help pay for eligible healthcare expenses with tax-free money now and/or save and invest for the future. Watch this short video or check out the HSA User Guide for more information.