Health & Life Insurance

Medical and Prescription Drug Coverage

PNC offers two medical options to full- and part-time employees: Health Choice 1 and Health Choice 2.

What the two options have in common:

  • Both are high-deductible health plans with a Health Savings Account (HSA) that offers tax advantages.
  • Both plans include prescription drug coverage through CVS Caremark.
  • Benefits cover eligible medically necessary care.
  • You can see any doctor you’d like, but you’ll typically save money when you use in-network providers.
  • When you get care, you must pay the full cost of services (this cost is typically discounted when you use in-network providers) up to a certain amount (the deductible) before the plan begins paying benefits. This doesn't apply to eligible in-network preventive care, which is 100% covered.
  • Covered preventive care includes routine services like flu shots, mammograms and well-child care. Eligible in-network preventive services are not subject to the deductible or coinsurance.
  • Certain preventive-care drugs are covered at 80% or 100% and not subject to the deductible.
  • Once you meet the deductible, you pay a percentage of the cost for covered non-preventive services. This is called coinsurance.
  • Each plan has an out-of-pocket (OOP) maximum that protects you against very high health care costs in any given year. If you reach the OOP maximum, the plan pays 100% of eligible expenses for the rest of the plan year. (The OOP maximum amount is different for each option.)

How the options are different:

  • Different deductible and out-of-pocket maximum amounts. Health Choice 1 has a lower deductible and lower out-of-pocket maximum; Health Choice 2 has a higher deductible and higher out-of-pocket maximum.
  • Different payroll contribution amounts. You’ll pay more out of each pay for Health Choice 1 and less for Health Choice 2. (Contributions come out of your pay before taxes, regardless of which medical option you choose.)

2019 medical carriers

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 does not 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.

  • Aetna — Aetna Choice POS II (Open Access) — aetna.com
  • Highmark Blue Cross Blue Shield* — BCBS PPO — highmarkbcbs.com
  • UnitedHealthcare — UnitedHealthcare Choice Plus — uhc.com

*Important information for employees in western Pennsylvania (and other areas impacted by the Highmark/UPMC dispute): In 2014, Highmark and UPMC signed a Consent Decree that provided participants covered by Highmark with limited in-network access to certain UPMC providers through June 30, 2019. Effective July 1, 2019, the organizations agreed to a 10-year contract offering Highmark members in certain health products, including PNC’s medical plan, full in-network access to UPMC providers in Pittsburgh and Erie.

For more information, visit Highmark's informational website (www.highmarkanswers.com) or call My Care Navigator at 888-258-3428.

To learn more about which family members you can cover on your PNC health and insurance benefits, please visit the Eligibility section of the PNC General Plan Information Summary Plan Description (SPD).

For details on when and how you can make changes to your coverage, see the Changing Your Elections section of the PNC General Plan Information SPD.

This chart highlights in-network* benefits under both the Health Choice 1 and Health Choice 2 plans.

For more information about out-of-network benefits, please refer to the Medical Benefits Summary Plan Description (SPD).

2019 Health Plan Comparison Chart

Feature Health Choice 1 Health Choice 2
Annual Deductible**

If you cover yourself only: $1,350
If you cover any family members: $2,700

If you cover yourself only: $2,500
If you cover any family members: $5,000

Preventive Care (based on federal guidelines)

100% covered; deductible does not apply

Coinsurance

After you meet the deductible, plan pays 80% and you pay 20%

Teladoc

Telemedicine service that gives you and your covered family members convenient, affordable access to a board-certified doctor by phone or online. Note: Limitations apply in some states. 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 can be paid from your HSA and are subject to your medical plan deductible, coinsurance and out-of-pocket maximum. That means you’ll pay the full cost of these services until you’ve met your deductible, then only 20% of the regular fee after that until you meet the out-of-pocket maximum.

If eligible, you can even earn $100 in wellness credits when you register for Teladoc or complete a consultation. See the Wellness Incentive Program Checklist for details.

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, flu shots and health education events are available at the Well-being Centers for all employees, at no cost to you. This means you can take advantage of these services even if you’re not enrolled in a PNC medical option. Note: Family members must be covered under a PNC medical option to use any Well-being Center services.
Emergency Room (ER) After you meet the deductible, plan pays 80% and you pay 20%. Non-emergency treatment is not covered in the ER.
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:

  • any individual who meets $3,000 is covered at 100%
  • all other family members are not covered at 100% until family expenses total $6,000

If you cover yourself only: $5,000 must be met before you’re covered at 100%

If you cover any family members:

  • any individual who meets $6,850 is covered at 100%
  • all other family members are not covered at 100% until family expenses total $10,000

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***

Covered Health Care Reform preventive care drugs: No deductible; you pay nothing (plan pays 100%)

Covered preventive care drugs: Deductible does not apply; you pay 20%

All other covered drugs: After you meet the deductible, you pay 20%

  • If you use an out-of-network pharmacy, you must pay the full price and submit a claim to receive reimbursement.
To see the lists of covered drugs, requirements for drugs in the CVS Caremark Maintenance Choice and/or Generic Step Therapy programs, or details about drugs that require pre-authorization, visit caremark.com.

*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 Health Care Reform 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.

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.

  • Pittsburgh – Firstside: 412-807-7878 (7 a.m. to 5 p.m. ET Monday through Friday)
  • Miamisburg, OH – Building 3: 937-913-7878 (7 a.m. to 5 p.m. ET Monday through Thursday)

To align with other Living Well offerings, Biometric Screenings, flu shots and health education events are available at the Well-being Centers for all employees, at no cost to you. This means you can take advantage of these services even if you’re not enrolled in a PNC medical option.
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 benefits issues, locating doctors and medical facilities, coordinating PNC’s benefits with Medicare and managing claims issues. Call the HR Service Center at 877-YOUR-PNC (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 some ways to make the most of your health and health care dollars.

  1. 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.

  2. 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 or call the customer service number on your medical plan ID card.

  3. 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.

  4. Try Teladoc. You and your eligible family members can speak with a board-certified doctor by phone or video for non-emergency issues. Note: Limitations apply in some states.

  5. Use the Well-being Centers in Pittsburgh and Miamisburg. Employees enrolled in PNC medical coverage (and their covered family members age 2 and older) can visit the centers for primary, preventive and urgent care, physical therapy, chronic condition support, immunizations and more. All employees, regardless of coverage, have access to free Biometric Screenings, flu shots and health education events.

  6. 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. If eligible, you can expect to receive more information directly from CVS Caremark.

    At the , 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.

  7. 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. If you’re not 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.

  8. 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.