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 carriers based on your 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.
*Note to employees in Western Pennsylvania and surrounding areas: As you know, the consent decree governing the 2014 expiration of the Highmark/UPMC contract contained a number of transition rules. UPMC and Highmark negotiated an extension of the continuity of care provisions through June 2019. Visit discoverhighmark.com/consentWP for details on the provisions. If you’re considering choosing Highmark as your medical carrier for 2018, call Highmark at 800-241-5703 to ask about access to UPMC providers in 2018 and whether you can continue to receive in-network benefits for certain services, and ask your current providers about their network status in 2018 and how they will bill or invoice individuals who are insured through Highmark.
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.
Go to Pathfinder > Benefits > Health Care > More Coverage Details to see 2018 rates for Health Choice 1 & 2 (and other available benefits). Your actual cost may be affected by:
When you elect PNC medical benefits, you need to affirm your tobacco 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 both you and spouse 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 2018, the calculation is based on 2016 W-2 earnings. In most cases, this contribution will be deducted from your pay on a pretax basis.
Note: The Tobacco and Working Spouse 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 the Health Choice 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. For details and to register, 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.
[This service will be available through June 30, 2018, only.] If you or an eligible family member is uncertain about a medical diagnosis or treatment, you don’t have to figure everything out on your own. Expertise on Demand is a confidential service that connects you with medical experts in a variety of specialties at no cost to you. Whether you’re facing cancer treatments, surgery or a chronic health condition, a second opinion can offer peace of mind. You might even learn of different options that could result in better outcomes and/or save you money. You don’t need to be enrolled in a PNC medical plan and you don’t need to register for this service. You can call about your own medical condition or for an eligible family member. Call 888-251-4158 weekdays between 8 a.m. and 11 p.m. ET to connect with a Physician Case Manager.
PNC medical plan participants and their family members age two 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 health 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.
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 cost you less. Use “Find a provider” or a similar tool on your health plan’s website to find participating doctors.
Compare costs when you can. Use the cost comparison tools (if available) on your health plan’s website, or call medical plan concierge (the customer service number on your 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.
Get a no-cost second opinion. All employees and their eligible family members have free access to Advance Medical Expertise on Demand. If you have a diagnosed medical condition, this service can provide valuable information and guidance from medical professionals.
More information [This service will be available through June 30, 2018, only.]
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.