2015 Network Guide 1

Transcription

1 2015 Network Guide 1

2 Selecting the right health insurance plan is important. And remember that selecting a plan also means that you are choosing a network. The network refers to the specific hospitals, facilities, physicians, and other providers participating with the plan. Understanding the network is important so you know where you, and your employees, can go for health care needs. UPMC Health Plan offers three different provider networks. All of our networks guarantee full in-network access to UPMC doctors and hospitals as well as many local community doctors and hospitals. Here is a brief description of each network: The UPMC Partner Network includes UPMC providers and UPMC-owned facilities in UPMC Health Plan s 28-county service area and other select facilities within Erie and Allegheny counties. To offer plans in the Partner Network, your company must be located in Erie or Allegheny counties. The UPMC Standard Network includes providers in UPMC Health Plan s 28-county service area. This network includes all UPMC providers and UPMC-owned facilities. Many community providers and facilities are also included. To offer plans in the Standard Network, your company must be located in any of the 28 counties in our service area. The UPMC Premium Network is the broadest network. The UPMC Premium Network includes providers in UPMC Health Plan s 29-county service area. This network includes all UPMC providers and UPMC-owned facilities. Many community providers and facilities are also included. To offer plans with the Premium Network, your company must be located in the 29-county service area. To get the full list of the hospitals included in each network, turn to the appropriate pages of this guide. Remember, if your employees need emergency care, their medical care will be covered no matter which emergency department they go to. Your employees also have peace of mind when traveling 100 miles or more away from home for business or for pleasure. Their UPMC Health Plan coverage gives them access to Assist America the Health Plan s global emergency assistance partner. If an emergency comes up, Assist America provides immediate access to doctors, hospitals, pharmacies, and other services. The service is available 24 hours a day, 365 days a year. Finding a participating doctor or facility Your employees receive the highest benefit when they use doctors and facilities in their network. The online provider directory includes hospital affiliations for each participating doctor. They can search for specific providers by following these steps: Go to: Select Coverage Type: Coverage Through Your Employer Select Plan Name: Choose a specific plan or network name Enter a specific provider or practice name or search for all. You can also filter by type of provider, specialty, languages spoken, and more. 2

3 UPMC Partner Network To be eligible for the UPMC Partner Network, your employer must be located in Erie or Allegheny counties. The UPMC Health Plan Partner Network consists of doctors, hospitals, and other medical providers located within the 28 counties in our service area, shown below. You will be covered as outlined in your plan documents when you seek care from the participating providers within the Partner Network. ERIE WARREN CRAWFORD FOREST VENANGO MERCER JEFFERSON CLARION McKEAN POTTER ELK CAMERON MAP LEGEND Home Location LAWRENCE BEAVER BUTLER ARMSTRONG INDIANA CLEARFIELD Number of In-Network Physicians < ,999 2,000 2,999 ALLEGHENY CAMBRIA BLAIR WESTMORELAND HUNTINGDON WASHINGTON GREENE FAYETTE SOMERSET BEDFORD In-network hospitals* Allegheny Children s Hospital of Pittsburgh of UPMC Eye & Ear Institute Magee-Womens Hospital of UPMC UPMC East UPMC McKeesport UPMC Mercy UPMC Montefiore UPMC Passavant McCandless UPMC Presbyterian UPMC St. Margaret UPMC Shadyside Western Psychiatric Institute and Clinic of UPMC Bedford UPMC Bedford Memorial Blair UPMC Altoona Butler UPMC Passavant Cranberry Erie Corry Memorial Hospital UPMC Hamot McKean Kane Community Hospital Mercer UPMC Horizon Greenville UPMC Horizon Shenango Valley Venango UPMC Northwest *Network provider information is current as of January 15, 2015, but is subject to change from time to time. As such, some network providers may have been added or removed from the list since this document was created. UPMC Health Plan recommends that you contact Member Services to confirm that the information is current. 3

4 UPMC Standard Network The UPMC Health Plan Standard Network consists of doctors, hospitals, and other medical providers located within the 28 counties in our service area, shown below. You will be covered for services as outlined in your plan documents when you seek care from the participating providers within the Standard Network. ERIE CRAWFORD WARREN McKEAN POTTER MERCER VENANGO FOREST ELK CAMERON MAP LEGEND LAWRENCE BUTLER CLARION JEFFERSON CLEARFIELD Home Location BEAVER ALLEGHENY ARMSTRONG INDIANA CAMBRIA BLAIR Number of In-Network Physicians < ,499 2,500 3,999 WASHINGTON WESTMORELAND HUNTINGDON GREENE FAYETTE SOMERSET BEDFORD In-network hospitals* Allegheny Children s Hospital of Pittsburgh of UPMC Eye & Ear Institute Heritage Valley Health System Heritage Valley Sewickley Kindred Hospital Pittsburgh Kindred Hospital Pittsburgh North Shore LifeCare Hospitals of Pittsburgh Main LifeCare Hospitals of Pittsburgh Suburban Magee-Womens Hospital of UPMC Ohio Valley Hospital McKeesport Pittsburgh St. Clair Hospital The Children s Home of Pittsburgh The Children s Institute UPMC East UPMC McKeesport UPMC Mercy UPMC Montefiore UPMC Passavant McCandless UPMC Presbyterian UPMC St. Margaret UPMC Shadyside Western Psychiatric Institute and Clinic of UPMC Armstrong Armstrong County Memorial Hospital Beaver Heritage Valley Health System Heritage Valley Beaver Bedford UPMC Bedford Memorial 4

5 Blair Nason Hospital Tyrone Hospital UPMC Altoona Butler Butler Memorial Hospital UPMC Passavant Cranberry Cambria Conemaugh Memorial Medical Center Conemaugh Miners Medical Center Lee Campus of Conemaugh Memorial Medical Center Johnstown Clarion Clarion Hospital Clearfield Penn Highlands Clearfield Penn Highlands DuBois Crawford Meadville Medical Center Titusville Area Hospital Elk Penn Highlands Elk - St. Mary s Campus Erie Corry Memorial Hospital Millcreek Community Hospital Erie UPMC Hamot Fayette Highlands Hospital Uniontown Hospital Greene Southwest Regional Medical Center Huntingdon J.C. Blair Memorial Hospital Indiana Indiana Regional Medical Center Jefferson Penn Highlands Brookville Punxsutawney Area Hospital Lawrence Ellwood City Hospital Jameson Hospital North Campus Jameson Hospital South Campus McKean Bradford Regional Medical Center Kane Community Hospital Mercer Grove City Medical Center UPMC Horizon Greenville UPMC Horizon Shenango Valley Potter Cole Memorial Somerset Conemaugh Meyersdale Medical Center Somerset Hospital Windber Medical Center Venango UPMC Northwest Warren Warren General Hospital Washington Monongahela Valley Hospital Washington Hospital Westmoreland Excela Frick Hospital Excela Latrobe Hospital Excela Westmoreland Hospital Laurel Highlands *Network provider information is current as of January 15, 2015, but is subject to change from time to time. As such, some network providers may have been added or removed from the list since this document was created. UPMC Health Plan recommends that you contact Member Services to confirm that the information is current. 5

6 UPMC Premium Network The UPMC Health Plan Premium Network consists of doctors, hospitals, and other medical providers located within the 29 counties in our service area, shown below. You will be covered for services as outlined in your plan documents when you seek care from the participating providers within the Premium Network. ERIE CRAWFORD WARREN McKEAN POTTER MERCER VENANGO FOREST ELK CAMERON MAP LEGEND CLARION JEFFERSON LAWRENCE BUTLER CLEARFIELD CENTRE Home Location BEAVER ALLEGHENY ARMSTRONG INDIANA CAMBRIA WESTMORELAND BLAIR HUNTINGDON Number of In-Network Physicians < ,499 2,500 4,500 WASHINGTON GREENE FAYETTE SOMERSET BEDFORD In-network hospitals* Western Pennsylvania Allegheny Children s Hospital of Pittsburgh of UPMC Eye & Ear Institute Heritage Valley Health System Heritage Valley Sewickley Jefferson Hospital Kindred Hospital Pittsburgh Kindred Hospital Pittsburgh North Shore LifeCare Hospitals of Pittsburgh Main LifeCare Hospitals of Pittsburgh Suburban Magee-Womens Hospital of UPMC Ohio Valley Hospital 6 McKeesport Pittsburgh St. Clair Hospital The Children s Home of Pittsburgh The Children s Institute UPMC East UPMC McKeesport UPMC Mercy UPMC Montefiore UPMC Passavant McCandless UPMC Presbyterian UPMC St. Margaret UPMC Shadyside Western Psychiatric Institute and Clinic of UPMC Armstrong Armstrong County Memorial Hospital Beaver Heritage Valley Health System Heritage Valley Beaver Bedford UPMC Bedford Memorial Blair Nason Hospital Tyrone Hospital UPMC Altoona Butler Butler Memorial Hospital UPMC Passavant Cranberry

7 Cambria Conemaugh Miners Medical Center Conemaugh Memorial Medical Center Lee Campus of Conemaugh Memorial Medical Center Johnstown Centre Mount Nittany Medical Center Clarion Clarion Hospital Clearfield Penn Highlands Clearfield Penn Highlands DuBois Crawford Meadville Medical Center Titusville Area Hospital Elk Penn Highlands Elk St. Mary s Campus Erie Corry Memorial Hospital Millcreek Community Hospital Saint Vincent Hospital Erie UPMC Hamot Fayette Highlands Hospital Uniontown Hospital Greene Southwest Regional Medical Center Huntingdon J.C. Blair Memorial Hospital Indiana Indiana Regional Medical Center Jefferson Penn Highlands Brookville Punxsutawney Area Hospital Lawrence Ellwood City Hospital Jameson Hospital North Campus Jameson Hospital South Campus McKean Bradford Regional Medical Center Kane Community Hospital Mercer Grove City Medical Center UPMC Horizon Greenville UPMC Horizon Shenango Valley Potter Cole Memorial Somerset Conemaugh Meyersdale Medical Center Somerset Hospital Windber Medical Center Venango UPMC Northwest Warren Warren General Hospital Washington Monongahela Valley Hospital Washington Hospital Westmoreland Excela Frick Hospital Excela Latrobe Hospital Excela Westmoreland Hospital Laurel Highlands Maryland Western Maryland Regional Medical Center New York Olean General Hospital West Virginia Mon General Hospital Ohio Valley Medical Center Reynolds Memorial Hospital Sistersville General Hospital Weirton Medical Center Wetzel County Hospital Wheeling Hospital *Network provider information is current as of January 15, 2015, but is subject to change from time to time. As such, some network providers may have been added or removed from the list since this document was created. UPMC Health Plan recommends that you contact Member Services to confirm that the information is current. 7

8 U.S. Steel Tower, 600 Grant Street Pittsburgh, PA Copyright 2015 UPMC Health Plan Inc. All rights reserved. Standard Network Info Sheet 15SAM0006 (MJA) 3/25/15 10M KP