Frequently Asked Health Care Questions
Note: The information contained here is:
- Not meant to be self-explanatory
- Not meant to be all inclusive
- Not meant to provide advice
You are encouraged to do your own research (Medicare itself, Social Security Administration, APPRISE, PA Department of Aging, etc.) to find the answers to your particular questions or to your particular situation.
Under Age 65
How will I know if my doctor is Level 1, Level 2, or Out-Of-Network?
Which network does our UPMC plan fall under?
What additional costs are associated with Level 2 or Out-Of-Network services?
Level 2 and Out-Of-Network services require more cost-sharing for the member. In each of these tiers, there is a deductible and coinsurance as well as increased copays. Please refer to your medical schedule of benefits for specific costs.
What are the copays under the new plan?
Which hospitals fall in the Level 1 network?
What labs may be used for bloodwork?
If I see a Level 2 doctor and he/she orders blood work, will I receive Level 1 benefits for that bloodwork if the labs are done at a Level 1 facility?
Even if the ordering physician is a Level 2 doctor, you will receive the highest benefit (Level 1) if using in-network lab facilities such as Quest Diagnostics.
If my doctor is Level 1 or Level 2 but only has admitting privileges to an out-of-network hospital, how will that affect me?
A provider needs to have privileges – or an admitting arrangement – at a participating hospital in order to be a participating provider. An admitting arrangement is an agreement with a participating provider in the same specialty to admit for the provider who does not have privileges at a participating hospital.
Can I still go to MedExpress?
Will Optum Rx still be the pharmacy used for mail-in medications?
Can I appeal to have a medication covered?
Will I be forced to use mail order for my maintenance medications?
How do I receive care if traveling outside of Western PA?
How does my college student living out of state receive in-network services under this plan?
What do I do if I live outside of Western PA?
Age 65 and Above
When I retire from NA, what are my health care options until I reach age 65?
You may enroll in NA’s post-retirement health care plan and pay whatever premium the District pays for you, according to the NASD/NAFT contract in effect at the time of your retirement. or you may purchase a plan through a market place of plans.
Does NAR provide help with medicare supplementary insurance decisions?
You can contact Dave McDonald at firstname.lastname@example.org.
Where can I find a comparison of Medicare supplementary insurance plans?
Dave McDonald is a trained volunteer for APPRISE, an agency affiliated with the PA Dept of Aging and has information comparing a number of popular health care plans in both services and costs.
Also to be considered in the Medicare decision is a choice between a Medicare supplement plan or a Medicare Advantage plan. Furthermore, choosing between a Health Options Plan (from PSERs) or the District’s own retiree plan should be studied.
NAR, twice yearly (usually fall & spring), sponsors a comprehensive program addressing these issues. However, should a retiree be turning 65 prior to our program, contact Dave McDonald.
You can contact Dave McDonald at email@example.com for further details.
What is Premium Assistance?
As long as you remain in a health plan offered by PSERs or one offered by North Allegheny, you are eligible to receive a $100 stipend per month from the state.
What health care plan is offered by North Allegheny?
What is APPRISE?
Statewide hot-line: 800-783-7067
Allegheny County: 412-661-1438
Note: Each PA County has its own APPRISE program.
When I turn 65, what are my health care options?
- You may accept one of the plans offered by Health Options Program
- You may elect North Allegheny’s post 65 coverage plan
- You may go to the health care market place.
What is HOP?
What is the difference between a Medicare supplement plan and a Medicare Advantage plan?
With a Medicare Advantage Plan (managed care), whatever plan you choose is your primary coverage and you are covered to the conditions of the policy. This plan typically includes prescription drug coverage.
How do I get a supplement plan?
After 65, will I be able to purchase NA's dental plan and vision plan?
When I near 65, what information will I receive?
- You will receive copies of many Medicare options.
- You may request copy of NA’s post 65 health care plan.
- You will receive notice from PSERs of the Health Options plans it offers.
If I am 65 and elect NA's post 65 plan, can I later change to a HOPs plan?
If I am 65 and elect a HOP plan, can I later change to NA's plan?
What are life changing or qualifying events?
Check Medicare booklet but some examples include:
- You lose your employer coverage
- A dependent status change (marriage, divorce, death of spouse, addition of a dependent)
- A plan approved for PA terminates
- A person moves of out the plan’s coverage area
What is the difference between an HMO and a PPO?
A PPO (Preferred Provider Organization) provides both in and out of network services and typically does not require referrals.
What is the Open Enrollment period?
What is the donut hole?
What is Medicare A, B, C, and D?
B – Covers medical, surgical and physician expenses (your premium based on your income is deducted from your Social Security benefit. If you are not on SS, you will be billed monthly.)
C – Medicare Advantage, premiums of which you pay to the company you choose
D – Prescription Drug plan providing 3 tiers of coverage
I spend 5 or 6 months outside of PA each year. What must I do to be sure my insurance will follow me?
If you are covered by the District’s current UPMC plan for pre-65 retirees, consult that plan’s provisions. If you are covered by another plan and are post 65, consult the provisions of those individual plans.
Each plan has some sort of concierge service with an 800 number whose representative can advise you more specifically.
Please contact Dave McDonald at firstname.lastname@example.org for further details.