HIGHMARK/UPMC AGREEMENT PROVIDER Q&A JULY 2019

Highmark and UPMC have agreed to a 10-year contract offering full in-network access for Highmark members in certain health products that include UPMC providers and facilities in their networks in the Pittsburgh and Erie areas. Below are some questions and answers about this agreement.

Q. What does this agreement mean to community hospitals? A. Highmark Health is committed to its strategy of community-based, close-to-home care for its members and patients. Community hospitals will continue to play an important role in serving the needs of our members and patients going forward. A contract with UPMC does not change that.

Q. What does this agreement mean for your patients right now? A. Commercial (non-ACA, non-MA) • In Western PA, commercial members in high-performing narrow network products such as Community Blue Flex or Connect Blue are in a high-quality, lower-cost plan. Members in these products will have access to some, but not all, UPMC facilities and doctors effective July 1, 2019. This is very similar to what they had before the negotiation of this new agreement. • Certain UPMC Providers will be in-network at the highest tier. These include: o UPMC Altoona o UPMC Bedford o UPMC Cole o UPMC Horizon (for Community Blue Flex, Horizon is moving from Standard to Enhanced tier) o UPMC Jameson (for Community Blue Flex, Jameson is moving from Standard to Enhanced tier) o UPMC Kane o UPMC Northwest o UPMC Somerset o Western Psychiatric Institute and Clinic of UPMC o UPMC physicians and ancillary providers affiliated with the hospitals listed above o Over 20 UPMC and Community Hospital Cancer Centers (e.g., Excela Arnold Palmer Cancer Center, St. Clair Cancer Center).

• Certain UPMC facilities and services will remain out-of-network starting July 1, 2019. These include: o Magee-Women’s Hospital of UPMC o UPMC East o UPMC Mercy o UPMC McKeesport o UPMC Passavant o UPMC Presbyterian Shadyside o UPMC St. Margaret o UPMC Hamot (for Community Blue Flex, Hamot is moving from Standard tier to out-of-network; this change is not new and was planned to happen before the new agreement) o UPMC physicians and ancillary providers affiliated with the hospitals listed above • Members in these products will not have access to the core UPMC Hillman Cancer Centers. These include: o Mary Hillman Jennings Radiation Oncology at UPMC Shadyside o The Mario Lemieux Center for Blood Cancers o UPMC Hillman Cancer Center at Magee-Women’s Hospital of UPMC o UPMC Hillman Cancer Center at UPMC East o UPMC Hillman Cancer Center at UPMC Hamot o UPMC Hillman Cancer Center at UPMC McKeesport o UPMC Hillman Cancer Center at UPMC Mercy o UPMC Hillman Cancer Center at UPMC Natrona Heights o UPMC Hillman Cancer Center at UPMC Passavant o UPMC Hillman Cancer Center at UPMC Passavant North o UPMC Hillman Cancer Center at UPMC St. Margaret o UPMC Hillman Cancer Center in Bethel Park o UPMC Hillman Cancer Center in Monroeville o UPMC Hillman Cancer Center in Shadyside o UPMC Hillman Cancer Center in West Mifflin • Members in these products will continue to have access at the highest tier to all AHN and community-owned cancer centers. • Members should always go to the nearest emergency room in a true emergency and know that they have strong out-of-network protections for emergency department services at all UPMC facilities (including those that are out-of-network, such as UPMC Presbyterian). • Children’s Hospital and all UPMC pediatric practices are in-network at the highest tier.

Medicare Advantage • This announcement does not have any impact on Community Blue Medicare Advantage members. • This means that the UPMC physicians and facilities that are now out-of-network, remain out-of-network. • Members should always go to the nearest emergency room in a true emergency and know that they have strong out-of-network protections for emergency department services

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at all UPMC facilities (including those that are out-of-network, such as UPMC Presbyterian). • If a UPMC provider was in-network earlier this year, that provider will remain in-network. o This includes hospitals and physicians that were recently acquired by UPMC, such as UPMC Cole in Potter County and UPMC Somerset. o It also includes over 20 joint ventures with local independent hospitals, like the Excela Arnold Palmer Cancer Center or the St. Clair Cancer Center. • UPMC facilities that were not a part of the Community Blue network and will remain out-of- network include: o Magee-Women’s Hospital of UPMC o UPMC East o UPMC Mercy o UPMC McKeesport o UPMC Passavant o UPMC Presbyterian Shadyside o UPMC St. Margaret o UPMC Hamot o UPMC Jameson o UPMC Northwest o UPMC Bedford o UPMC Kane o UPMC Horizon o UPMC Altoona o UPMC physicians and ancillary providers affiliated with the hospitals listed above • Members in these products did not and will continue to not have access to the core UPMC Hillman Cancer Centers. These include: o Mary Hillman Jennings Radiation Oncology at UPMC Shadyside o The Mario Lemieux Center for Blood Cancers o UPMC Hillman Cancer Center at Magee-Women’s Hospital of UPMC o UPMC Hillman Cancer Center at UPMC East o UPMC Hillman Cancer Center at UPMC Hamot o UPMC Hillman Cancer Center at UPMC McKeesport o UPMC Hillman Cancer Center at UPMC Mercy o UPMC Hillman Cancer Center at UPMC Natrona Heights o UPMC Hillman Cancer Center at UPMC Passavant o UPMC Hillman Cancer Center at UPMC Passavant North o UPMC Hillman Cancer Center at UPMC St. Margaret o UPMC Hillman Cancer Center in Bethel Park o UPMC Hillman Cancer Center in Monroeville o UPMC Hillman Cancer Center in Shadyside o UPMC Hillman Cancer Center in West Mifflin

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Affordable Care Act (ACA) • In Western PA, ACA members in our high-performing narrow network product myDirectBlue will have access to some, but not all, UPMC facilities and doctors on July 1, 2019. • Certain UPMC providers will now be in-network. These include: o UPMC Altoona o UPMC Bedford o UPMC Cole o UPMC Horizon o UPMC Jameson o UPMC Kane o UPMC Northwest o UPMC Somerset o Western Psychiatric Institute and Clinic of UPMC o UPMC physicians and ancillary providers affiliated with the hospitals listed above o Over 20 UPMC and Community Hospital Cancer Centers (e.g., Excela Arnold Palmer Cancer Center, St. Clair Cancer Center). • Certain UPMC facilities and services will remain out-of-network starting July 1, 2019. These include: o Magee-Women’s Hospital of UPMC o UPMC East o UPMC Mercy o UPMC McKeesport o UPMC Passavant o UPMC Presbyterian Shadyside o UPMC St. Margaret o UPMC Hamot o UPMC physicians and ancillary providers affiliated with the hospitals listed above • Members in these products did not and will continue to not have access to the core UPMC Hillman Cancer Centers. These include: o Mary Hillman Jennings Radiation Oncology at UPMC Shadyside o The Mario Lemieux Center for Blood Cancers o UPMC Hillman Cancer Center at Magee-Women’s Hospital of UPMC o UPMC Hillman Cancer Center at UPMC East o UPMC Hillman Cancer Center at UPMC Hamot o UPMC Hillman Cancer Center at UPMC McKeesport o UPMC Hillman Cancer Center at UPMC Mercy o UPMC Hillman Cancer Center at UPMC Natrona Heights o UPMC Hillman Cancer Center at UPMC Passavant o UPMC Hillman Cancer Center at UPMC Passavant North o UPMC Hillman Cancer Center at UPMC St. Margaret o UPMC Hillman Cancer Center in Bethel Park o UPMC Hillman Cancer Center in Monroeville o UPMC Hillman Cancer Center in Shadyside o UPMC Hillman Cancer Center in West Mifflin

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• Members in these products will continue to have access AHN and community-owned cancer centers. • Members should always go to the nearest emergency room in a true emergency and know that they have strong out-of-network protections for emergency department services at all UPMC facilities (including those that are out-of-network, such as UPMC Presbyterian). • Children’s Hospital and all UPMC pediatric practices are in-network.

Q. How should my staff know how to research additional in-network services? A. Before making any kind of referral for additional services, please ensure that staff members validate the patient’s benefits. Staff members can confirm insurance coverage and benefits by accessing NaviNet® (under Eligibility and Benefits), which will provide extensive and detailed information for patients with all types of benefit plans, including a listing of in-network providers and facilities.

Q. What happens to a patient if they are sent to an out-of-network emergency department (ED)? A. Highmark was able to negotiate protections for members that must visit out-of-network emergency departments (all the way through to discharge). However, utilizing an out-of-network emergency department will still be cost-prohibitive for the patient when applying their cost share amount.

Please note that in an emergency, you should direct patients to the closest emergency department.

Q. Will Highmark still actively stabilize and transfer patients at an out-of-network emergency departments (ED)? A. Yes. Highmark members in narrow network commercial products that are transported to an out-of- network emergency department and have been stabilized, but are in need of continued care, will have the option to be transferred to an in-network hospital to reduce their financial exposure. Community facilities have the potential to receive increased volume transferred in from out-of-network facilities. In order to serve our members and respect their preference, we ask that you act quickly to place patients when you receive a call from the Highmark Transfer Center.

Highmark Medicare Advantage members will not be transferred from UPMC emergency departments to community facilities, unless at the request of the member. Medicare Advantage always covers emergency care as in-network, including emergency care at out-of-network UPMC facilities.

Q. Will Hillman Cancer Center at Shadyside be in-network for Highmark members? A. For Highmark members in broad products, like PPO Blue, BlueCard, Security Blue HMO, and Freedom Blue PPO, Hillman Cancer Center will remain in-network on July 1, 2019.

For Highmark members in high-performing or narrow products, like Community Blue Flex, Connect Blue, Community Blue Medicare HMO, and myDirectBlue, Hillman Cancer Center will be out-of-network on July 1, 2019. However, there are many other community cancer centers that will remain in-network for patients to choose from.

Q. What about Children’s Hospital? A. This agreement includes an extension of the Children’s Hospital contract for 10 years starting on July 1, 2019.

Q. What about Western Psychiatric Institute and Clinic (WPIC)? A. This agreement includes an extension of the WPIC contract for 10 years starting on July 1, 2019.

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Q. What about UPMC providers at community hospitals? A. UPMC physicians that provide services at an in-network non-UPMC facility will remain in-network for Highmark members on July 1, 2019.

Q. Will this change your strategy in investing in Allegheny Health Network (AHN) and other health systems? A. Not at all. We are focused on doing what’s right for our members and the community. Competition in health care will help drive lower costs, higher quality, and innovations in care.

Q. What does this mean for access to UPMC hospitals in other regions, like central PA? A. This agreement is focused on Western PA and does not affect other regions.

Q. Will AHN now accept UPMC Health Plan Patients? A. We have always believed that our AHN physicians and hospitals should be accessible to all patients and AHN is willing to negotiate in good faith with any insurance company that offers fair and reasonable terms for a contract that allows their members to access AHN’s services at affordable in-network rates. UPMC Health Plan currently has contracts with AHN’s Jefferson and Saint Vincent hospitals, and some of our physician practices accept UPMC insurance as well.

We are open to negotiating with UPMC Health Plan for contracts at our other AHN hospitals and care sites, but UPMC has historically chosen not to do so. We still recommend that patients with UPMC Health Plan check with their plan administrators to confirm which hospitals and physician practices they have access to in-network.

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