Pitt Student Health Insurance Medical Hardship Assistance Fund
The aim of the Pitt Student Insurance Medical Hardship Assistance Fund (MHAF) is to provide funding to graduate and professional students who face financial hardship due to the difference in medical costs between the 2022-23 Graduate Student Health Insurance plan and the 2023-24 Graduate Student Health Insurance plan. Questions about the fund can be directed to medhardship@pitt.edu.
Expenses covered by the Student Health Insurance Medical Hardship Assistance Fund:
The Medical Hardship Assistance Fund is intended to cover the difference in medical costs for co-pays, deductibles, and other out-of-pocket costs between the 2022-23 plan and the 2023-24 plan for graduate and professional students as well as other individuals covered by the plan. The maximum potential funding is equal to the maximum potential difference in medical costs between the plans. The amount of potential funding varies by who is covered on the plan. For individual coverage, the out-of-pocket maximum is $4,200. For individual coverage plus one or more dependents, the out-of-pocket maximum is $8,400. Note that expenses covered under Dental and Vision insurance are not covered by this fund.
If you are unsure if a cost will be covered, please reach out to medhardship@pitt.edu for consultation. The MHAF Team may need to ask you for additional information, including an estimate provided by UPMC.
- How was the amount of $4200 determined?
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$4200 is the maximum potential difference in medical costs between the plans for the primary policy holder (or student).
- How was the amount of $8400 determined?
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$8400 is the maximum potential difference in medical costs between the plans that cover the primary policy holder and one or more dependents.
- Who are covered individuals?
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Covered individuals include the policy holder (or graduate student) as well as partners and/or dependents enrolled under the same policy.
- What expenses qualify?
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Qualifying expenses include the increased cost of co-pays, deductibles, and other out-of-pocket expenses for medical testing and treatment between 9/1/23 and 8/31/24. For example, if the specialist co-pay was $10 in the 22-23 Plan Year, and increased to $40 in the 23-24 Plan Year, the student is eligible to receive the $30 difference.
- Is the money I receive from the MHAF taxable?
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The University is required to report the awarded amount as taxable income. If the aggregate amount awarded to you from all University sources including the MHAF (e.g., prize money, study participant payments) in calendar year 2023 or 2024 exceeds $600, you should expect to receive a 1099-MISC form. Please direct questions about filing your taxes to your financial or tax advisor.
- Why is Dental and Vision not covered?
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Expenses covered under the Dental and Vision plans are not eligible because there was no change from the 2023 plan to the 2024 plan.
- What if I am unsure if my expense is eligible?
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If you are unsure if a cost is eligible for funding, reach out to medharship@pitt.edu for consultation.
- How do I obtain a cost estimate from UPMC?
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Contact the UPMC Members Services Line. That contact information is on the back of your insurance card. Explain to the UPMC Concierge that you are looking to receive an out-of-pocket cost-estimate for the service that you need. Note that UPMC can only provide an estimate and there is potential that cost may change. Cost estimates will not be accepted as documentation for the formal funding request.
- How frequently can I apply to the Medical Hardship Assistance Fund?
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You may apply once a month until you have reached the maximum amount of $4200 for an individual or $8400 for student plus dependents plan. Each application may contain multiple expenses. If more than one application is submitted in the same calendar month, the application will be held and reviewed in the following month. The expenses incurred do not have to be incurred in the same month the application is submitted.
Required Documentation for Student Health Insurance Medical Hardship Assistance Fund (changed effective March 11, 2024):
Documentation must connect the expense paid with the type of service received. Acceptable documentation includes a copy of your Explanation of Benefits and an unpaid invoice or a receipt of qualifying medical services received between September 1, 2023, and August 31, 2024. In most cases, the combination of these two documents is sufficient for the application review. In some cases, the MHAF Team may need to request additional documents to connect the expense and the service and/or determine the payable amount.
- What are examples of documentation that is acceptable?
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Acceptable documentation includes 1) a copy of the Explanation of Benefits (except with pharmacy claims) AND 2) an invoice or receipt that includes: 1) the student’s name, 2) a clear out-of-pocket expense that is expected to be paid or was paid, 3) date of service and 4) an indication of what service will occur or has occurred.
- Where can I access the Explanation of Benefits?
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An Explanation of Benefits (EOB) will be generated for all claims except pharmacy/prescription claims. The EOB is not accessible immediately after the date of service. It will be made available once the claim has been processed through UPMC. The EOB can be accessed by following these steps:
STEP 1: Register or log in to www.upmchealthplan.com
STEP 2: On the home page under Your Insurance click Claims and EOBs
STEP 3: Locate date of service needed and click the “EOB” link to the right.
STEP 4: The EOB will populate in another window.
Note: Please ensure your pop-up blockers are turned off.
- What are examples of documentation that is not acceptable?
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Documentation that is not acceptable includes, but is not limited to, a doctor’s note, or a patient visit summary.
- Can I submit multiple documents with my application?
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Yes. To do so, combine all documents into one PDF before uploading into the application.
- If my application is denied, can I resubmit with different documentation?
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The MHAF Review Team will work with you to obtain acceptable documentation. The primary reason an application would be denied is because it was determined that the expense did not change from the 22-23 Plan Year. Therefore, resubmitting a new application will not be necessary.
Managing applicant’s sensitive information and protection of privacy:
The University is dedicated to the privacy of its students, staff, and faculty. The University handles electronic records and documentation containing personally identifiable information, including personal health information, with the appropriate standard of care and complies with all applicable regulations, which may include the Family Education Rights and Privacy Act (FERPA) or the Health Insurance Portability and Accountability Act (HIPAA).
- Who is reviewing my information?
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The MHAF Team includes staff members from the Office of the Provost and the Human Resources Benefits Department. All members of the review team have been trained in handling Personal Health Information. All patient/medical information will be redacted before being submitted through the financial system to issue payment.
- How is my sensitive information being used?
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The information submitted in the application will be used for the sole purpose of determining funding and will not be shared beyond the review team. Additionally, the MHAF Team aims to collect as little specific medical information as possible to process the application.
- Will my information be shared with my Advisor or Program?
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No. Access to the systems containing the applications and supporting documents is limited to those necessary to carry out the fund.
- Why does the MHAF need any medical information at all?
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The MHAF team does not ask for detailed medical information; however, as this fund will reimburse for the difference in medical costs between the 2022-23 Graduate Student Health Insurance plan and the 2023-24 Graduate Student Health Insurance plan, it is necessary to know the service provided.
- Are the systems being used to process applications secure?
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Yes. The systems used to collect, analyze and house the applications and supporting documents to the Medical Hardship Assistance Fund are annually vetted by Pitt IT and the Pitt Privacy Office and are determined to be compliant with federal privacy regulations. In the event of a security breach, the University Cyber Incident Response Plan would be activated. If you have questions about privacy, please see the Pitt Privacy Office website at https://www.compliance.pitt.edu/pitt-privacy-office or email compliance@pitt.edu.
Payment for approved applications to the Medical Hardship Assistance Fund:
Applications are processed as quickly as possible in the order they are received. Determination of any payable amount may be straightforward and fast, but depending on the circumstances, it may at times require more time-consuming investigation or additional documentation/information. Upon approval of an application, you will receive an email indicating the payable amount, after which the payment will be processed and issued.
- Is there a guaranteed turnaround time for submitted applications?
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All applications are handled expeditiously, but each application and expense is unique and must be handled case-by-case so an exact timeframe cannot be determined. However, most applicants have received funds within 3 weeks after receiving the award email
- How will I receive my payment?
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If you have a graduate student appointment or are otherwise on University Payroll and have signed up for Direct Deposit, the payment will be deposited directly to your bank account. If you are not on University Payroll, a check will be mailed to you. The MHAF Team will contact you if additional information is needed.