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Episcopal Church Medical Trust
Healthcare Benefits for The Diocese of East TennesseeOpen Enrollment 2012
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Agenda
Introduction
The Episcopal Church Medical Trust
• Medical Plans
• High Deductible Health Plan/Health Savings Account
• Additional Benefits
Resources
Denominational Health Plan
Questions?
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The Episcopal Church Medical Trust
Chartered by General Convention in 1978
Reports to Church Pension Fund Trustees
Voluntary Employees’ Beneficiary Association (VEBA)
ERISA-exempt, free of most state benefit mandates
Tax-favored not-for-profit church plan
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The Episcopal Church Medical Trust
Our Mission …
“Balancing compassionate
Christian benefits with financial stewardship”
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Your 2012 Medical Plan ChoicesIn-Network and Out-of-Network Plans
Empire BCBS PPO 80/60
Empire BCBS 75/50
Empire BCBS High Deductible Health Plan with Health Savings Account (HDHP/HSA)
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ALL PLANS – Preventive Care
Routine and Preventive Services
$0 Copay Network
Benefits include covered services received in a physician’s office such as:
• Routine exams
• Well-Woman and Well-Man exams
• Routine exam X-rays and lab services
• Well-Child checkups
• Immunizations
• Other Routine Services
Plan Provision Network
Annual deductible (single/family) $500 / $1,000
Annual OOP max (single/family) $2,000 / $4,000
Office visit copay$0 Preventive
$25
Member coinsurance 20%
Inpatient hospital coinsurance$100 per day, not to exceed
$600 per admission20% coinsurance
Outpatient hospital coinsurance$500 deductible
20% coinsurance
Empire BCBS PPO 80/60 – At a Glance
Plan Provision Network
Annual deductible (single/family) $900/$1800
Annual OOP max (single/family) $3,200/$6,400
Office visit copay$0 Preventive
$35/$45
Member coinsurance 25%
Inpatient hospital copay$100 per day, not to exceed
$600 per admission25% coinsurance
Outpatient hospital copay $900/1800 deductible
25% coinsurance
BCBS PPO 75/50 – At a Glance
Empire BCBS High Deductible Health Plan & Health Savings Account
(Preferred Provider Organization)
www.empireblue.com (800) 352-3152
HDHP/HSA: What is it?
High Deductible PPO Health Plan consumer-directed health plan
with preventive services covered at 100%
+Health Savings Account
allows employer and employees to make tax-free contributions and save for future healthcare
expenses
Employees can begin thinking like consumers when it comes to healthcare.
HDHP Benefits
All Plans Subject to Plan Deductible and Coinsurance…
Medical Plan - Administered by BCBS
Pharmacy - Administered by Medco
Mental Health - Administered by BCBS
Except the Eyemed Vision Benefits and CIGNA Employee Assistance Program (EAP).
Health Savings Account (HSA)
Tax-advantaged account regulated by the IRS
Employee sets up and owns the account
Balances accumulate and rollover year-to-year
Funds for qualified healthcare expenses only
Account must be held by qualified trustee • Mellon Bank for Empire BCBS• Funds may be invested
Only available to HDHP participants without other medical coverage
HSA - Contributions
Employers, employees or others may contribute to an employee’s HSA.
Limits on annual contributions set by IRS.• For 2012 - single $3,100, family $6,250• Employee responsible for ensuring max not
exceeded.
Additional contributions are possible for those age 55 (or older) by the end of the year ($1,000 for 2012).
Deadline for 2012 HSA contributions - April 15, 2013.
HSA – Distributions
Distributions from an HSA for qualifying medical expenses are tax-free.
• HDHP deductibles and coinsurance• Post-employment healthcare costs, Medicare
Part B premiums• Long-term care premiums
May be used for employee or dependent expenses.
Other distributions subject to federal income tax plus a 20% penalty. (Penalty waived after age 65 or on account of death or disability.)
HSA - How are distributions made?
Employees may: Use the HSA debit card at doctor’s office or
pharmacy Write a check on the HSA account Pay the provider or pharmacy out of personal funds
and reimburse him/herself from the HSA
Caution: Employee must keep records to prove the funds
were used for qualifying medical expenses. Employee is responsible for any overdraft fees on
the HSA.
Mental Health/Substance Abuse
In an HDHP, MH/SA benefits are embedded in the plan design and are administered by BCBS
However, the Employee Assistance Program (EAP) is still available to members
Benefits of the EAP include:
• 10 in-person sessions with no copay
• Unlimited telephone sessions
• Multiple episodes of treatment per year
• Includes Family Care, Personal, and Online services
Health Savings Accounts – Death
If the employee’s spouse is the beneficiary of the HSA, the HSA will be treated as an HSA of the spouse after the employee’s death.
• No taxable event for Federal income tax purposes.
If there is a non-spouse beneficiary, the account ceases to be an HSA and the value of the account is taxed to the beneficiary.
• If the employee’s estate is the beneficiary, the HSA balance is included in the employee’s final Federal income tax return.
Design Elements In Network Out of Network
Deductible$2,700 Individual
$5,450 Family$3,000 Individual
$6,000 Family
Coinsurance Maximum$1,500 Individual
$3,000 Family$4,000 Individual
$7,000 Family
Out of Pocket$4,200 Individual
$8,450 Family$7,000 Individual$13,000 Family
Coinsurance (after deductible) 20% 45%
PCP (after deductible) 20% 45%
Specialist (after deductible) 20% 45%
Hospital (after deductible) 20% 45%
Emergency Room (after deductible) 20% 45%
Preventive Care 0% 45%
Prescription Drug (after deductible)Generic - 15%
Formulary Brand - 25%Non Forumulary Brand - 50%
Precertification is required for inpatient hospital admissions. Failure to precertify these services will lead to a reduction in benefits.
Empire BCBS HDHP/HSA Plans
HDHP Cost Comparison per Employee
BCBS 80/60 Plan Monthly AnnuallySingle $642 $7,704Single Plus One $1,157 $13,884Family $1,798 $21,576
Empire BCBS HDHPSingle $440 $5,280Single Plus One $792 $9,504Family $1,232 $14,784
SavingsSingle $2,424Single Plus One $4,380Family $6,792
HDHP Cost Comparison per Employee
Health Savings Account (HSA) Funding
Single $2,200Single Plus One $3,325 *Family $4,450
Net Savings To EmployerSingle $224Single Plus One $1,055 *Family $2,342
*Note that the funding and net savings amounts for Single Plus One for the Diocese of East Tennessee differ from the amounts of $4,450 [funding] and $(70) [net savings to employer] used for illustration purposes in the regional meetings held on Nov. 10, 2011.
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Medco Pharmacy Tiers
Generic: Same active ingredients as the brand-name it replaces. Binder
may differ.
Formulary: A list of brand-name drugs preferred by a plan based on clinical
effectiveness and cost. (Also called “Preferred Brand Name”)
Non-Formulary: Brand-name drugs not on your plan’s formulary. (Also called
“Non-Preferred Brand Name”)
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Medco Pharmacy Plan Designs
Standard Plan HDHP/HSA
Retail Mail Order Retail & Mail Order
Annual Prescription Deductible
(Retail Only)
$50 per person
none $2,700 per person
$5,450 per family
(combined with medical deductible)
Copays Tier 1: Generic
Up to $10 Up to $25 You pay 15% after deductible
Copays Tier 2: Formulary
Up to $35 Up to $90 You pay 25% after deductible
Copays Tier 3: Non-formulary
Up to $60 Up to $150 You pay 50% after deductible
Dispensing Limits per Copayment
Up to a 30-day supply
Up to a 90-day supply
Up to a 30-day supply (retail) or 90-day
supply (mail order)
CIGNA Behavioral Health
Mental Health / Substance Abuse Benefits
www.cignabehavioralhealth.com (866) 395-7794
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Mental Health / Substance Abuse Benefits
Plan Partner – CIGNA Behavioral Health*
Thirty years experience
Extensive mental health provider network
Out-of-network MH/SA benefits in all MT Plans*
Employee Assistance Program (EAP)
*Empire BCBS HDHP has only EAP through CIGNA Behavioral Health. MH/SA benefits are embedded in the plan designs.
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Mental Health / Substance Abuse Benefits
Plan Partner – CIGNA Behavioral Health*• Thirty years experience• Extensive mental health provider network
Out-of-network MH/SA benefits in all MT Plans*• Annual deductibles do not apply to MH/SA benefits• Shares out-of-pocket maximums with medical benefits• See Summary Plan Document for your specific plan details
Employee Assistance Program (EAP)• Administered by CIGNA
*Empire BCBS HDHP has only EAP through CIGNA Behavioral Health. MH/SA benefits are embedded in the plan designs.
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Employee Assistance Program (EAP)
Administered by CIGNA Behavioral Health
10 in-person sessions PER ISSUE at $0 COPAY
Multiple episodes of treatment per year
Unlimited telephonic sessions
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Employee Assistance Program (EAP)
Assistance with Family Care Services• Child care• Parenting programs• Adoption information• Long-distance care-giving• Researching nursing homes
Personal Services• 30-minute free legal consultation
• Stress management
• Debt management
• Identity theft management
Online Services• Emotional well-being and life events
• Family and care-giving resources
• Health & wellness resources
• Daily living resources
• Email assisted search
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Health Advocate
Advocacy and assistance service
Facilitates member interactions with healthcare providers, insurance plans, and other community resources
Assists members with:
• Finding doctors, hospitals and other healthcare providers
• Resolving claims, billing and administrative problems with providers
• Issues encountered while accessing the healthcare system
Protects privacy and confidentiality
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EyeMed Vision Care Benefits – At a Glance
Plan Provision Network Out-of-Network
Annual Eye Exam You pay $0 Plan pays up to $30
Choose Eyeglasses OR Contact Lenses Each Calendar Year:
Lenses
single vision
bifocal
trifocal
You pay
$10
Plan pays up to
$32
$46
$57
Frames $130 allowance,
20% off balance over $130
Plan pays up to $47
Contact Lenses
Conventional$130 allowance,
15% off balance over $130
Plan pays up to $100
Contact Lenses
Disposable$130 allowance, then
you pay balance over $130
Plan pays up to $100
For Assistance: (866) 723-0513 www.eyemedvisioncare.com
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FrontierMedex and HearPO
FrontierMedex Access to FrontierMEDEX Travel Assistance
Provides 24/7 Emergency Medical Advocacy
Note: FrontierMEDEX is not responsible for medical costs while you are traveling.
HearPO Access to HearPO network discounts
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Getting Help: Contacts
Empire BlueCross BlueShield• (800) 352-3152
• www.empireblue.com/medicaltrust
CIGNA Dental• (800) 224-6224
• (800) CIGNA24
• www.cigna.com
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Getting Help: Contacts
Medco• (800) 841-3361
• www.medco.com
CIGNA Behavioral Health (& EAP)• (866) 395-7794
• www.cignabehavioral.com.com
EyeMed Vision Care• (866) 723-0512
• www.eyemedvisioncare.com
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Getting Help: Contacts
Health Advocate• (866) 695-8622
• www.healthadvocate.com
FrontierMEDEX• (800) 527-0218 (U.S., Canada, Virgin Islands, Bermuda)
• (410) 453-6330 (All other locations – call collect)
• www.frontiermedex.com
HearPO• (888) 432-7464
• www.hearpo.com
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Client Engagement
Best sequence for problem resolution:
1st: Call Vendor for most benefit-related issues
2nd: Call Health Advocate
3rd: Call Medical Trust
We are here to serve our members
Monday through Friday:8:30am to 8:00pm Eastern
Telephone Direct Toll Free
1-800-480-9967
Email: [email protected]
HDHP/HSA Web Resources
U.S. Treasury Department – Health Savings Accountswww.treas.gov/offices/public-affairs/hsa/The HSA section of the US Treasury Department website contains links to informational brochures, up to date regulations, frequently asked questions, press releases, IRS forms and publications and technical guidance.
IRS – Health Savings Accountswww.irs.govThe HSA section of the IRS website contains publications, bulletins and tax filing instructions.
Publication 502www.irs.gov/publications/p502/index.htmlPublication 502 provides a list of qualified medical expenses.
HDHP/HSA Web Resources continued…U.S. Government Office of Personnel Managementwww.opm.gov/hsa/Although primarily intended for government employees, this site is also a good resource for finding information about HDHPs and HSAs.
HSA Insider (a division of Canopy Financial) – HSA Road Ruleswww.hsainsider.com/roadrules.aspxYou will need to login to download the HSA Road Rules. This brochure includes a Table of Contents making it very user friendly. It also appears that this brochure is kept up to date with government regulations. In addition to the Road Rules, the HSA Insider site contains other valuable information.
Resolution A177: What Was the Spirit in which the Resolution was Passed
Speaks to social justice issues around adequate benefits for the Church’s lay employees
Cost concerns are real, but so is the need of lay employees to have adequate healthcare benefits
The support and dedication of lay employees make many ministries possible…it’s the right thing to do
General Convention actions will now assure lay employees the safety net of healthcare benefits
Currently, some lay employees do not have access to healthcare benefits , and others have a higher cost-share than clergy
DHP- con’t
Required:
• All domestic US dioceses, cathedrals, missions, and chapels by 2013
• All clergy and lay employees who work 30+ hours/week. Individuals may opt out through spousal coverage, Tri-care, etc.
• Parity between clergy and lay coverage levels
• Employees who work between 20 and 30 hours/week may participate---not required
DHP- con’t
Diocesan Choice and Control
• Dioceses will determine whether diocesan institutions, schools, and agencies will be required to participate.
• Diocese will establish cost sharing guidelines for congregations, i.e. parity.
• Dioceses decide whether to offer healthcare coverage for domestic partners.
• Diocese select plan designs.
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Disclaimer
This presentation is provided for your informational purposes only. In the event of a conflict between the information contained in this presentation and the official plan documents, the official plan documents will govern. The Church Pension Fund and its affiliates retain the right to amend, terminate, or modify the terms of any benefit plans described in this presentation, consistent with applicable law.