Healthcare Information Session

Uwharrie DistrictSeptember 15, 2014

Jennifer Burton, Benefits Officer

& Dale Bryant, Benefits Administrator

What’s included…..

Medical benefits, including wellness programDental benefitsVision benefitsPharmacy benefits

What’s changing? What’s not?

Dental benefits: Stays the same with services and cost to participant

Vision benefits: Stays the same with services; copays for annual visit/exam will match to changes with medical benefits plan

What’s changing? What’s not?

Medical benefits: Covered services remain the same; Choice of two plan options with changes in either medical costs or premium costs

Pharmacy benefits: Slight changes in formulary with new Pharmacy Benefit Manager; no changes in copays for types of medications (generics, formulary, or non-formulary)

Pharmacy Benefit Manager (PBM)

Currently using ExpressScripts, formerly known as Medco, with a traditional model of retail pricing with incentives given to persons involved from pharmacies to manufacturers to PBMs

New PBM is PharmAvail…. Working with a fiduciary model where pricing to the consumer isn’t padded with costs of the incentives; PBM profits only through administrative fee.

Company created with persons who are clinicians.

Pharmacy Benefit Manager (PBM)

Plan design based on clinical research and discussion. Recommendations to doctors based on this.

Service center calls answered by real people in US

Committed to least disruption for participants, expecting the change will be an upgrade.

Change will be seamless to participant in the plan. Present your insurance card to your pharmacy of choice as always.

Pharmacy Benefit Manager (PBM)

Mail order prescriptions will continue to be available (more information by end of year) with transfer of prescriptions

For pharmacy locations, review all those working with PharmAvail from their website www.pharmavail.com/about/network

Addition of injectable immunizations at pharmacy at no cost

Medical Health Plan Options

Each participant will have the choice between two plans:

Basic plan: Same covered services; participant bears more of the medical costs

Basic plus plan: Same covered services; participant pays a higher premium

As participant selects a plan option, any dependents must also be included in the same plan.

Medical Health Plan Option: Basic

Same covered services as currently have

Participant will bear additional medical costs through increased co-pays, deductibles, coinsurance, and out-of-pocket limits.

Annual premium cost will total $10,200 with an affordable portion to be contributed by pastor based on your total base compensation.

Medical Health Plan Option: Basic

Medical costs (in network) will be based on:

Co-pays for primary physician $30

Co-pays for specialty/urgent care visit $40

Individual deductible$1,500

Family deductible$4,500

Coinsurance percentage70%

Out-of-pocket limitations (individual) $6,000

Out-of-pocket limitations (family) $13,200

Medical Health Plan Option: Basic Plus

Same covered services as currently have

Participant will bear additional costs through increased premiums, although the total premium is still reduced from the prior year health insurance premium.

Annual premium cost will total $12,300 with the pastor contributing both a portion of the base premium relative to your total base compensation PLUS the differential between the premium for the basic plan and the basic plus plan (differential equals $2,100)

Medical Health Plan Option: Basic Plus

Medical costs (in network) will be based on:

Co-pays for primary physician $15

Co-pays for specialty/urgent care visit $25

Individual deductible $1,000

Family deductible $3,000

Coinsurance percentage 80%

Out-of-pocket limitations (individual) $4,000

Out-of-pocket limitations (family) $12,000

Pastor’s/Church’s Contribution under Plans

Pastor’s contribution under the Basic Plan will be only the percentage of the premium based on your salary range under our sliding scale currently in place.

Pastor’s contribution under the Basic Plus Plan will be the percentage of the premium based on your salary range under our sliding scale currently in place PLUS the difference between the annual cost of the basic plan and the annual cost of the basic plus plan (difference equals $2,100).

Church contribution equals the remainder of the premium less the pastor’s contribution.

Example for Plan Determination

Consider the following:

Participant visits primary physician once per year for annual physical.

Participant visits specialists (ophthalmologist, gastroenterologist, cardiologist, hematologist, etc.) a total of 15 times per year.

Participant has certain tests performed (colonoscopy, sleep study, etc.) totaling $3,000 before insurance or participant payments.

Example for Plan Determination Medical costs for the participant under basic and basic plus:

Primary care physician for annual physical Basic: $ 0Basic Plus: $ 0

Specialist visits ($40/$25 x 15)$ 600 $ 375

Tests performed at (coinsured) 30%/20% x $3,000 $ 900$ 600

Total medical costs$1,500 $ 975

Premium costs$ 204 $2,304

Total health insurance costs for the year $1,704$3,279

Participant would have less out-of-pocket costs under Basic plan. Choice would also have to include risk assessment of overall health for potential medically major events.

Added Wellness Program & Incentives

Current plan does include some wellness items with no charges:

Annual physical for participants

Mammograms for women

Vaccines (flu, pneumonia, shingles, TDAP) for adults

Children’s vaccines

Clergy Health Initiative (Spirited Life) had asked us to hold any changes to our plan to add additional wellness items or incentives because of their research study over the last three years. We have been released from this restriction now that all cohorts have completed their first year!

Added Wellness Program & Incentives

Introduction of Wellness Incentives to go along with our Healthcare Plans

Incentives to include rewards for activity, rewards for assessment completion, rewards for biometric screenings, rewards for healthy ranges or improvement in certain biometrics…..

These incentives will also include challenges periodically during a year as additional activity within the five dimensions of health: physical, emotional, spiritual, social, and financial.

Reimbursements for certain items will also be included within the wellness incentives.

Approved Incentive Plans - Activity

Activity tracking through Virgin Pulse Physical Activity Program

Incorporates Virgin HealthMiles walking program (including pedometers)

Other activities will also be able to be tracked for additional “steps” or miles

Various challenges throughout the year for which you can earn additional reward points or “badges”

Challenges between other UMC geographic groups within the US or districts of our own conference

Challenges between participants within the conference

Reward point goals will be adjusted throughout your progress based on Virgin Pulse algorithm

Pedometer from Virgin Pulse….

Meet… MAX

Approved Incentive Plan - Biometrics

Metabolic Syndrome:

Blood pressure

Blood sugar (glucose)

Cholesterol (HDL/LDL)

Triglycerides

Body Mass Index (BMI)

Waist circumference

Approved Incentive Plans - Biometrics

Rewards for biometric items:

Health Risk Assessment completion through Healthgram

Biometric screening

Reward points for healthy ranges or improvement in certain specific biometric items

Reimbursements for certain items

Fitness center fees based on number of visits per year

Participation in Pfeiffer University Clergy Health Institute

Reward Points to Cash

Each quarter, based on reward points earned, cash rewards will be distributed.

At the end of the year, especially for activity rewards, bonus awards may be earned for meeting quarterly reward point goals.

Total incentives available will be a substantial portion (up to 2/3) of the total premium costs of the participant.

More information about wellness program

In adding the Virgin Pulse program, more communication will be forthcoming from both the conference office as well as from Virgin Pulse before the end of the year.

A “landing page” designed specifically for the WNC participants will be created on the Virgin Pulse website. Registration for the page will be required to begin earning the activity reward points.

All this and full incentive awards and programs will be within the communications later this year…. a communication blitz between VirginHealthMiles and us.

How do we enroll?

Pre-populated forms have been provided to us from Healthgram for re-enrollment of ALL participants. Key information to be provided on these forms:

Check your name, address, and phone number. If these are correct or complete, please change on the form itself.

Select the plan in which you want to enroll with the boxes on the right.

Complete the middle section for spouse and all dependents, including birth dates and social security numbers, who will be enrolled.

Note “qualifying events” which can cause a time at which plan choices can be altered.

When do we complete the forms?Where do we send?

All forms need to be completed prior to November 1.

Please write legibly!!

After completion of your forms, please submit the forms with original signatures to Dale Bryant, Benefit Administrator, at the Conference office for us to receive no later than November 1!

Western NC Conference

PO Box 18005

Charlotte, NC 28218

Other enrollment thoughts… If your form is not received by November 1, you will be

enrolled in the basic plus plan if eligible for health benefits. In order to have the plan that you request, please submit as quickly as possible. Delays in receipt will also mean delays in receiving new health cards!

Enrollment for all portions of the health plan (medical, wellness, pharmacy, dental, and vision) will be through this one form. The only other step that participants will need to perform will be the Virgin Pulse registration after December 31.

New health cards are anticipated to be released so that participants will have them prior to year end, December 31.

Changes to Clergy Compensation Form

Due to these plan changes, there will be small changes you will notice on your clergy compensation form. This will include check boxes within the health insurance section of the form where you will also show your selection of plans. Remember these selections are your choice and not those of the church!!

Also to note, as of January 1, 2014, employers are no longer allowed to reimburse medical premiums for its employers as non-taxable compensation. Therefore, for 2014 and forward, these amounts MUST be included in your total compensation as shown in Line 1 of the form (and on your Form W-2 at the end of the year).

Church Cost for Pastor Benefits in 2014

Churches fund the pension and health benefits of the pastor each year. For 2014, these items and their cost were as follows:

Pension costs within three parts:

Defined benefit at set cost per pastor of $5,118

Defined contribution at 3% of pastor’s plan compensation

Comprehensive Protection Plan premium at 2.87% of plan compensation (partially subsidized as GBOPHB invoices 3%)

Health care premiums at their share of $13,788

Church Cost for Pastor Benefits - 2015

In funding the pension and health benefits of the pastor, in 2015, these items and their cost will be as follows:

Pension costs within three parts:

Defined benefit at set cost per pastor of $4,092 (partially subsidized as GBOPHB will invoice $5,356)

Defined contribution at 3% of pastor’s plan compensation

Comprehensive Protection Plan premium at 2.78% of plan compensation (partially subsidized as GBOPHB invoices 3%)

Health care premiums at their share of $10,200 (either plan)

Comparison between years….

In comparing these, the following savings are noted for each church, per pastor:

Pension benefits (defined benefit): $5,118 - $4,092 = $1,026 (20% savings)

Pension benefits (comprehensive protection plan): 2.87% - 2.78% = .09% of plan compensation (3.1% savings)

Health benefits: $13,788 - $10,200 = $3,588 (26% savings)

Total potential savings at minimum salary: $1,026 + ($40,000

x .09%) + $3,588 = $4,650

How could these savings be used??

Ministry needs of the church and community

Apportionment payments if not currently at 100%

Savings or reserves for future needs

OR……if the pastor has not had a salary increase or, for the needs of health, will enroll in the basic plus plan, utilize these savings to provide additional compensation to the pastor.

Are the pastors ready to approach PPRC?

Requesting an increase in salary can be an awkward event for even the most self-confident of us. Here’s some facts to provide, especially if the pastor has not had an increase or if, medically, the pastor will be selecting the basic plus plan:

Inflation (which equates to cost of living) has averaged 1.5% over each of the last three years.

At minimum salary, additional cost of basic plus plan will be approximately 6% of salary.

Are the pastors ready to approach PPRC?

You may be asked to “justify” your health plan choice. While this is not appropriate for you to have to do, a basic response could be that you have selected this plan based on your current health needs. By being attuned to these needs and utilizing the medical profession to assist in you becoming healthier, you are able to provide stronger pastoral care to them and your congregation that would not be possible if this was not available.

From the conference office, we are also available to provide average pastor salary based on size of church by membership or worship attendance for comparison.

Items to remember….

Health plan choice is yours and yours alone. Church does not have the ability to make this choice for you.

Church can provide a “reimbursement” for healthcare premiums for our conference plan. However, it must be included in your total compensation (Line 1) as taxable income.

If the church does not report in this manner, they will be subject to penalties totaling $100 per day, annually $36,500, and possible penalties for the misreporting of income on your Form W-2 at the end of the year.

Items to remember….

Pastor’s contribution to their health care premiums, along with those of spouses and children if all are enrolled on the conference plan, can be shown on Line 2b of the clergy compensation form and reduce your taxable income for year end reporting.

Enrollment forms are due back to the Conference office no later than November 1!!

It’s a lot of information…..

Any and all questions……?