Episcopal Church Medical Trust
Healthcare Benefits for
The Diocese of Southern Ohio
Open Enrollment 2012
The Rev. Rusty McCown
Regional Manager
November 2 & 3, 2012
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Agenda
 Introduction
 The Episcopal Church Medical Trust
• Medical Plans – and HDHP/HSA plan
• Additional Benefits
• Dental Plans
 Resources
 Questions?
2
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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Episcopal Church Medical Trust
Medical Plans– 2012
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Your 2012 Medical Plan Choices
In-Network and Out-of-Network Plans
 Empire BCBS PPO 80/60
 Empire BCBS High Deductible Health Plan with Health
Savings Account (HDHP/HSA)
In-Network Only Plans
 Aetna HMO/CIGNA Open Access
 Aetna Select EPO
 Empire BCBS EPO 90
 Empire BCBS EPO 80
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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
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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.
Empire BCBS HDHP/HSA Plans
Design Elements
In Network
Out of Network
$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%
Deductible
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.
HDHP Cost Comparison per Employee
Diocese of Southern Ohio
Monthly Rates for 2012
Aetna HMO/CIGNA OAP
Aetna Select EPO
Empire BCBS PPO – 80/60
Empire EPO 80
Empire EPO 90
Single
$675
$742
$875
$667
$705
E+1
$1,214
$1,335
$ 1,576
$1,200
$1,269
Family
$1,889
$2,078
$2,447
$1,866
$1,972
Empire BCBS HDHP
$504
$ 907
$1,412
HDHP Cost Comparison per Employee
Health Savings Account (HSA) Funding
Monthly Cost to Employers for HDHP/HSA
Single
E+1
Family
Empire BCBS HDHP
$504
$907
$1,412
HSA Funding ($2,000/$4,000)
$167
$333
$333
Total Cost to Employer
$671
$1,240 $1,745
HDHP Cost Comparison per Employee
Diocese of Southern Ohio
Monthly Rates for 2012
Aetna HMO/CIGNA OAP
Aetna Select EPO
Empire BCBS PPO – 80/60
Empire EPO 80
Empire EPO 90
Single
$675
$742
$875
$667
$705
Empire BCBS HDHP + HSA Funding $671
E+1
$1,214
$1,335
$ 1,576
$1,200
$1,269
Family
$1,889
$2,078
$2,447
$1,866
$1,972
$1,240 $1,745
Medco Pharmacy Benefits
www.medco.com (800) 841-3361
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
$50 per
person
none
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
Up to a 30day supply
Up to a 90day supply
Up to a 30-day supply
(retail) or 90-day
supply (mail order)
Annual
Prescription
Deductible
(Retail Only)
Dispensing
Limits per
Copayment
Retail & Mail Order
$2,700 per person
$5,450 per family
(combined with
medical deductible)
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CIGNA Behavioral Health
Mental Health / Substance Abuse Benefits
www.cignabehavioralhealth.com (866) 395-7794
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


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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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Value Added Benefits
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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
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Child care
Parenting programs
Adoption information
Long-distance care-giving
Researching nursing homes
Personal Services
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30-minute free legal consultation
Stress management
Debt management
Identity theft management
Online Services
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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
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

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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
Annual Eye Exam
Network
Out-of-Network
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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CIGNA Dental Plans
www.cigna.com (800) 244-6224 (800-CIGNA24)
CIGNA Dental Plans – At a Glance
Plan Provision
Preventive
Dental
Basic Dental
Dental &
Orthodontia
What You Pay
Preventive Services
0%
0%
0%
Basic Services
20%
15%
15%
Major Services
99%
50%
15%
Orthodontic Services
99%
Not Covered
50%
(includes 3 cleanings per year)
($1,500 Lifetime Max)
Deductible (single/family)
Out-of-Network Benefits
(based on Usual & Customary)
Annual Benefit Maximum
(in addition to preventive care)
None
$50 / $150
$25 / $75
Same as
Network
Same as
Network
Same as
Network
$1,500
$1,500
$1,500
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Dental Rates 2012
Diocese of Southern Ohio
Monthly Rates for 2012
Preventive Dental
Basic Dental
Dental and Orthodontia
Single
$121
$66
$53
E+1
$36
$116
$95
Family
$56
$177
$148
Online Open Enrollment
Online Open Enrollment
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Online Open Enrollment
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Online Open Enrollment
Please print this
confirmation for
your records.
Thank you!
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Resources
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Getting Help: Contacts
 Empire BlueCross BlueShield
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(800) 352-3152
www.empireblue.com/medicaltrust
 CIGNA Dental
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•
•
(800) 224-6224
(800) CIGNA24
www.cigna.com
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Getting Help: Contacts
 Medco
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(800) 841-3361
www.medco.com
 CIGNA Behavioral Health (& EAP)
•
•
(866) 395-7794
www.cignabehavioral.com.com
 EyeMed Vision Care
•
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(866) 723-0512
www.eyemedvisioncare.com
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Getting Help: Contacts
 Health Advocate
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(866) 695-8622
www.healthadvocate.com
 FrontierMEDEX
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(800) 527-0218 (U.S., Canada, Virgin Islands, Bermuda)
(410) 453-6330 (All other locations – call collect)
www.frontiermedex.com
 HearPO
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(888) 432-7464
www.hearpo.com
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Client Engagement
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: mtcustserv@cpg.com
Best sequence for problem resolution:
1st:
Call Vendor for most benefit-related issues
2nd:
Call Health Advocate
3rd:
Call Medical Trust
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The Medical Trust Website
www.cpg.org
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HDHP/HSA Web Resources
U.S. Treasury Department – Health Savings Accounts
www.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 Accounts
www.irs.gov
The HSA section of the IRS website contains publications, bulletins and
tax filing instructions.
Publication 502
www.irs.gov/publications/p502/index.html
Publication 502 provides a list of qualified medical expenses.
HDHP/HSA Web Resources continued…
U.S. Government Office of Personnel Management
www.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 Rules
www.hsainsider.com/roadrules.aspx
You 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.
Your ID Cards
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Thank you!
Any Questions?
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Definitions

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

Benefits Period: A benefit period begins the day you are admitted to a
hospital or skilled nursing facility (SNF), and ends when you have not
received any inpatient hospital or SNF care for 60 days in a row. If you
are admitted after a benefit period ends, a new one begins. You must
pay any deductibles for each new benefit period.
Coinsurance: an amount, usually a percentage, you may be required
to pay as your share of the cost of services after deductibles have
been met.
Copayment or Copay: a fixed amount you may be required to pay as
your share of the cost for services.
Deductible: the amount you must pay for healthcare or prescriptions
before your benefits begin to be paid by the plan (where applicable.)
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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.
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