Benefits through the stages of your life.
THE BENEFITS PLAN OF THE
PRESBYTERIAN CHURCH (U.S.A.)
Regional Representatives
The Benefits Plan of the PC(USA) provides
pension, healthcare and death and disability
benefits to members of the Benefits Plan, their
eligible dependents, and beneficiaries, where
applicable.
2
COMMUNITY NATURE
• Key foundation of the plan
• Community: plan members, churches, and
other employing organizations
• The whole community shares cost for the
sake of all
• Minimum benefits ensured for all plan
members
3
“For just as the body is one and has many members,
and all the members of the body, though many, are
one body, so it is with Christ. ...
God has so arranged the body ... that there may be
no dissension within the body, but the members may
have the same care for one another. If one member
suffers, all suffer together with it; if one member is
honored, all rejoice together with it.”
1 Corinthians 12:12, 24-26 (NRSV)
4
BUILDING BLOCKS
5
EFFECTIVE SALARY
• Basis for dues and benefits
• Not necessarily IRS or SECA salary
amount
• Includes
– Cash salary
– Housing or manse value
– Deferred compensation
[403(b)(9); Sec. 125 plan]
– Other cash payments
6
2013 & 2014 MEDIAN EFFECTIVE
SALARIES
Employment Classification
Median Salaries
% Change in Median
2013
2014
2013 to 2014
Pastors*
$54,000
$54,500
+ 1.0%
Exempt Lay Members
$40,900
$41,700
+ 2.0%
Non-Exempt Lay Members
$29,800
$30,400
+ 2.0%
*Although the figures used to calculate the pastors’ median include only
teaching elders serving churches, the median applies to all teaching elders for
determining benefits based on effective salary: pension credit accruals,
disability benefits, and death benefits.
7
Benefits through the stages of your life.
TRADITIONAL COVERAGE UNDER
THE BENEFITS PLAN
CORE BENEFITS
Healthcare
Retirement
Death
Disability
9
HEALTHCARE
10
NATIONWIDE GROUP PLAN
11
MEDICAL PPO NETWORK
• Network – Healthcare providers who agree
to negotiated fees when treating patients in
the network
• Out of network – Healthcare providers in a
geographic network area who do not
participate in the networks offered by the
Board
• Non-network – A geographic area that
does not have sufficient network providers
within a reasonable distance of members
12
MEMBER COST: OFFICE VISIT COPAYS
• Network office visit copays
– $25 for primary care/mental health
– $45 for specialists
• Out of network
– 50% of the plan allowance
• Office visit copays do not count toward
annual deductibles or copayment maximums
13
2014 DEDUCTIBLE AND COPAYMENT
PERCENTAGES
YOUR COSTS
TYPE OF COST
Annual deductible
• Member
• Family
Network
Out-of-Network
1.25% of effective salary
1.25% of effective salary
2.5% of effective salary
2.5% of effective salary
Copayment (per service)
20%, up to the
copayment maximum
40%, up to the copayment
maximum
Annual family copayment
maximum
5% of effective salary
15% of effective salary
14
MEMBER COST: DEDUCTIBLES
• Medical deductibles are based on effective
salaries, reflecting the ability of the member
to pay
• Members are responsible for two
deductibles*
– 1.25% of effective salary for the member
– 1.25% of effective salary for the rest of the family
*(Network) Out of Network – 2.5%
15
MEMBER COST: NETWORK
COPAYMENT LIMITS
• After network deductible is met, member
pays 20% copayment for eligible network
services
– This counts toward copayment limit
• After member has paid 5% of effective
salary in copayments, Board pays 100% of
eligible network costs
16
MEMBER COST: OUT-OF-NETWORK
COPAYMENT LIMITS
• After out-of-network deductible is met,
member pays 40% copayment for eligible
out-of-network services
– This counts toward copayment limit
• After member has paid 15% of effective
salary in eligible costs, Board pays 100% of
eligible costs
• Costs for out-of-network services that
exceed plan allowance do not count toward
copayment limit
17
2014 HEALTHCARE DEDUCTIBLES
AND COPAYMENT MAXIMUMS
Salary Range
Deductible
Network and
Non-Network Out of Network
Copayment Maximum
Network and
Non-Network
Out of Network
$0 - $46,974
1.25%
$525
2.50%
$1,050
5%
$2,100
15%
$6,300
$46,975 - $51,954
$590
$1,175
$2,350
$7,050
$51,955 - $56,929
$650
$1,300
$2,600
$7,800
$56,930 - $61,909
$715
$1,430
$2,845
$8,535
$61,910 - $66,889
$775
$1,550
$3,095
$9,285
$66,890 - $71,864
$840
$1,675
$3,345
$10,035
$71,865 - $76,844
$900
$1,800
$3,595
$10,780
$76,845 - $81,819
$965
$1,925
$3,845
$11,535
$81,820 - $86,799
$1,025
$2,050
$4,090
$12,270
$86,800 or more
$1,085
$2,170
$4,340
$13,020
18
PRESCRIPTION DRUG PLAN
19
PRESCRIPTION DRUG PLAN
• No annual deductible
• $2,500 copayment annual limit
• Maintenance medications by mail order
Type of
Pharmacy
Retail
pharmacy
Mail-order
service
Maximum fill
Up to a 30-day
supply
Up to a 90-day
supply
Your cost per prescription
Generic
Formulary
Non-Formulary
$10
30% of cost;
min $20 to
max $100
50% of cost;
min $50 to
max $150
$25
30% of cost;
min $50 to
max $300
50% of cost;
min $125 to
max $450
20
PRESCRIPTION DRUGS
21
MAINTENANCE MEDICATIONS
MAIL ORDER
• Maintenance medications are drugs
taken regularly for long-term chronic
conditions
• Does not apply to one-time
prescriptions
• 90-day supply
• Efficient, safe, and economical
22
PREVENTIVE CARE BENEFIT
• Not subject to deductible
• $0 office visit copay for network providers
– Plan pays 100% of office visit, lab work,
and tests, according to preventive
schedule
– Non-preventive (diagnostic) lab work or
tests recommended by the provider
during annual physical are covered
subject to normal Medical Plan
provisions
23
MENTAL HEALTH/SUBSTANCE ABUSE
• Provided through Cigna
• Treatment is reviewed by Cigna for medical
necessity
• Pre-certification is required for inpatient or
higher-level services
• Contact Cigna at 866-640-2772 or visit
www.cignabehavioral.com for network
providers
24
EMPLOYEE ASSISTANCE PROGRAM
• Cigna
– For members and household members
– Confidential counseling/referral service
for family, financial, alcohol, drugs, legal,
life events, and stress issues
– Six free counseling visits/per person/per
issue; confidential counseling/referral
service
– Financial and legal help
25
HEALTH MANAGEMENT: ACTIVEHEALTH
26
PRE-CERTIFICATION
• Pre-certification is required for:
– Scheduled outpatient imaging (MRI, MRA, CAT,
PET, SPECT, etc.) and nuclear stress test
– Bariatric surgery or any weight loss surgery
– All inpatient hospitalizations including maternity
– 7-10 days in advance or within 48 hours of
emergency hospital admission
• Call ActiveHealth®,866-794-3127
27
PRE-CERTIFICATION
If it is a scan,
find out
if you can!
28
EMERGENCY CARE
• In a life-threatening or other emergency
situation, seek care immediately at the
closest appropriate facility
• If hospitalized from emergency room,
contact must be made with ActiveHealth
within 48 hours
29
INFORMED CARE MANAGEMENT
• Informed Care Management
– Managed by ActiveHealth
– Supports those with diabetes or cardiac
conditions, lower back pain, and other
chronic health conditions
30
PERSONAL HEALTH RECORD
• Online confidential health record that conveniently does
your health history record-keeping for you
• Includes information you provide
• Automatically updates when your claims from Highmark,
Catamaran, and Quest Diagnostics * (if you use its labs)
are processed
• Start your PHR on myactivehealth.com/pcusa
*not all Quest labs are in network
31
CASE MANAGEMENT
• Case Management supports those with extended
hospitalizations and complex medical conditions. It is a
confidential service that can assist you with managing
your medical condition by:
– helping you understand the care resources available
– coordinating and helping arrange medical services for
you providing education and support for you and your
family
32
24-HOUR NURSE LINE
• Toll free: 866-794-3127
• You can call the Nurse Line if you:
– wonder whether you need to get medical care
– need information about a medication, test, or
medical procedure
– want reliable information about a health condition
– aren’t sure what questions you should ask your
doctor
– have questions about how you or your family can
stay healthy
33
34
2014 HEALTH ACTIONS
•
All Members must complete:
 Preventive Exam
 Engage with ActiveHealth Nurse (if called)
•
And complete at least 2:
1.
2.
3.
4.
5.
Health Assessment
“Know Your Numbers” lab test
Vision exam
Tobacco cessation program*
Attend CREDO (if appropriate)
35
2014 HEALTH ACTIONS
•
Who?
–
•
When?
–
•
Members only in 2014
Complete Health Actions between October
1, 2013 - September 30, 2014
How tracked?
–
In “Call to Health”
• via Benefits Connect, or
• www.MyActiveHealth.com/pcusa
36
CALL TO HEALTH
37
OTHER HEALTH BENEFITS
• VSP - $25 annual eye exam
– Find a vision provider:
• 800-877-7195
– vsp.com
38
INTERNATIONAL TRAVEL
• Before travel outside United States, call
the Board at 800-773-7752 (800PRESPLAN) or visit pensions.org
• International SOS
– Obtain wallet card with regional toll-free
telephone numbers
• BlueCard Worldwide
– Advises members about safe, reliable
medical providers while outside United
States.
39
RETIREMENT PENSION
40
RETIREMENT PENSION
• Defined Benefit Plan
• Pension credits accrue over entire length
of service
• Experience apportionments may be
granted by the Board of Directors
• Experience apportionments permanently
increase the pension credits
41
IN 2013 THE PLAN PAID …
Retirees: $254,981,237 to 15,157 lives
Survivors: $57,772,162 to 4,502 lives
Total Paid: $312,753,339 to 19,659 lives
Source: Benefits Plan Highlights
42
EXPERIENCE APPORTIONMENT HISTORY: 2000-2014
5%
4.6%
5%
4%
3.6%
3.7%
3.7%
3.8%
4%
3%
3.0%
3.0%
3%
2.0%
2%
2%
1.0%
1%
1%
0%
2000
0.0%
0.0%
2001
2002
2003
2004
2005
2006
2007
2008
0.0%
0.0%
0.0%
0.0%
2009
2010
2011
2012
2013
2014
Apportionment %
43
Monthly Benefit Comparison
1988-2013
3000
Actual Pension Benefits
$2,681
2500
Basic Benefit + CPI
$1,990
2000
1500
Basic Benefit
1000
$1,000
500
0
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
44
PENSION OPTIONS
• Joint and Survivor options available at
retirement provide a larger benefit to
surviving spouse
• Early retirement available at 55 with
reduced benefit
• Post-normal retirement provides increased
benefit for retirement after age 65
45
EARLY RETIREMENT
• Retirement benefits may be initiated as
early as age 55
• Benefit amount is determined actuarially for
each year before age 65
– 55 years
50%
– 58 years
59%
– 60 years
65%
– 63 years
84%
46
POST-NORMAL RETIREMENT
• Enhanced benefit for retirement past age
65 (pension credits continue to accrue)
• Additional 6.5% per year until age 70
66
6.5%
67
13%
68
19.5%
69
26%
70
32.5%
70+ 32.5%
• Pro-rated to the month
47
DEATH
48
DEATH BENEFITS
• Salary continuation
• Lump-sum payment
• Education benefit for dependent children
• Survivor medical coverage for one year
49
DEATH BENEFIT: LIVING NEEDS
BENEFIT
• To assist those with a terminal illness
(life expectancy of 24 months or less)
• Allows prepayment of part of death
benefits up to
– 75% of covered effective salary as
lump- sum benefit, or
– 100% of the present value of the salary
continuation benefit, or
– Both
50
DISABILITY
51
DISABILITY BENEFIT
• All disability cases are actively managed
and provide
– Partial income replacement
– Medical coverage
– Continued pension accrual (Traditional
coverage only)
– Death benefit
52
DISABILITY BENEFIT — INCOME
• Begins after 90 consecutive days away
from work
• 60% of effective salary or churchwide
median salary for employment
classification (whichever is greater)
• Initial benefit cannot exceed 100% of
member’s salary
• Covered salary is capped at $90,000
51
DISABILITY MEDICAL CASE
MANAGERS
• All disability cases are actively managed
by Liberty Mutual
• Benefits offset and coordinated with other
payments (Social Security, workers’
compensation, military benefits, etc.)
54
DISABILITY . . .
WAYS YOU CAN BE HELPFUL
• Inquire about disability coverage early so
can be fully informed
• Report disabilities early to Board of
Pensions (within the first 90 days)
55
STRETCH BREAK
OPTIONAL BENEFITS
•
•
•
•
•
Optional dental
Supplemental death
Supplemental disability
Long-Term Care Insurance
Retirement Savings Plan 403(b)(9)
57
OPTIONAL DENTAL
• Group dental program through Aetna
• Plan provisions vary depending
on where you live
• Limited enrollment periods
58
SUPPLEMENTAL DEATH
• Varying coverage levels available for
– Member
– Spouse
– Dependent children
• Dues are greater for tobacco users
• Medical underwriting
59
SUPPLEMENTAL DISABILITY
• Available for those earning $100,000 or
more annually
• Increases basis for salary protection
• Member or church/employing
organization may purchase the
coverage
60
LONG-TERM CARE
•
•
•
•
Underwritten by CNA
Age-based rates
Four tiers of coverage
Open to members and family members
61
RETIREMENT SAVINGS PLAN 403(b)(9)
62
RETIREMENT SAVINGS PLAN
ADVANTAGES
• Tax-deferred savings
• Tax-deferred earnings
• Contributions through payroll
deduction
• Numerous investment options
• Easy account access
• Withdrawals are designated housing
allowance for clergy
• Low annual fee - $15
63
RETIREMENT SAVINGS PLAN
• Any employee of an eligible employing
organization may participate
• Contributions may be made by employee,
employer, or both
• Fidelity Investments is record keeper
64
2014 CONTRIBUTION LIMITS
• Employee
– $17,500 annually or 100% of annual cash
salary, whichever is lower. Participants
over 50 may increase by $5,500
• Employer/Employee
– Combined contribution equal to 100% of
annual cash salary or $52,000
• Tax credits for lower annual income
65
THE PARTICULARS
66
TRADITIONAL PROGRAM MEDICAL DUES FOR 2014 & 2015
2014
Coverage Tier
Dues Percentage
(percentage of member’s
effective salary*)
Medical Participation Basis
(also known as the dues
minimum)
Sample Total Dues
(calculated on the dues
minimum)
Sample Allowable Duesshare Amount
(up to 1.5% for Member +
Family coverage)**
Member + Family
2015
Member –only
23%
Member + Family
23%
$42,000
24.5%
$44,000
$805/mo
$9,660/yr
$843/mo
$10,120/yr
$898/mo
$10,780/yr
$0
$0
$0 - $55/mo
$0 - $660/yr
(at minimum dues
basis of $44,000)
* Subject to the medical participation minimum and maximum and based on the standard full-time equivalent (FTE)
calculation for medical dues
** Sample calculated on the dues minimum; subject to presbytery rules
67
DUES FOR 2014 & 2015
2014
2015
Pension dues
11%
11%
Death and Disability
dues
1%
1%
68
ENROLLMENT PRINCIPLES
• Installed teaching elders are mandated
into the plan
• Non-installed teaching elders and lay
employees may be covered through
Traditional coverage under the Benefits
Plan or the Affiliated Benefits Program
• Lay employment classifications
• Equal coverage for employment
classification
69
CALCULATING DUES
• Healthcare
• Pension/Death and
disability
• Minimums and
maximums
• Calculator available on
pensions.org in Available
Resources section and
at bottom of page
70
Benefits through the stages of your life.
AFFILIATED BENEFITS PROGRAM
A FLEXIBLE APPROACH
• Designed to provide an option for
Presbyterian employing organizations to
extend benefits coverage to employees
who work at least 20 hours per week who
are not enrolled in Traditional coverage
• Cost-sharing provision
• Medical, disability, and death benefit
options
72
COVERAGE CAN INCLUDE
• Medical benefits
• Death and disability coverage
• Optional coverages
– Optional dental
– Supplemental death
– 403(b)(9) Retirement Savings Plan
– Long-Term Care Insurance
– Supplemental disability
73
FLEXIBLE PRICING
• Employees may be required to pay a
portion of the Medical Plan cost
• Employer must pay at least 50% of
member only cost
• Employees covered through other sources
(a covered partner’s employer, for
example) may decline coverage
74
AFFILIATED BENEFITS PROGRAM
2014 Active Medical Dues
Coverage Level
Monthly
Annually
Member Only
$624.00
$7,488.00
Member & Child(ren) Only
926.00
11,112.00
Member & Covered
Partner
1,281.00
15,372.00
Member & Family
1,668.00
20,016.00
75
AFFILIATED BENEFITS PROGRAM
Death and Disability 2014
Dues are 3.5% of whichever is greater: the enrolled member’s total
annual effective salary or the minimum participation basis subject to
maximum established by federal law. The minimum participation
basis is 25% of the median.
Monthly
Annual
$13,625
$39.74
$476.88
Maximum Basis: 255,000
743.75
8,925.00
Minimum Basis:
76
Benefits through the stages of your life.
OTHER PROGRAMS
THE ASSISTANCE PROGRAM
78
THE ASSISTANCE PROGRAM
• Church workers: Shared, Emergency
Assistance, Adoption Assistance, and
Transition-to-College Grants
• Retired church workers: Income and
Housing Supplements
• Pastor’s vocational leadership needs:
Seminary Debt Assistance, CREDO,
Sabbath Sabbatical Support
79
THE ASSISTANCE PROGRAM
The Assistance Program is funded through:
•
•
•
•
Christmas Joy Offering
Bequests
Endowments
Individual gifts
80
ASSISTANCE PROGRAM FUNDING
Types of Grants
Funds
1.
2.
3.
4.
Shared Grants
Emergency Assistance Grants
Income Supplements
Housing Supplements
Gifts, Bequests &
Endowments
5.
6.
(Investment Earnings)
7.
Adoption Assistance Grants
Transition-to-College Assistance
Grants
Seminary Debt Assistance
Grants
Sabbath Sabbatical Support
Grants
Presbyterian CREDO
Christmas Joy Offering
8.
9.
81
SEMINARY STUDENTS
• May participate for medical coverage only
• Must be inquirer or candidate and enrolled
as a full-time student
• Enrollment period is in fall
except for life-change events
• Coverage may continue
after graduation
82
2014 SEMINARY STUDENT MEDICAL
DUES
Coverage Level
Monthly
Annual
Member Only
$458
$5,496
Member & Covered Partner
702
8,424
Member & Child(ren) Only
702
8,424
Member & Family
804
9,660
83
MEDICARE SUPPLEMENT
• Medicare Supplement available to
members and covered partner at $218 per
person per month in 2014
• “Choosing Healthcare Coverage at
Retirement” – great resource for options
84
AT TERMINATION OR RETIREMENT
If plan participant for at least one year, member
receives 30 days of free medical coverage, then:
• Transitional participation (24 months)
– While actively seeking a call within Presbyterian
Church (USA), $805/month per family
• Medical Continuation Program (18 months, unless
meets Rule of 70)
– $733/person, $1,466/family
• Medicare Supplement
– $218/person, $436/couple
85
POST-RETIREMENT SERVICE
• Retired members may be employed in
post-retirement service
• Church pays post-retirement dues on
honorably retired ministers of 12% for
20 hours/week or more
• Post-retirement service dues provide a
direct subsidy to Medicare Supplement
fund
86
VACANCY DUES
• Applicable for 12 months
• Dues basis – 12%
• Vacancy dues support Medicare
Supplement fund
87
RESOURCES
pensions.org
88
BOARD UNIVERSITY
• Learn how to make the most of your
finances, benefits and retirement
– Seminars
• Getting in Shape Fiscally, A Financial Planning
Seminar
• Growing Into Tomorrow … Today, A Pre-Retirement
Planning Seminar
• Post-Retirement Seminar
• Render Unto Caesar, A Clergy Tax and Terms of Call
Seminar
pensions.org/seminars
89
BOARD UNIVERSITY
• Learn at your convenience
– E-Learning
•
•
•
•
•
•
•
Getting Ready: The Change in Medical Dues
Tax Advantage Plans
Call to Health
Tax Tips
Housing Allowance
Personal Finance Series
And more
pensions.org/BoardUniversity
90
CONTACTS: 800-773-7752 (800-PRESPLAN)
• Member Services team
– Available Monday-Friday
• 8:30 a.m. – 5:00 p.m. ET, (closed between noon and 1:00 p.m.)
•
•
•
•
•
Member Advocate
Regional Representative
Education Specialists
All staff and benefits areas
Website – pensions.org
91
REGIONAL REPRESENTATIVES CAN:
• Help members understand and maximize their
benefits
• Help enroll new pastors and church employees
in the Benefits Plan
• Help presbyteries assist church workers with
financial needs with Board programs
• Assist members obtain Assistance grants
• Maintain contact with retirees
• Keep presbyteries informed of Board programs
92
IMPORTANT PHONE NUMBERS
•
•
•
•
•
•
•
•
•
Board of Pensions
Cigna Behavioral Health
ActiveHealth 24-Hour Nurse Line
Highmark Blue Cross/Blue Shield
Fidelity Investments
Liberty Mutual – Disability
CNA – Long-Term Care
Aetna – Dental (call the Board)
VSP
800-773-7752
866-640-2772
866-794-3127
888-835-2959
800-343-0860
800-838-5290
800-528-4582
800-773-7752
800-877-7194
93
IMPORTANT FORMS
• Benefits Plan Membership Application
(enr-001)
• Affiliated Benefits Program Membership
Application (enr-002)
• Service Change (enr-110)
• Change of Salary (enr-111)
• Change of Address (enr-106)
• Service Termination (enr-301)
• Medical Continuation Subscription or
Waiver (med-100)
94
95