Our Mission Chartered by General Convention in 1978 Reports to - - PDF document

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Episcopal Church Medical Trust

Healthcare Benefits for The Diocese of Kansas Open Enrollment 2012 Toni Marie Sutliff Regional Relationship Specialist Provinces VI/VII November 2011

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Agenda

• Introduction
• The Episcopal Church Medical Trust
• Medical Plans
• All Things High Deductible
• Additional Benefits
• Dental Plans
• Wellness and Personal Responsibility
• Resources
• 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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Who Can Participate?

• Salaried (exempt) clergy and lay employees
• Hourly employees working a minimum of 20 hours/week (1,000

hours/year)

• Dependent children to age 30
• Employees on short-term or long-term disability

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The Episcopal Church Medical Trust – Serving You

• We are here to support you with:
• Problem Resolution
• Education and Awareness
• Patient Advocacy

Our Client Engagement Team is Available Monday through Friday 8:30 am to 8:00 pm ET 7:30 am to 7:00 pm CT 1-800-480-9967 / mtcustserv@cpg.org

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Episcopal Church Medical Trust

Medical Plans– 2011

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Your 2012 Medical Plan Choices

Network Only Plan

• Empire BCBS EPO 90

Network and Non-Network Plans

• Empire BCBS PPO 80/60
• Empire BCBS 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

Empire BlueCross BlueShield EPO 90 Plan (Exclusive Provider Organization)

www.empireblue.com (800) 352-3152

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Empire BCBS EPO 90 – At a Glance

Plan Provision Network Annual deductible (single / family) $200 / $500 Annual OOP max (single / family) $1,500 / $3,000 Office visit copay

$0 Preventive

$25 (PCP or specialist) Urgent care coinsurance 10% Member coinsurance 10% Inpatient hospital coinsurance 10% Outpatient hospital copay 10% Emergency room care $100 (waived if admitted)

Empire BlueCross BlueShield PPO 80/60 Plan

(Preferred Provider Organization)

www.empireblue.com (800) 352-3152

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Empire BCBS PPO 80/60 – At a Glance

Plan Provision Network Out-of-Network Annual deductible (single / family) $500 / $1,000 $1,000 / $2,000 Annual OOP max (single / family) $2,000 / $4,000 $5,500 / $11,000 Office visit copay

$0 Preventive

$25 (PCP or specialist) 40% Urgent care coinsurance 20% 40% Member coinsurance 20% 40% Inpatient hospital copay / coinsurance $100 copay per day, max $600 per admission; then 20% 40% Outpatient hospital coinsurance 20% 40% Emergency room care $100 (waived if admitted) $100 (waived if admitted)

Episcopal Church Medical Trust

www.empireblue.com (800) 352-3152

Empire BlueCross BlueShield High Deductible Health Plan

and

Health Savings Account (HDHP/HSA)

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Empire BCBS HDHP – At a Glance

Plan Provision (Medical & Rx Combined) Network Out-of-Network Annual deductible (single / family) $2,700 / $5,450 $3,000 / $6,000 Annual Coinsurance max (excluding deductible) $1,500 / $3,000 $4,000 / $7,000 Annual OOP max (single / family) $4,200 / $8,450 $7,000 / $13,000 Office visit copay/coinsurance $0 Preventive 20% 45% Urgent care coinsurance 20% 45% Member coinsurance 20% 45% Inpatient hospital coinsurance 20% 45% Outpatient hospital coinsurance 20% 45% Emergency room care 20% 20%

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HDHP/HSA – How the Pieces Work Together

High Deductible PPO Health Plan

with preventive services covered at 100% +

Health Savings Account

that allows employer and/or employees to make tax-free contributions to save for future healthcare expenses +

Health and Decision Tools

to help employees become more knowledgeable consumers

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What Will it Cost the Employer in 2012?

Plan Single Rate Mo/Yr Plus One Rate Mo/Yr Family Rate Mo/Yr HSA Contrib ution Total Annual S/+One/ Family Rate Diff 2011/2 012 BCBS EPO 90 $875/ $10,500 $1,574/ $18,888 $2,447/ $29,364 $0 $10,500/ $18,888/ $29,364 2.09% BCBS PPO 80/60 $843/ $10,116 $1,516/ $18,192 $2,356/ $28,272 $0 $10,116/ $18,192/ $28,272 NA BCBS HDHP/HSA $611/ $7,332 $1,099/ $13,188 $1,708/ $20,496 $2,500/ $4,950 $9,832/ $18,138/ $25,446 NA

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Health Savings Account - HSA

• HSA is a tax-advantaged account
• Employee sets up the account and owns it
• Balances accumulate and roll over year after year
• Account must be held by a qualified trustee
• Empire BCBS / Mellon Bank
• IRS sets annual limits on contributions
• $3,100 single / $6,250 family
• Anyone can make a contribution
• Distributions for qualified healthcare expenses (as defined by

the IRS)

• You must activate the account
• Sign and return the card – designate beneficiaries and

receive personalized check book

• Activate online – after 1/1, and receive debit card only
• The Medical Trust pays set up and maintenance fees
• Cannot fund the account until it is set up!!

Creating the HSA Health Savings Accounts - Contributions

• Employers and employees (or others) may contribute to

an employee’s HSA on an annual basis

• Limits on annual contributions for 2012:
• Individual Coverage

$3,100

• Family Coverage

$6,250

• Employee is responsible for ensuring the

maximum is not exceeded.

• Additional contributions for those (account holder only)

who will attain age 55 (or older) by the end of the year ($1000 for 2012).

• Deadline for HSA contributions is April 15th of the

following year

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• Employee contributions can be made on a pretax

basis

• Through salary reduction by election prior to the

beginning of the year, with a written cafeteria plan document, and/or

• As an adjustment to income on the employee’s annual

tax return

• Employer contributions are not taxable income to the

employee

• Employees that are enrolled in Medicare cannot

have contributions to the HSA as of the date of enrollment.

Health Savings Accounts - Contributions Health Savings Accounts – Distributions

• Distributions from an HSA for qualifying medical

expenses are tax-free

• Qualifying medical expenses are unreimbursed

costs incurred by the employee or dependent for medical care, including:

• HDHP deductibles and coinsurance
• Post-employment healthcare costs

(Medicare Part B premiums, etc.)

• Long-term care premiums
• Include (but not limited to):
• Braces
• Dental expenses
• Lasik surgery
• Hearing aids
• Do NOT include (and not limited to):
• Health club memberships
• Hair transplants
• Nutritional supplements
• Teeth whitening
• Over the counter medications
• See IRS publications for assistance

Qualifying Medical Expenses Health Savings Accounts – Distributions

• Other distributions from an HSA are subject to federal

income tax and an additional 20% penalty (penalty is waived if the distribution is made after age 65 or on account of death or disability)

• Distributions do not have to be made in any year and can

be rolled over from year to year

• Account earnings are not subject to taxation, if eventually

used for qualifying medical expenses

• Distributions can be made for the qualifying medical

expenses of dependents (but not domestic partners)

• Distributions can be made even after the employee is no

longer eligible to contribute to an HSA

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How are distributions made?

• Employee can use the HSA debit card at the

provider’s office or pharmacy

• Employee can write a check to the provider or

pharmacy on the HSA account

• Employee can pay provider or pharmacy out of

the employee’s funds and reimburse him or herself from the HSA

• Caution:
• Employee must keep records to prove the distributions

from the HSA were used for qualifying medical expenses

• Employee is responsible for any overdraft fees on the HSA

Using the HSA at the Office or Hospital Using the HSA at the Pharmacy 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.

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• Employee must keep track of all contributions and

distributions

• Review bank statements!
• Employee must file Form 8889 with Form 1040
• Trustee bank will send Form 5498-SA showing

contributions

• Trustee bank will send Form 1099-SA showing

distributions

• Employer will include contributions on W2, box 12,

using the W code

Health Savings Accounts – Paperwork

Medco Pharmacy Benefits

www.medco.com (800) 841-3361

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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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“Generic or Pay the Difference”

Here’s an example of what the member pays if a generic is available, but the brand name is specified: Brand Name Cost = $90 Generic Cost = $30 Generic Copayment = $10 $90 Brand Name Cost - $30 Generic Cost = $60 Difference $10 Copayment + $60 Difference

= $70 Net Cost to the Member If a generic medication cannot be used for a medical reason, call us to discuss.

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Mail Order for Maintenance Meds Mail Order required for most maintenance meds

• 3 fills covered at retail pharmacy
• After 3rd fill, Medco mail order required for benefit

Mail Order is easy, convenient, accurate

• Member can mail prescription
• Doctor can fax or order online
• Email/mail reminder when refill is due
• Automatic refill available on request

Up to triple the supply for less than triple copay

• Controls costs for both member and plan

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Be Proactive! Talk to your doctor about your plan

• Review the Medco Formulary
• Ask for generic drugs when available

Look over / discuss your prescriptions

• Are paper prescriptions for Mail Order for 90 days?
• Does you doctor know to request “90 days supply”?
• Did your doctor specify that generics may be dispensed?

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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*
• 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)
• CIGNA also Plan Partner for EAP

*Empire BCBS HDHP has only EAP through CIGNA Behavioral Health; MH/SA benefits are embedded in the HDHP plan design.

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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
• UNLIMITED telephonic sessions
• MULTIPLE EPISODES of treatment per year
• Extensive geographic availability of services
• Telephone access virtually unlimited

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Employee Assistance Program (EAP)

EAP helps YOU AND YOUR HOUSEHOLD find the services you need -

Assistance with Family Care Services

• Child care
• Parenting programs
• Adoption information
• Long-distance care-giving
• Researching nursing homes
• Pet insurance
• … and more!

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

• ffers assistance with ANY aspect of the healthcare system to YOU, YOUR

HOUSEHOLD, AND YOUR PARENTS AND PARENTS-IN-LAW

• Additional layer of service provided by the Medical Trust
• 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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Health Advocate

Personal Health Advocates, typically RNs, who with a team of medical directors and administrative experts:

• Identify leading healthcare providers and institutions anywhere in the

country

• Schedule specialized treatment and tests
• Answer questions about test results, treatment recommendations and

medications recommended by your physician

• Assist in the transfer of medical records, x-rays and lab results
• Arrange for home care equipment following discharge from a hospital
• Foster communication and benefits coordination between physicians

and insurance companies

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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
• Please 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)

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CIGNA Dental Plans – At a Glance

Plan Provision Preventive Dental Basic Dental Dental & Orthodontia What You Pay Preventive Services

(includes 3 cleanings per year)

0% 0% 0% Basic Services 20% 15% 15% Major Services 99% 50% 15% Orthodontic Services 99% Not Covered 50%

($1,500 Lifetime Max)

Deductible (single/family) None $50 / $150 $25 / $75 Out-of-Network Benefits

(based on Usual & Customary)

Same as Network Same as Network Same as Network Annual Benefit Maximum

(in addition to preventive care)

$1,500 $1,500 $1,500

2012 Dental Rates – Active Plans

Plan/Tier Single Plus One Family Preventive Dental $19 $34 $52 Basic Dental $54 $101 $154 Dental & Orthodontia $67 $116 $179

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Online Open Enrollment

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Tips for Selecting Your Plan

• Enrollment Guide
• Historical Usage
• Current Needs
• Covered Benefits
• Provider Choice and Availability
• Premiums vs. Out-of-Pocket Costs

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Online Open Enrollment

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Online Open Enrollment

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Online Open Enrollment

Please print this confirmation for your records and take a moment to complete the survey at the end. Thank you!

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Wellness & Personal Responsibility

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What is Wellness?

Medical Trust Definition of Wellness

Wellness is an active, lifelong process of becoming aware of choices and making decisions that will enable a person to achieve the best possible level of physical, mental, and spiritual well-being. It is an approach to healthcare that emphasizes preventing illness and prolonging one’s quality of life, as opposed to emphasizing treating diseases. Wellness is not the absence of illness, but an individual’s active process of managing or achieving their full potential. This quality of life definition can be applied to anyone, regardless of any physical

• r mental limitations.

A more extensive definition of wellness must acknowledge that family, workplace, church, community, and the world in which one lives, have the potential both positively and negatively to influence or impact one’s level of wellbeing.

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The Focus is on Population Based Wellness Previously:

• Health plans focused on disease management
• Emphasis placed on those already ill

Now the Focus is:

• Helping the healthy stay healthy
• Reducing health risks
• Encouraging healthier lifestyle choices

How “Well” are We?

• Approximately 80% of healthcare costs are

preventable and make up 90% of all healthcare costs

• Preventable illnesses account for eight of the nine

leading causes of death (www.preventdisease.com)

• The U.S. spends more on healthcare than any
• ther industrialized nation in the world yet, in

many respects, its citizens are not the healthiest

• In 2008, the U.S. healthcare cost was $2.8 Trillion

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Our struggle …

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Why? Times Have Changed

We walked, pushed and raked … No more pushing, but we still walked and raked … Then, all we had to do was walk, until …

Now, we just sit and ride!

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Taking Personal Responsibility

• Think like a consumer when it

comes to healthcare and take personal responsibility for:

• Improving your own health
• Managing costs both to

yourself and your plan

• Making thoughtful decisions

when choosing coverage during enrollment and using coverage throughout the year

Visible Cost of Health Care Real Health Care Costs

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Our Commitment to Wellness

• Network preventive care coverage
• Preventive Care at $0 copay
• Health Fairs, monthly “Health & Wellness News”
• Nutritional counseling, smoking cessation
• Outstanding mental health benefits
• Partnering with vendors that offer:
• World class informational web access
• 24-hour nurse lines in all plans
• Condition and case management

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Resources

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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 7:30am to 7:00pm Central Telephone Direct Toll Free 1-800-480-9967 Email: mtcustserv@cpg.com

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The Medical Trust Website

Our website is open 24 / 7 / 365 for members to:

• Access and print forms, handbooks, and other information

and documents

• Access updated information relating to plans
• Access a wide variety of information and resources other

than healthcare related

www.cpg.org

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Your ID Cards

ALL VENDORS: MED & DENTAL

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Empire BlueCross BlueShield Website

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Medco Website

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CIGNA Behavioral Health Website

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EyeMed Website

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CIGNA Dental Website

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Thank you! Any Questions?

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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.