Synod of the Pacific 2020 Open Enrollment Audio Dial in - PowerPoint PPT Presentation

Synod of the Pacific 2020 Open Enrollment Audio Dial in Information: 1.855.842.6063 Access Code: 996 426 682

Benefits Overview  Eligibility  Evaluating your Benefit Options  Medical Options  Sutter Health Plus HMO and DHMO  Kaiser HRA, HMO  Dental Plan Options: High & Low  Vision Plan Options: Core & Buy-Up  Making Changes to your Benefits  Questions and Contact Information 2

Eligibility  Who Is Eligible for Benefits? Churches and organizations within the bounds of Synod of the Pacific are eligible to offer all of the Synod of the Pacific’s Benefit Services to lay employees working twenty (20) or more hours per week, and Dental/Vision Benefit Plans to ordained clergy. You Qualify! Your employer may pay up to 100% of the employee only premium. If you choose to cover your spouse or dependent children you may pay the cost of the dependent premium on a pre-tax basis by payroll deduction. Domestic Partner premium is paid on a post- tax basis. Dependent Children can be covered on the medical, dental and vision plans up until they turn age 26. Employees interested in benefits should check with the Benefit Administrator at their church or organization to determine which plans are available to them and if there are any costs in participating. 3

Summary of Benefits S UTTER H EALTH P LUS Medical Plans  HMO  DHMO 4

Sutter Health Plus Network – Bay Area 5

Sutter Health Plus Network – Valley 6

How to Find a Provider sutterhealthplus.org/providersearch Search for:  Doctors  Specialists  Hospitals  Urgent care centers 7

Summary of Benefits Sutter Health Plus – California HMO $20 - $0 Deductible None Out of Pocket Maximum: $1,500/Member; $3,000/Family Primary Care Physician Required Yes Office Visit Copay $20 Copay per visit Specialist $20 Copay per visit Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $20 Copay/No Copay Inpatient Hospitalization $250 per admission Emergency Room $100 Copay per visit (waived if admitted) Mental Health Outpatient $20 Copay per visit Prescription Drugs ( 30-day supply ) $10 Copay Generic $30 Copay Brand Name $60 Copay Brand Name Non-formulary 8

Summary of Benefits Sutter Health Plus – California Deductible HMO $20 - $1000/20% Deductible $1,000/Member; $2,000/Family Out of Pocket Maximum: $3,000/Member; $6,000/Family Primary Care Physician Required Yes Office Visit Copay $20 Copay per visit (deductible waived) Specialist $20 Copay per visit (deductible waived) Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $20 Lab/$10 X-Ray (deductible waived) Inpatient Hospitalization 20% Coinsurance (after deductible) Emergency Room 20% Coinsurance (after deductible) Mental Health Outpatient $20 Copay per visit (deductible waived) Prescription Drugs (30-day supply) $10 Copay Generic (deductible waived) $30 Copay Brand Name (deductible waived) $60 Copay Brand Name Non-formulary (deductible waived) 9

Summary of Benefits Medical Plans  HMO  HRA  NW HMO 10

Summary of Benefits Kaiser Permanente – California Traditional HMO $30 Copay Deductible None Out of Pocket Maximum: $1,500/Member; $3,000/Family Primary Care Physician Required Yes Office Visit Copay $30 Copay per visit Specialist $30 Copay per visit Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $10 Copay per encounter Inpatient Hospitalization $500 per admission Emergency Room $150 per visit (waived if admitted) Mental Health Outpatient $30 Copay per visit Prescription Drugs ( 30-day supply ) $15 Copay Generic $35 Copay Brand Name 11

Summary of Benefits Kaiser Permanente – California HRA Plan SYNOD Contribution (allocated on 1/1/2020) $1,000/individual $2,000/family Deductible $ 2,000 per member/ $4,000 per family Out of Pocket Maximum: $4,000 per member/ $8,000 per family Primary Care Physician Required Yes Office Visit Copay $20 Copay per visit ( after deductible ) Specialist $20 Copay per visit (after deductible) Preventative/Wellness Visits No Copay (deductible waived) Outpatient Lab & X-ray $10 Copay per encounter (after deductible) Inpatient Hospitalization 20% (after deductible) Emergency Room 20% (after deductible) (waived if admitted) Mental Health Outpatient $20 Copay per visit (after deductible) Prescription Drugs ( 30-day supply ) $10 Copay Generic (deductible waived) $30 Copay Brand Name (deductible waived) Unused HRA funds will roll over for the next year to help offset future out-of-pocket costs 12

Summary of Benefits Kaiser Permanente – NW HMO $15 Copay Deductible None Out of Pocket Maximum: $2,000 per member/ $4,000 per family Primary Care Physician Required Yes Office Visit Copay $15 Copay per visit Specialist $25 Copay per visit Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $15 Copay Inpatient Hospitalization $250 per admission Emergency Room $150 per visit (waived if admitted) Mental Health Outpatient $15 Copay per visit Prescription Drugs (30-day supply) $15 Copay Generic $30 Copay Brand Name 13

Summary of Benefits Dental Plans  High Plan  Low Plan 14

Summary of Benefits Anthem Dental – High Plan - California and all states In Network Out of Network Annual Deductible $50 $50 Waived for Preventive Yes Yes Calendar Year Benefit Maximum $1,500 (both in & out of network)  Preventive Services Office visits/cleanings/fluoride treatments 100% 100%  Diagnostic Services  Oral exams/x-rays/consultations 100% 100%   Restorative Services  Fillings/oral surgery/extractions/root canal Endodontics/Periodontics 90% 80%  Major Services (after six months of continuous dental coverage) Prosthondontics/removable and fixed implants 60% 50%   Orthodontia 50% 50% Lifetime Benefit Maximum $1,500 (both in & out-of-network)  15

Summary of Benefits Anthem – Low Plan - California and all states In Network Out of Network Annual Deductible $50 $50 Waived for Preventive Yes No Calendar Year Benefit Maximum $1,000 (both in & out of network)  Preventive Services Office visits/cleanings/fluoride treatments 100% 80%  Diagnostic Services  Oral exams/x-rays/consultations 100% 80%   Restorative Services  Fillings/oral surgery/extractions/root canal Endodontics/Periodontics 80% 60%  Major Services (after six months of continuous dental coverage) Prosthondontics/removable and fixed implants Not Covered Not Covered   Orthodontia Not Covered Not Covered 16

Finding a Dental PPO Provider Internet Access: www.anthem.com/ca/mydental  Select “Find Dental Provider”  Select “Dental Complete” under Network  Enter search criteria based on the desired search you wish to perform 17

Resource Advisor  All employees that enroll in one of our Dental Plans will automatically receive this benefit.  Legal  Counseling  A telephone or face to face consultation with  Receive 3 counseling sessions for yourself and a local attorney, plus a discount off the family members per issue. hourly rate. Face-to-face counseling  Will  Online counseling  Family law  Real Estate  Personal Injury   Other Services Available Financial Planning  Identity Theft  To make a confidential appointment, Beneficiary Support  Call Resource Advisor at: 888-209-7840 24 hours a day 7 days a week www.ResourceAdvisorCA.anthem.com Program name: ResourceAdvisor 18

Group Term Life Insurance All employees that enroll in one of our Dental Plans will automatically receive this benefit. Anthem Blue Cross  Group Term Life and AD&D Benefit Amount: $15,000  For more information on this plan and current rates, please go to www.synodpacific.org and click on “Benefits”. 19

Summary of VSP Vision Benefits VSP Vision Plan  Core Plan  Buy-Up Plan 20

Summary of VSP Vision Benefits Benefits Core Vision Plan In-Network Out-of-Network Vision Service Plan Allowance California and all states Exam Only $10 Copay Up to $50 Frequency – Every 12 Months Benefits Buy-Up Vision Plan Examination $10 Copay Up to $50 Lenses Frequency – Every 12 Months • Single Vision $25 Copay Up to $50 • Bifocal Vision $25 Copay Up to $75 • Trifocal Vision $25 Copay Up to $100 Lenticular Vision $25 Copay Up to $125 • Contact Lenses • Medically Necessary $25 Copay Up to $210 • Cosmetic/Convenience Up to $130 Up to $105 Frames Up to $130 & 20% off the Up to $70 Frequency – Every 24 Months remaining amount over the allowance *Costco is now part of the VSP Network- Please refer to plan summary for further detail. 21

Finding a VSP Provider Internet Access: www.vsp.com  Enter your zip code in the “Find a VSP Doctor” section  Refine your search by range, services and products on the left navigation pane 22