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
Audio Dial in Information: 1.855.842.6063 Access Code: 996 426 682
Medical Options
Sutter Health Plus HMO and DHMO Kaiser HRA, HMO
Dental Plan Options: High & Low Vision Plan Options: Core & Buy-Up
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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.
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
participating.
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HMO DHMO
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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
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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)
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HMO HRA NW HMO
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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
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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
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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
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High Plan Low Plan
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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)
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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
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All employees that enroll in one of our Dental Plans will automatically receive this benefit.
Counseling Receive 3 counseling sessions for yourself and family members per issue.
Face-to-face counseling
Online counseling Legal A telephone or face to face consultation with a local attorney, plus a discount off the hourly rate.
Will
Family law
Real Estate
Personal Injury
To make a confidential appointment, Call Resource Advisor at: 888-209-7840 24 hours a day 7 days a week www.ResourceAdvisorCA.anthem.com Program name: ResourceAdvisor
Other Services Available
Financial Planning
Identity Theft
Beneficiary Support
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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”.
Anthem Blue Cross
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All employees that enroll in one of our Dental Plans will automatically receive this benefit.
Core Plan Buy-Up Plan
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Benefits Core Vision Plan
California and all states
In-Network Vision Service Plan Out-of-Network Allowance
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
$25 Copay Up to $50
$25 Copay Up to $75
$25 Copay Up to $100
$25 Copay Up to $125
Contact Lenses
$25 Copay Up to $210
Up to $130 Up to $105
Frames Frequency – Every 24 Months
Up to $130 & 20% off the remaining amount over the allowance Up to $70
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*Costco is now part of the VSP Network- Please refer to plan summary for further detail.
Enter your zip code in the “Find a VSP Doctor” section Refine your search by range, services and products on the left navigation pane
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You will need to fill out the Universal Enrollment Form for yourself and any dependents that you wish to cover under the plan. If you are currently enrolled and not making any changes. No action is needed.
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Thursday, December 5, 2019– All universal enrollment forms due to the Synod office if you are making changes January 1st, 2020 – All plan changes go into effect Plans are effective 1/1/2020 -12/31/2020
All materials are published and available for download on the Synod website www.synodpacific.org , under “Benefits”
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