Topics and Tasks Presenters: Lauri Begley Associate Account - - PowerPoint PPT Presentation

Presenters:

Lauri Begley

Associate Account Specialist (IBAMS)

Jeff Hamilton

Account Specialist (IBAMS)

October 15, 2020 CPG Administrator Webinar Series

The Administrator Journey: Unpacking Key Topics and Tasks

The Administrator Journey

Today’s Agenda

Benefits Management Medical Trust Eligibility Employee Enrollment and Changes Health Plan Options for Active Employees Age 65+ Cigna Employee Assistance Program (EAP) Health Advocate Additional Vendor Programs and Services COVID-19

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Benefits Management

• The IBAMS Team
• How We Work Together
• Expectations
• Administrator Resources

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The IBAMS Team

Relationship Management* and Business Development

• Regionally based
• Consultative and personalized
• Special care for issue resolution

Administrator Resources and Professional Development

• Administrators’Resource Center
• Webinars, newsletters, job aids, resources, and conferences
• New administrator onboarding

Implementation and Operations

• Managing “behind the scenes”
• New group enrollments for all products

*Account management is provided to dioceses, parishes with 10+ enrolled employees, and institutions or schools which provide benefits through CPG. Visit cpg.org/ibams to learn who is your account manager. Other resources provided are for all administrators. 4

The IBAMS Team: Who We Serve

Domestic and International dioceses

• Bishops
• Bishop staff and leadership
• Benefit administrators

Domestic benefit administrators

• Parishes
• Parochial and non-parochial schools
• Independent institutions

– Camp and Conference Centers,

Social Service Agencies, etc.

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How We Work Together

• Understanding and adhering to CPG

policies and procedures

• Educating employees about CPG benefits
• Complying with federal/state laws

and regulations

• Making timely contribution payments

Administrator roles vary, but there are common responsibilities

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How We Work Together

• Providing education, information,

and resources

• Assisting with system and process

issue resolution

• Collaborating to address

your benefit needs

We are here to help you and your employees by…

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How We Work Together

Supporting you with educational programs.

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Enrollment and benefit education Financial and physical wellness education In-person, conferences, web-based, customized for our members

Benefits Management—Expectations

• Confirming eligibility for benefits
• Timing
• Training newly enrolled staff
• MyCPG Accounts
• Notifying CPG of employee changes
• ER (administrator)
• MyCPG Accounts (member)
• Calling CPG Client Services Call Center
• Processing your monthly invoices

Administrator roles vary, but there are common responsibilities

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Benefits Management—Administrator Resources

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CPG Webinars News & Updates What to Do When

Benefits Management—Administrator Resources

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CPG Client Services Administrator Services Call (855) 215-5990 Monday through Friday 8:30AM to 8:00PM ET Email admin-assist@cpg.org Administrative Policy Manual Administrators’ Resource Center cpg.org/ARC

New CPG Call Center Authentication Process

One-time passcode authentication process rolled out

June 2020

One-time passcode is sent to client’s mobile device

• r land line,

and read back by the client

One (1)

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This approach is used by many financial institutions.

Future Online Authentication Process

Step 1

Enter password

Step 2

Confirm identity

Step 3

Access granted Multi-Factor Authentication

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Medical Trust Eligibility

• Active Employees
• Active Employee Dependents
• Pre-65 Retirees
• Seminarians

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Medical Trust Eligibility: Active Employees

Eligible

Exempt employee Non-exempt employee scheduled to work 1,000 or more compensated hours annually* A postulant, novice, or professed member of Episcopal Religious Orders who has been accepted or received by the Religious Order

Not Eligible

Non-exempt employee scheduled to work and be compensated for fewer than 1,000 hours per year Contracted employees who receive a Form 1099 (and not a Form W-2) Temporary or seasonal employee Volunteer Employee whose working papers have expired and can no longer legally work

15 *Employees are eligible for coverage at 1,000 hours, but if employer is subject to the DHP, they are required to participate at 1,500 hours.

x x x x x

Medical Trust Eligibility: Active Employee Dependents

Eligible

Spouse Domestic Partner, if Domestic Partner benefits are elected by the Participating Group Eligible Children to the end of the calendar year in which they turn 30* Disabled Child, regardless of age, if physically or mentally disabled and incapable of self-support (provided the disability began before the age of 25)

16 *Fully insured plans may not cover children up to age 30; as the eligibility rules of the regional or local plans vary and will apply, please confirm prior to enrollment.

Medical Trust Eligibility: Pre-65 Retirees

Pre-65 Retiree

Retired from a Participating Group, and; Covered, or eligible to be covered, and; At least 55 years of age, or if younger, eligible for a disability benefit under a CPF pension plan, and; Has at least 5 years of continuous service (Lay) or credited service (Clergy)

Dependents

Spouse Domestic Partner, if Domestic Partner benefits elected by the Participating Group Eligible Children to the end of the calendar year in which they turn 30 Disabled Child, regardless of age, if physically or mentally disabled and incapable of self-support (provided the disability began before the age of 25)

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Medical Trust Eligibility: Seminarians

Eligible

Seminarian who is a full-time student enrolled at a participating seminary of the Association of Episcopal Seminaries

Not Eligible

Seminarian who is a not a full-time student enrolled at a participating seminary of the Association of Episcopal Seminaries Employees of the Seminary are not eligible for Seminarian Plans but may be eligible as active employees

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x x

Employee Enrollments and Changes

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Employee Enrollments and Changes

• Add a new cleric or lay employee
• Report a termination, retirement,
• r death
• Record Compensation Changes
• Report a life event

Use the “What to Do When” checklists on the Administrators’ Resource Center (ARC) for instructions on how to:

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cpg.org/administrators/resources/arc/what-to-do-when/

Administrators

Health Plan Options for Active Employees Age 65+

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Active Employees Age 65+

Under the Age Discrimination in Employment Act…

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An employer who offers Medical Trust health plans to active employees under age 65 and their spouses, must offer the same health plans to its employees age 65 and over and their spouses. Regardless of Medicare eligibility — provided they meet the eligibility rules.

• Retain Medicare as primary coverage
• Can also purchase secondary coverage

BUT not from employer group plan

• Employer can not provide financial incentive

to take Medicare as primary

Active Employees Age 65+

Medicare beneficiaries can decline employer coverage.

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Medicare Secondary Payer Small Employer Exception Plans

Less expensive than the corresponding standard plan, because they coordinate with Medicare Offered to certain employees and employers

• Employers with fewer than 20 employees in the current and preceding year

(Small Employer)

• Employees of Small Employer and/or their spouses who are eligible for and

enrolled in Medicare Part A (or Parts A and B)

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Medicare Secondary Payer (MSP) Rules

What are the MSP rules?

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MSP rules determine when Medicare is not responsible for paying first (or primary) Employer group health plans usually pay primary for Medicare-eligible members according to MSP rules*

*Comparable to private insurance “coordination of benefits”

MSP rules provide an exception for small employers

What is the Small Employer Exception (SEE)?

Medical Trust offers MSP SEE Plans through Anthem and Cigna.

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Individual employers (parish, institution, etc.) must meet SEE criteria to enroll eligible employees and their eligible dependents.

Medical Trust will pay secondary Medicare becomes the primary payer Participating groups must elect to offer the plans during annual renewal

MSP SEE Eligibility

An employee and their eligible dependents are eligible if they meet each

• f the following conditions.
• Employee meets standard Medical Trust eligibility criteria
• Employer offers MSP SEE plan to employees
• Employee and/or eligible dependent is 65 or over
• Employee is working for an employer who has fewer than

20 full- and/or part-time employees in the current and preceding years

• Employee and/or eligible dependent is enrolled in

Medicare Part A or Parts A and B (enrollment must be

• n the basis of age only)

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MSP SEE Eligibility (cont’d.)

How does the family plan work if not everyone is age 65+?

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Any member of the family under age 65 who meets standard eligibility requirements for coverage under an active employment-based plan will be enrolled in the MSP SEE plan along with the 65+ member who qualified; however, their benefits will not be coordinated with Medicare.

SEE Enrollment Process Overview

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Church Pension Group Client Service

Receives Eligibility Certification, Online Enrollment Transaction, and Member Medicare

• Card. Verifies eligibility and submits to…

Diocesan/Group Administrator

Signs Eligibility Certification & Completes Online Enrollment Transaction forwards Certification to …

Employee/Employer

Submits Eligibility Certification & Copy of Medicare Card to…

CMS

Receives Eligibility Certification & Member Medicare Card as a Small Employer Exception

• request. Approves/Denies the

Exception Request and sends approval/denial with date to …

Health Plan Carrier

Receives Eligibility Certification & Member Medicare Card to process the Small Employer Exception approval as

• f the CMS exception date.

Approved Denied

CPG Client Service Center

Receives Approval from CMS. CPG completes enrollment in MSP SEE

• Plan. Sends notice of approval to

Member and Administrator.

CPG Client Service Center

Receives Denial from CMS. CPG sends notice of denial to Member & Administrator.

MSP SEE Resources

Fact Sheet for Members and Administrators Bulletin for Group Benefit Admins: Understanding Health Plan Options for Employees age 65+ MSP SEE Eligibility Certification Form Administrative Policy Manual Letter Template for Active Employees Turning Age 65 CMS.gov: Small Employer Exception CMS.gov: SEE Training Material for GHPs

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Cigna Employee Assistance Program (EAP)

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For the Bumps in the Road

The Employee Assistance Program is here for you.

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Help   Support Information Guidance

EAP Overview

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What it includes Getting in touch Additional points

• (866) 395-7794
• mycigna.com
• Confidential
• No cost to you
• 24/7 availability
• Up to 10 face-to-face

sessions per issue with a Cigna EAP provider

• Unlimited telephonic

consultations

• Available to you and

anyone else in your household, whether or not they are enrolled in a Medical Trust plan

Accessing Cigna EAP Resources Online

Under “Coverage” menu, click on “Employee Assistance Program”

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First-time visitors must register

mycigna.com Webpage detail

Health Advocate

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Health Advocate

Helping you navigate the complexities of healthcare

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What it includes Getting in touch

• (866) 695-8622
• HealthAdvocate.com/members
• Understanding and

troubleshooting claims

• Private, confidential

assistance

Available 24/7 to:

• Verify current providers’ network participation
• Locate new participating providers
• Determine out-of-pocket cost differences

between plans

• Understand Consumer-Directed Health Plans

and Health Savings Accounts

At Your Service

Resources to guide you to your destination

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HealthAdvocate.com

Accessing Resources Online

From homepage, click on topic of interest

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HealthAdvocate.com/ecmt

Additional Vendor Programs and Services

• Care Management Programs
• Telehealth Services

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Anthem Health Guide

With just one phone call, members can access multiple resources and help ensure that they are getting the right care at the right time, at the right cost.

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Anthem Health Guide

These programs can help you in many ways:

• Coordinate care across multiple doctors
• Manage chronic conditions
• Confirm coverage of various services
• Understand authorizations required for certain treatments
• Answer other questions that arise in serious health situations

Cigna One Guide

With just one phone call, members can access multiple resources and help ensure that they are getting the right care at the right time, at the right cost.

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These programs can help you in many ways:

• Coordinate care across multiple doctors
• Manage chronic conditions
• Confirm coverage of various services
• Understand authorizations required for certain treatments
• Answer other questions that arise in serious health situations

Cigna One Guide

Telehealth Services

Care from the safety and convenience of your home.

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• Secure, private video chat access with the type of doctor you would like
• Log on and visit an available provider in minutes
• Can obtain prescriptions for certain medications, if needed
• For medical care and behavioral health

Cigna my.cigna.com Anthem livehealthonline.com Kaiser kp.org

24/7/365 access to board certified physicians

COVID-19

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Evaluation, Testing, and Treatment

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• The Medical Trust waived all member copayments,

deductibles, and coinsurance for healthcare services relating to the evaluation and testing for COVID-19 through December 31, 2021

• Additionally, the Medical Trust waived active member

copayments, deductibles, and in-network coinsurance for healthcare services relating to the treatment of COVID-19 through December 31, 2021

Vendor Telehealth Platforms and Virtual visits

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• The Medical Trust waived member cost shares for

services received through our health plan carriers’ telehealth platforms

• The Medical Trust also removed plan exclusions

to allow virtual visits with members’ personal healthcare providers to be covered at the usual in-person office visit cost share

• Kaiser member exceptions:
• Kaiser members must use the

Kaiser telehealth platform

• These provisions will continue at least through

December 31, 2021

Express Scripts

Express Scripts’ temporary limited out-of-network delivery exception

• Express Scripts granted CVS and Walgreens

(via its Walgreens Express™ delivery program) a temporary limited out-of-network delivery exception, which permits free home delivery of prescriptions to our Express Scripts members that would otherwise be prohibited

• Express Scripts will notify members who have

utilized this delivery exception in advance of the exception being discontinued

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COVID-19 Vaccination Update

• The Medical Trust, along with our health

plan carriers and Express Scripts benefit manager, continues to monitor FDA approval

• f appropriate SARS-CoV-2 vaccinations
• Members should always consult with their

healthcare professional about vaccinations

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Reflections, Questions, and Discussion

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For your participation and feedback.

Thank you!

Disclaimers

Church Pension Group Services Corporation (“CPGSC”), doing business as The Episcopal Church Medical Trust, maintains a series

• f health and welfare plans (the “Plans”) for eligible employees (and their eligible dependents) of the Episcopal Church (the “Church”).

The Medical Trust serves only eligible Episcopal employers. The Plans that are self-funded are funded by the Episcopal Church Clergy and Employees’ Benefit Trust, a voluntary employees’ beneficiary association within the meaning of section 501(c)(9) of the Internal Revenue Code. The Plans are church plans within the meaning of section 3(33) of the Employee Retirement Income Security Act of 1974, as amended, and section 414(e) of the Internal Revenue Code. Not all Plans are available in all areas of the United States or outside the United States, and not all Plans are available on both a self-funded and fully insured basis. Additionally, the Plan may be exempt from federal and state laws that may otherwise apply to health insurance arrangements. The Plans do not cover all healthcare expenses, so members should read the official Plan documents carefully to determine which benefits are covered, as well as any applicable exclusions, limitations, and procedures. This material is provided for informational purposes only and should not be viewed as investment, tax, or other advice. It does not constitute a contract or an offer for any products or services. In the event of a conflict between this material and the official plan documents or insurance policies, any official plan documents or insurance policies will govern. The Church Pension Fund (“CPF”) and its affiliates (collectively, “CPG”) retain the right to amend, terminate, or modify the terms of any benefit plan and/or insurance policy described in this material at any time, for any reason, and, unless otherwise required by applicable law, without notice.

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