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Episcopal Church Medical Trust

Healthcare Benefits for The Diocese of East TennesseeOpen Enrollment 2012

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Agenda

Introduction

The Episcopal Church Medical Trust

• Medical Plans

• High Deductible Health Plan/Health Savings Account

• Additional Benefits

Resources

Denominational Health Plan

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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Episcopal Church Medical Trust

Medical Plans– 2012

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Your 2012 Medical Plan ChoicesIn-Network and Out-of-Network Plans

Empire BCBS PPO 80/60

Empire BCBS 75/50

Empire BCBS High Deductible Health Plan with Health Savings Account (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

Plan Provision Network

Annual deductible (single/family) $500 / $1,000

Annual OOP max (single/family) $2,000 / $4,000

Office visit copay$0 Preventive

$25

Member coinsurance 20%

Inpatient hospital coinsurance$100 per day, not to exceed

$600 per admission20% coinsurance

Outpatient hospital coinsurance$500 deductible

20% coinsurance

Empire BCBS PPO 80/60 – At a Glance

Plan Provision Network

Annual deductible (single/family) $900/$1800

Annual OOP max (single/family) $3,200/$6,400

Office visit copay$0 Preventive

$35/$45

Member coinsurance 25%

Inpatient hospital copay$100 per day, not to exceed

$600 per admission25% coinsurance

Outpatient hospital copay $900/1800 deductible

25% coinsurance

BCBS PPO 75/50 – At a Glance

Empire BCBS High Deductible Health Plan & Health Savings Account

(Preferred Provider Organization)

www.empireblue.com (800) 352-3152

HDHP/HSA: What is it?

High Deductible PPO Health Plan consumer-directed health plan

with preventive services covered at 100%

+Health Savings Account

allows employer and employees to make tax-free contributions and save for future healthcare

expenses

Employees can begin thinking like consumers when it comes to healthcare.

HDHP Benefits

All Plans Subject to Plan Deductible and Coinsurance…

Medical Plan - Administered by BCBS

Pharmacy - Administered by Medco

Mental Health - Administered by BCBS

Except the Eyemed Vision Benefits and CIGNA Employee Assistance Program (EAP).

Health Savings Account (HSA)

Tax-advantaged account regulated by the IRS

Employee sets up and owns the account

Balances accumulate and rollover year-to-year

Funds for qualified healthcare expenses only

Account must be held by qualified trustee • Mellon Bank for Empire BCBS• Funds may be invested

Only available to HDHP participants without other medical coverage

HSA - Contributions

Employers, employees or others may contribute to an employee’s HSA.

Limits on annual contributions set by IRS.• For 2012 - single $3,100, family $6,250• Employee responsible for ensuring max not

exceeded.

Additional contributions are possible for those age 55 (or older) by the end of the year ($1,000 for 2012).

Deadline for 2012 HSA contributions - April 15, 2013.

HSA – Distributions

Distributions from an HSA for qualifying medical expenses are tax-free.

• HDHP deductibles and coinsurance• Post-employment healthcare costs, Medicare

Part B premiums• Long-term care premiums

May be used for employee or dependent expenses.

Other distributions subject to federal income tax plus a 20% penalty. (Penalty waived after age 65 or on account of death or disability.)

HSA - How are distributions made?

Employees may: Use the HSA debit card at doctor’s office or

pharmacy Write a check on the HSA account Pay the provider or pharmacy out of personal funds

and reimburse him/herself from the HSA

Caution: Employee must keep records to prove the funds

were used for qualifying medical expenses. Employee is responsible for any overdraft fees on

the HSA.

Mental Health/Substance Abuse

In an HDHP, MH/SA benefits are embedded in the plan design and are administered by BCBS

However, the Employee Assistance Program (EAP) is still available to members

Benefits of the EAP include:

• 10 in-person sessions with no copay

• Unlimited telephone sessions

• Multiple episodes of treatment per year

• Includes Family Care, Personal, and Online services

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.

Design Elements In Network Out of Network

Deductible$2,700 Individual

$5,450 Family$3,000 Individual

$6,000 Family

Coinsurance Maximum$1,500 Individual

$3,000 Family$4,000 Individual

$7,000 Family

Out of Pocket$4,200 Individual

$8,450 Family$7,000 Individual$13,000 Family

Coinsurance (after deductible) 20% 45%

PCP (after deductible) 20% 45%

Specialist (after deductible) 20% 45%

Hospital (after deductible) 20% 45%

Emergency Room (after deductible) 20% 45%

Preventive Care 0% 45%

Prescription Drug (after deductible)Generic - 15%

Formulary Brand - 25%Non Forumulary Brand - 50%

Precertification is required for inpatient hospital admissions. Failure to precertify these services will lead to a reduction in benefits.

Empire BCBS HDHP/HSA Plans

HDHP Cost Comparison per Employee

BCBS 80/60 Plan Monthly AnnuallySingle $642 $7,704Single Plus One $1,157 $13,884Family $1,798 $21,576

Empire BCBS HDHPSingle $440 $5,280Single Plus One $792 $9,504Family $1,232 $14,784

SavingsSingle $2,424Single Plus One $4,380Family $6,792

HDHP Cost Comparison per Employee

Health Savings Account (HSA) Funding

Single $2,200Single Plus One $3,325 *Family $4,450

Net Savings To EmployerSingle $224Single Plus One $1,055 *Family $2,342

*Note that the funding and net savings amounts for Single Plus One for the Diocese of East Tennessee differ from the amounts of $4,450 [funding] and $(70) [net savings to employer] used for illustration purposes in the regional meetings held on Nov. 10, 2011.

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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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*

Employee Assistance Program (EAP)

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

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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)• Administered by CIGNA

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

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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

Multiple episodes of treatment per year

Unlimited telephonic sessions

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Employee Assistance Program (EAP)

Assistance with Family Care Services• Child care• Parenting programs• Adoption information• Long-distance care-giving• Researching nursing homes

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

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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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

Note: FrontierMEDEX is not responsible for medical costs while you are traveling.

HearPO Access to HearPO network discounts

Online Open Enrollment

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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.

Thank you!

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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

Telephone Direct Toll Free

1-800-480-9967

Email: mtcustserv@cpg.com

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The Medical Trust Website

www.cpg.org

HDHP/HSA Web Resources

U.S. Treasury Department – Health Savings Accountswww.treas.gov/offices/public-affairs/hsa/The HSA section of the US Treasury Department website contains links to informational brochures, up to date regulations, frequently asked questions, press releases, IRS forms and publications and technical guidance.

IRS – Health Savings Accountswww.irs.govThe HSA section of the IRS website contains publications, bulletins and tax filing instructions.

Publication 502www.irs.gov/publications/p502/index.htmlPublication 502 provides a list of qualified medical expenses.

HDHP/HSA Web Resources continued…U.S. Government Office of Personnel Managementwww.opm.gov/hsa/Although primarily intended for government employees, this site is also a good resource for finding information about HDHPs and HSAs.

HSA Insider (a division of Canopy Financial) – HSA Road Ruleswww.hsainsider.com/roadrules.aspxYou will need to login to download the HSA Road Rules. This brochure includes a Table of Contents making it very user friendly. It also appears that this brochure is kept up to date with government regulations. In addition to the Road Rules, the HSA Insider site contains other valuable information.

Denominational Health Plan

Resolution A177

Resolution A177: What Was the Spirit in which the Resolution was Passed

Speaks to social justice issues around adequate benefits for the Church’s lay employees

Cost concerns are real, but so is the need of lay employees to have adequate healthcare benefits

The support and dedication of lay employees make many ministries possible…it’s the right thing to do

General Convention actions will now assure lay employees the safety net of healthcare benefits

Currently, some lay employees do not have access to healthcare benefits , and others have a higher cost-share than clergy

DHP- con’t

Required:

• All domestic US dioceses, cathedrals, missions, and chapels by 2013

• All clergy and lay employees who work 30+ hours/week. Individuals may opt out through spousal coverage, Tri-care, etc.

• Parity between clergy and lay coverage levels

• Employees who work between 20 and 30 hours/week may participate---not required

DHP- con’t

Diocesan Choice and Control

• Dioceses will determine whether diocesan institutions, schools, and agencies will be required to participate.

• Diocese will establish cost sharing guidelines for congregations, i.e. parity.

• Dioceses decide whether to offer healthcare coverage for domestic partners.

• Diocese select plan designs.

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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.