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Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst October 8 and 9, 2013

Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Page 1: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Episcopal Church Medical Trust

Diocese of Central New York

Ms. Martha GardnerRegional Account Specialist

The Rev. Robert GriffithAss’t Business Analyst

October 8 and 9, 2013

Page 2: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Agenda

• Medical Plans

• Additional Benefits

• Dental Plans

• Wellness

Page 3: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

Page 4: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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The Episcopal Church Medical Trust

Our Mission …

“Balancing compassionate

Christian benefits with financial stewardship”

Page 5: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

89% of Every Dollar Received Provides Benefits to Participants versus National Healthcare which requires 85%

5

Page 6: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

Page 7: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

1-800-480-9967 / [email protected]

Page 8: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Episcopal Church Medical Trust

Diocese of Central New YorkMedical Plans– 2014

Page 9: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

Page 10: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Women’s Preventive Care

In accordance with the Affordable Care Act women’s preventive care services are available with no copay or coinsurance in-network:

Annual visit and recommended preventive services

Breastfeeding counseling and equipment such as breast pumps

FDA-approved contraceptive methods

Domestic violence screening and counseling

Gestational diabetes screening for pregnant and high-risk women

HIV screening and counseling annually

Sexually transmitted infections counseling annually

Human papillomavirus (HPV) testing every 3 years

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Page 11: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Your 2014 Medical Plan Choices

Empire High Option PPO

Empire BCBS High Deductible Health Plan

Page 12: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Network and Out-of-Network Plans - PPO

Basic Elements

No designated Primary Care Physician (PCP) required

No referrals required for specialty care

Out-of-network benefits are available, although you pay less when using a network provider

Page 13: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Empire BlueCross BlueShieldHigh Option PPO Plan

(Preferred Provider Organization)

www.empireblue.com (800) 352-3152

Page 14: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Empire BCBS High Option PPO – At a Glance

Plan Provision Network Out-of-Network

Annual deductible

(person / family)$200 / $500 $500 / $1,000

Annual OOP max

(person / family)

(includes deductible)

$2,200 / $4,500 $3,500 / $7,000

Member coinsurance 0% 30%

Office visit$0 Preventive

$30 (PCP or specialist)

30%

Urgent care $50 $50

Inpatient hospital $150 copay per admission 30%

Outpatient hospital $150 copay 30%

Emergency room care

(waived if admitted)$100 $100

Page 15: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Episcopal Church Medical Trust

www.empireblue.com (800) 352-3152

Empire BlueCross BlueShieldHigh Deductible Health Planand Health Savings Account (HDHP/HSA)

Page 16: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Consumer Directed Health Plans

Think like a consumer when it comes to healthcare and take personal responsibility for:

• Improving health

• Managing costs

• Making thoughtful decisions when choosing coverage during enrollment and using coverage throughout the year

Visible Cost of

Healthcare

Real Healthcare Costs

Page 17: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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HDHP/HSA – How the Pieces Work Together

High Deductible PPO Health Planwith preventive services covered at 100%

+

Health Savings Accountthat allows employer and/or employees to make tax-free

contributions to save for future healthcare expenses

+

Health and Decision Toolsto help employees become more knowledgeable consumers

HDHP / HSA Fact Sheet – www.cpg.org/mtdocs

Page 18: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Empire BCBS HDHP – At a Glance

Plan Provision(Medical & Rx Combined)

Network Out-of-Network

Annual deductible

(person / family)$2,700 / $5,450 $3,000 / $6,000

Annual OOP max

(person / family)

(includes deductible)

$4,200 / $8,450 $7,000 / $13,000

Member coinsurance

(after deductible is met)20% 45%

Office visit$0 Preventive

20%

45%

Urgent care 20% 45%

Inpatient hospital 20% 45%

Outpatient hospital 20% 45%

Emergency room care 20% 20%

Page 19: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Richard is single. How does a HDHP work for him?

It’s January 15, and Richard slips on the ice!

His in-network doctor sends him for an MRI at a in-network facility. The doctor’s visit and MRI would have cost Richard $5,000. Good thing he’s in the Medical Trust’s HDHP with negotiated rates! He pays $3,000.

Unfortunately, Richard broke his ankle during the fall and is in great pain. He needs lots of medicine, with a cost of $1,000. Good thing he’s in the Express Scripts program, with a negotiated cost of $800.

How do these medical and prescription costs work with an HDHP?

Let’s take a look!

Page 20: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Richard’s Bucket ListBucket #1: The Annual Deductible. Richard must fill this bucket by paying 100% of the negotiated cost of services ($2,700 for a single person)

Richard’s negotiated doctor and MRI costs = $3,000

Bucket #2: Your Maximum Annual Co-Insurance. Richard must fill this bucket by paying the appropriate co-insurance ($1,500 for a single person)

Richard’s co-insurance is 20% of the remaining $300 = $60

$60$2,700

Richard’s co-insurance for the $800 of formulary medication is 25% =$200

$200Richard’s 2nd bucket is not yet full. He still has to pay $1,240 to fill his bucket.

Bucket #1 = $2,700 Bucket #2 = $1,500 = $4,200 Out of Pocket Maximum (OOP)+

Page 21: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Richard, Mary and their two children, Nan and Bert have family coverage. How does a HDHP work for them?

On January 2nd the family gets hit by a beer truck!

While their injuries are minor, they all require medical care. At the emergency room, they had X-rays, medications and Bert had a broken arm. The cost for their care was $30,000! Good thing they are in the Medical Trust’s HDHP with negotiated rates which are $22,000.

How do these costs work with an HDHP?

Let’s take a look!

Watch out!

Watch out!

Page 22: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

The Family’s Bucket ListBucket #1: The Annual Deductible. The family must fill this bucket by paying 100% of the negotiated cost of services ($5,450 for a family)

The family’s negotiated cost of services = $22,000

Bucket #2: The Family’s Maximum Annual Co-Insurance. The family must fill this bucket by paying the appropriate co-insurance ($3,000 for family)

The family’s co-insurance is 20% of the remaining $16,550 (which equals $3,310). However, they only have to pay $3,000.

$3,000$5,450

They have met their annual Out of Pocket Maximum (OOP). For the remainder of the year, all of their in-network medical, pharmacy and behavioral health is

= $8,450 OOP+FREE!

Bucket #1 = $5,450 Bucket #2 = $3,000

Page 23: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

HDHP / HSA – The Details

Page 24: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

What are Health Savings Accounts?

Tax-advantaged savings account for qualified healthcare expenses

Employee sets up the account and owns it

Balances accumulate and roll over year after year

Portable from employer to employer

Act like an IRA or 401(k) for healthcare expenses

May be invested

Account must be held by a qualified trustee

Anyone can make a contribution to employee’s HSA on an annual basis:• Employer, employee, others

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Page 25: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Who is Eligible to Contribute to a Health Savings Account

Must be enrolled in a qualifying HDHP

Cannot be covered by other medical insurance, including Medicare, with limited exceptions:

• Can have AFLAC-type coverage

• Can have separate dental or vision coverage

• Can have disability coverage

Cannot contribute to a Health Savings Account while using a Flexible Spending Account (FSA), with minor exceptions

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Page 26: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Setting Up the Health Savings Account

The Medical Trust has a partnership with Mellon Bank for the BCBS HDHP.

You must set up the account

• The Medical Trust will pay the set-up and monthly maintenance fees

• Employer contributions go through our lock box

You can use any qualified financial institution – those that can set up IRAs – you are responsible for set up and maintenance fees

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Page 27: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Setting Up the Health Savings Account - continued

Account must be set up before contributions or distributions can be made

• January 1 is a holiday

• It will take a week or so to get through our lock box

Remember to designate a death beneficiary on the account

• If spouse, account balance not taxable on your death and your spouse can continue to use the funds as a tax-advantaged health savings account

• If anyone else, or if you fail to designate a beneficiary, the account will be closed, the balance will be taxed, and the money distributed to your heirs

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Page 28: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Contributing to the Account

Your employer may contribute to your account

You can contribute:

• Through payroll deductions if available

• By direct deposit, using your deposit slips

Anyone can contribute, using your deposit slips

IRS maximum contributions for 2014 are $3,300 and $6,550

• Additional $1,000 if the account holder is age 55+

Excess contributions are taxable to you and you pay a 10% penalty

You have until April 15, 2015 to make additional contributions – use your deposit slips and be sure to designate for 2014 contribution

You have until April 15, 2015, or the date of any extensions of your tax return, to withdraw excess contributions and the associated interest

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Page 29: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Contributing to the Account - continued

Special Rules for Spouses / Families

• If all are enrolled in HDHP plans, the maximum contribution is the family limit, which can be split evenly or as the parties decide

• Only the account holder can make the extra $1,000 contribution

• Each covered individual, except IRS dependents, is eligible for and can open a separate account

Partial / Last Month Rule

• You may make proportionate contributions only for the portion of the year you are eligible

• If you are not eligible for an HSA for the entire year, but are on the first day of December, you can make contributions as if you were eligible the entire year

• You must remain eligible for the entire next year

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Page 30: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Distributions from the Account

You do not have to use the money in any particular year

You can continue to use the money even when you are no longer eligible to contribute to the account

• Not enrolled in an HDHP

• Enrolled in Medicare

You are not taxed on the amount distributed from the account IF you use it for qualifying healthcare expenses

• IRS Publication 502

• Includes dental and vision out of pocket expenses

• Includes prescription medications – no OTC products

If used for non-qualifying expense, you will pay federal income tax and a 20% excise tax as a penalty

• If you are age 65+, you don’t pay the penalty30

Page 31: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

For Whom Can You Use the Account

Remember the account has to be used for qualifying healthcare expenses

Yourself

Your spouse (even if the spouse is not on your HDHP)

Your dependents that you can claim on your tax return (even if not on your HDHP)

• If your age 27+ children are on your HDHP, they are eligible to set up separate HSAs and can use that money themselves

• If your domestic partner is on your HDHP, he or she is eligible to set up a separate HSA and can use that money him or herself

• Remember the family contribution limit31

Page 32: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Using the Money in the Account

Remember that you do not have to use it!

Prescriptions – you will pay at the time of filling the prescription

• Could be 100% of Express Scripts negotiated cost!

• Consider getting prescriptions filled before the end of the year

Other services – you should NOT pay at the time of service

• The provider doesn’t know whether you have met the deductible – if not, you will pay 100% of the network negotiated cost of service

• The provider doesn’t know whether you have met the out-of-pocket maximum – if not, you will pay 20% of the network negotiated cost of service. If yes – your covered network services are fully paid by the plan!

• WAIT for the Explanation of Benefits before paying

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Page 33: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Using the Money in the Account - continued

You may choose to use the HSA funds

• Check

• Debit card

• ATM for cash

You may choose to use other funds and allow the HSA funds to accumulate

• You can reimburse yourself from HSA funds later in the year

• Write a check or use the ATM/Debit card for cash

You must keep receipts to match with all distributions to prove made for qualifying healthcare expenses

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Page 34: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Additional Paperwork

Remember to keep track of how much is contributed

• The trustee bank will send IRS Form 5498-SA to show the amount of contributions made to the account

• Your employer will enter the amount it contributed, including your contributions made through payroll deduction, in Box 12 of your W2

• If over the maximum, you have until April 15 (or the date of any extension to your return) to withdraw the excess plus any interest earned on the excess

Remember to keep track of how each distribution is used

• The trustee will send IRS Form 1099-SA

• Must have receipts to show used for qualifying healthcare expenses for audit purposes

Filing your tax return

• IRS Form 8889: http://www.irs.gov/pub/irs-pdf/f8889.pdf 34

Page 35: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Express Scripts Pharmacy Benefits

www.expressscripts.com (800) 841-3361

Page 36: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Express Scripts 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)

Page 37: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Express Scripts 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”)

Page 38: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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 = $90Generic 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.

Page 39: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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, Express Scripts 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

Page 40: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Prescription Benefits Managed by Express Scripts

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Coverage Management Program

• Majority of prescriptions filled immediately

• Some medications fall under this program

• Ensures Reasonable Cost, Safety, Medical Efficacy

• Ongoing monitoring of drug interactions

Step therapy required for certain medications

• Certain medications will be dispensed only after others have been tried and failed

Prior authorization required for certain medications

• Based on need

• Based on quantity

Page 41: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Rx Benefits Managed by Express Scripts

Behind-the-Scenes

Express Scripts review all prescriptions for:• Possible drug interactions

• Medical efficacy

• Safety (dose, duration, etc.)

Prior authorization may be required based on need, quantity

Express Scripts will call your doctor directly with questions

Page 42: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Be Proactive!

Talk to your doctor about your Rx plan• Discuss the formulary• Ask for generic when available

Review your prescriptions

• Are mail order prescriptions for 90 days?

• Did your doctor indicate “DAW” (dispense as written)?

If there is a question, an Express Scripts pharmacist will contact your doctor

Page 43: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Additional Benefits

Mental Health / Substance Abuse Employee Assistance Program (EAP) Health Advocate EyeMed Vision FrontierMEDEX HearPO

Page 44: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Mental Health / Substance Abuse Benefits

Empire BCBS / Cigna HDHP / HSA

IRS Guidelines: must be embedded with medical plan

Plan Partner Empire BCBS / Cigna

Annual deductibles combined with Medical and Rx

Network benefits• Inpatient & Outpatient – 20% after deductible

Out-of-network benefits• Inpatient & Outpatient – 45% after deductible

Refer to the plan’s Summary of Benefits and Coverage for specific plan details

Page 45: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

Page 46: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Because Life Happens

Work/Life balance

Adjustment to life events and change

Relocation

Child care, elder care, pet care needs

Stress

Depression and emotional health concerns

Substance abuse

Relationship issues

Parenting and family concerns

Career concerns and career counseling assistance

Crisis needs and critical incident response

Grief and loss

Legal and financial concerns

1-866-912-1689

Page 47: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

Page 48: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

10 Reasons to Call the EAP

1. School is back in session and I want to help my kids start the year with good homework habits.

2. Do you have a list of activities to do with Alzheimer’s patients?

3. I’m taking a trip with my family, and I need information about traveling with kids.

4. I’m retiring, and I would like to find some support groups in my area.

5. My son was arrested for driving while intoxicated. How can I help him?

6. I’m moving, and I need information about my new town.

7. I need to find a daycare facility for my child.

8. My grandparents are visiting, and I need to find some rentable medical equipment.

9. My daughter has allergies, and I need to find stores that carry wheat-free foods.

10. Should I get pet insurance?

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Page 49: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Health Advocate offers 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

Page 50: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

Page 51: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

10 Ways Health Advocate Can Help

1. Finding network doctors, hospitals and dentists

2. Scheduling appointments

3. Helping to resolve insurance claims

4. Negotiating fees with out-of-network providers

5. Obtaining unbiased health information

6. Working with health plans to obtain appropriate approvals

7. Answering questions about test results or treatment recommendations

8. Assisting in transfer of medical records, x-rays or lab tests

9. Locating and researching the newest treatments for a medical condition

10. Assisting with finding qualified wellness programs and services

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Page 52: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Vision

Administered by EyeMed

Annual eye exam - $0 network copay

Annual benefit for:• Frames• Lenses, or• Contact lenses

Broad-based PPO network• Retail chains• Independent provider locations

Page 53: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

5353

EyeMed Vision Care Benefits – At a GlancePlan 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

Progressive Lenses

standard

premium

You pay up to $75

You pay $75, then 80% of charge over $120

Not covered

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

Page 54: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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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

Page 55: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Cigna Dental Plans

www.cigna.com (800) 244-6224 (800-CIGNA24)

Page 56: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Dental Plan

Administered by Cigna Dental

3 Annual cleanings and related oral examinations• 4th Available if medically necessary

Extensive PPO Network

In and Out-of-Network Benefits

Page 57: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

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Cigna Dental Plans – At a Glance

Plan ProvisionPreventive

DentalBasic Dental

Dental & Orthodontia

What You Pay

Annual Out-of-Network Deductible

None$50 per person

$150 per family

$25 per person

$75 per family

Preventive Services(includes 3 cleanings per year)

0% 0% 0%

Basic Services 20% 15% 15%

Major Services 99% 50% 15%

Orthodontic Services 99% Not Covered50%

($1,500 Lifetime Max)

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 $2,000 $2,000

Page 58: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Wellness

Making a Case for Healthy Lifestyles

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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.

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

Now the Focus is:

• Helping the healthy stay healthy

• Reducing the health risks

• Encouraging healthier lifestyle choices

Previously:

• Health plans focused on disease management

• Emphasis placed on those already ill

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The Impact

75% of healthcare costs are attributable to chronic conditions caused by modifiable risk

factors – primarily obesity, sedentary lifestyles, and smoking.

Centers for Disease Control

Page 62: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

The Impact of Poor Health

• 50% of health care costs are preventable

• 60-80% of costs are incurred by those with chronic illness

• 50-80% of all premature deaths and illnesses in the U.S. relate directly to unhealthy lifestyle habits

• 50% of costs are generally from 5% of membership

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Medical Trust Promotes Healthy Changes

The biggest impact we can make as a nation to our healthcare dilemma is by making lifestyle changes

Small Changes, Big Difference• Campaign to raise awareness and encourage healthy lifestyle

changes

Recent studies show small changes can have significant impact on one’s overall health

Being aware of your health status is the first step – know your numbers! • Blood pressure• Glucose• Cholesterol

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Page 64: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Taking Control of Our Health

Living a healthy lifestyle is not just a good idea it, has become a national imperative

The New ‘Fountain of Youth’

Physical activity is one of the greatest bargains this world has ever known

If physical activity were a pill it would be the single most effective medicine

By walking 30-45 minutes on most or all days you can delay disability by 10-12 years

How long does it take for the body to begin experiencing the benefits of exercise? About 30 seconds!

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Can we improve our overall health?

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Eating Healthy

5-a-day →

Choose beverages wisely. →

Reduce saturated fats and try to eliminate trans fats. →

Eat complex carbs instead of fast-acting carbs. →

Love that protein! →

Add color to your diet with fruits and vegetables.

Avoid too much sugar and artificial sweeteners, and drink water.

Plant oils, nuts, and fish are the healthiest sources.

Whole grains are best. Avoid white flour foods.

Fish, Poultry, nuts and beans are the best choices.

Page 67: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

What is one thing you can do in the next 24 hours…

…..that will start you on the path to better health?

Health & Wellness – A Lifelong Journey not a Destination

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Our struggle…….

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Why? Times Have Changed

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Taking Personal Responsibility

•Think like a consumer when it comes to health care 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

Page 71: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

Our Commitment to Wellness

• Network preventive care coverage– Preventive care at $0 copay– 3 annual dental cleanings/oral examinations– Annual vision exam $0 copay

• Health Fairs, Monthly “Health & Wellness News” mailings

• 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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Your ID Cards

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Vendor Websites

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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

Express Scripts (Medco)

•(800) 841-3361

•www.express-scripts.com

Cigna Behavioral Health (& EAP)

•(866) 395-7794

•www.cignabehavioral.com

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Getting Help: Contacts

EyeMed Vision Care• (866) 723-0512

• www.eyemedvisioncare.com

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

Recommended 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 8:00om Eastern

Telephone Direct Toll Free

1-800-480-9967

Email: [email protected]

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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/mtdocs

Page 79: Episcopal Church Medical Trust Diocese of Central New York Ms. Martha Gardner Regional Account Specialist The Rev. Robert Griffith Ass’t Business Analyst

The Church Pension Fund and its affiliates do not provide, and none of the information furnished in this presentation should be viewed as, investment, tax, legal or other advice. Your personal decisions should be based on the recommendations of your own professional advisors.

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 or insurance contracts, the official plan documents or insurance contracts 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.

Important Notice

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Thank You!

Questions?