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Episcopal Church Medical Trust

Healthcare Benefits for The Diocese of Southern OhioOpen Enrollment 2012

The Rev. Rusty McCown Regional ManagerNovember 2 & 3, 2012

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Agenda

Introduction

The Episcopal Church Medical Trust

• Medical Plans – and HDHP/HSA plan

• Additional Benefits

• Dental Plans

Resources

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 Choices

In-Network and Out-of-Network Plans

Empire BCBS PPO 80/60

Empire BCBS High Deductible Health Plan with Health Savings Account (HDHP/HSA)

In-Network Only Plans

Aetna HMO/CIGNA Open Access

Aetna Select EPO

Empire BCBS EPO 90

Empire BCBS EPO 80

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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

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.

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

Diocese of Southern Ohio

Monthly Rates for 2012 Single E+1 FamilyAetna HMO/CIGNA OAP $675 $1,214 $1,889Aetna Select EPO $742 $1,335 $2,078Empire BCBS PPO – 80/60 $875 $ 1,576

$2,447Empire EPO 80 $667 $1,200 $1,866Empire EPO 90 $705 $1,269 $1,972

Empire BCBS HDHP $504 $ 907 $1,412

HDHP Cost Comparison per Employee

Health Savings Account (HSA) FundingMonthly Cost to Employers for HDHP/HSA

Single E+1 FamilyEmpire BCBS HDHP $504 $907 $1,412

HSA Funding ($2,000/$4,000) $167 $333 $333

Total Cost to Employer $671 $1,240 $1,745

HDHP Cost Comparison per Employee

Diocese of Southern Ohio

Monthly Rates for 2012 Single E+1 FamilyAetna HMO/CIGNA OAP $675 $1,214 $1,889Aetna Select EPO $742 $1,335 $2,078Empire BCBS PPO – 80/60 $875 $ 1,576

$2,447Empire EPO 80 $667 $1,200 $1,866Empire EPO 90 $705 $1,269 $1,972

Empire BCBS HDHP + HSA Funding $671 $1,240 $1,745

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

CIGNA Dental Plans

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

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CIGNA Dental Plans – At a Glance

Plan Provision Preventive Dental

Basic Dental Dental & Orthodontia

What You Pay

Preventive Services(includes 3 cleanings per year)

0% 0% 0%

Basic Services 20% 15% 15%

Major Services 99% 50% 15%

Orthodontic Services 99% Not Covered 50%($1,500 Lifetime Max)

Deductible (single/family) None $50 / $150 $25 / $75

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 $1,500 $1,500

Dental Rates 2012

Diocese of Southern Ohio

Monthly Rates for 2012 Single E+1 FamilyPreventive Dental $121 $36 $56Basic Dental $66 $116 $177Dental and Orthodontia $53 $95 $148

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.

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Your ID Cards

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Thank you!

Any Questions?

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Definitions

Benefits Period: A benefit period begins the day you are admitted to a hospital or skilled nursing facility (SNF), and ends when you have not received any inpatient hospital or SNF care for 60 days in a row. If you are admitted after a benefit period ends, a new one begins. You must pay any deductibles for each new benefit period.

Coinsurance: an amount, usually a percentage, you may be required to pay as your share of the cost of services after deductibles have been met.

Copayment or Copay: a fixed amount you may be required to pay as your share of the cost for services.

Deductible: the amount you must pay for healthcare or prescriptions before your benefits begin to be paid by the plan (where applicable.)

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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.