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The Episcopal Church Medical Trust – What’s New for 2010 Toni Marie Sutliff Account Manager Client Relations Department

The Episcopal Church Medical Trust – What’s New for 2010 Toni Marie Sutliff Account Manager Client Relations Department. Diocese of San Joaquin October 23, 2009 Serving the Church in a Season of Change. Agenda. 2010 Active Medical and Dental Plan Offerings

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The Episcopal Church Medical Trust – What’s New for 2010 Toni Marie Sutliff Account Manager Client Relations Department

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  1. The Episcopal Church Medical Trust – What’s New for 2010 Toni Marie Sutliff Account Manager Client Relations Department Diocese of San Joaquin October 23, 2009 Serving the Church in a Season of Change

  2. Agenda • 2010 Active Medical and Dental Plan Offerings • Changes in the Retirement Medical Plans for 2010 • Open Enrollment • The Denominational Health Plan • The Mandatory Lay Pension Plan • Health Awareness & Wellness • Anything else you want to talk about

  3. 2010 Plan Array for Actives • Kaiser HighOption EPO • Kaiser MidOption EPO • Kaiser EPO 80 • Empire BCBS PPO 80/60 • Empire BCBS HDHP/HSA

  4. Kaiser HighOption EPO

  5. Kaiser MidOption EPO

  6. Kaiser EPO 80

  7. Prescription Benefits for Kaiser • Kaiser is the benefits plan manager • 2-Tier benefits: generic and brand-name • Retail and mail order benefits

  8. Mental Health / Substance Abuse for Kaiser • Integrated into Medical benefits • Outpatient visits have a co-pay • Inpatient visits are treated as other hospitalization

  9. Empire BCBS PPO 80/60 at a Glance

  10. Empire BCBS HDHP at a Glance

  11. The High Deductible Our plans: • In network: $2,700 single / $5,450 family • Non network: $3,000 single / $6,000 family • Single versus Family deductible • Preventive care covered at 100% - no deductible required

  12. The Out of Pocket Maximum • After deductible, pay co-insurance until reach OOP • In network: $1,500 single / $3,000 family • Non network: $4,000 single / $7,000 family • Totals: $4,200 single / $8,450 family in network; $7,000 single / $13,000 family non network • No further co-pays

  13. Prescription Benefits for HDHP • Medco is Pharmacy Benefit Manager • RX costs are part of medical deductible • After reaching deductible, employee pays 15%, 25%, 50% • Co-insurance counts toward the deductible and out of pocket maximum

  14. Mental Health / Substance Abuse for HDHP • Managed as part of the medical plan, not through CBH • After reaching deductible, employee pays 20% for in network and 45% for non network services • Co-insurance counts toward deductible and out of pocket maximum

  15. HSA Contributions • IRS sets annual limits on contributions: $3,050 single / $6,150 family in 2010 • Catch-up contributions of $1,000 for those who are age 55 or older by the end of the year • Deadline for contributions is Tax Day of the following year • Anyone can make a contribution • Total cannot exceed the max

  16. Medical Plan Pricing

  17. Value-Added Benefits • Prescription Drug Coverage • Mental Health / Substance Abuse • Employee Assistance Program • Health Advocate • EyeMed Vision • MedEx Travel Assistance • HearPO

  18. Pharmacy Plan Designs

  19. Prescription Benefits Managed by Medco • 3 Tier Formulary • Generics • Preferred Brand Names • Non-Preferred Brand Names • Generic or pay the difference – Example: • Brand name costs $90 • Generic costs $30 • Generic copayment is $10 • Member pays $60 + $10 = $70 • Mail order required for maintenance medications • Be Proactive • Ask for 90 day prescriptions • Talk to your doctor • Be aware of ramification of “Dispense as Written”

  20. Prescription Benefits Managed by Medco • Coverage Management Program • Majority of medications are filled immediately • Some medications fall under this program • Coverage Review Process ensures: • Reasonable Cost and more importantly, • Safety and • Medical Efficacy • Step therapy required for certain medications • Utilizes evidence based medicine • 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

  21. Prescription Benefits Managed by Medco • Retail pharmacy communicates electronically with Medco for eligibility and Rx management • If there is a question, a pharmacist will contact your doctor • The process is more seamless if your doctor is willing to work with Medco • Easy to use – mail order / web order / phone or fax from your doctor • Email reminders for refills • Pharmacists carefully monitor all prescriptions for drug interaction • State of the art technology provides dispensing accuracy • For specific benefit questions please contact Medco at (800) 841-3361

  22. Mental Health / Substance Abuse • Plan Partner – CIGNA Behavioral Health* • Provides mental health benefits that achieve parity • Thirty years of experience • Shares the same basic values of compassionate care • Coverage for Pastoral Counselors & Colleague Groups • Extensive Mental Health Provider Network • Employee Assistance program (EAP) *Kaiser and Empire BCBS HDHP plans are EAP only with CIGNA Behavioral Health; inpatient and outpatient MHSA benefits are embedded in the plan design and are administered by the medical carrier.

  23. Employee Assistance Program (EAP) • Unlimited telephone consultations • Up to 10 in-person sessions, per issue with no copay • Multiple episodes of treatment per calendar year • Geographic availability of services • Urban – 99.6% access • Rural – 97.2% access • Access to the EAP is virtually 100% - telephone, web • & in-person services

  24. Employee Assistance Program (EAP) • Achieve Work/Life Balance • Personal Services: • 30-minute free legal consultation • Stress management • Debt management • Identity theft assistance • Online Services: • Family & care giving resources • Health & wellness resources • Daily living resources • Article library • Family Issues: • Child care • Parenting programs • Adoption information • Long-distance care-giving • Nursing home research • Pet care • Education guidance

  25. Employee Assistance Program (EAP) 2007 CBH Data • EAP Utilization – 4% • Web Presentations – 8.6% 2008 CBH Data • EAP Utilization – 4% • Web Presentations – 9.8%

  26. Employee Assistance Program (EAP) • Utilization of this benefit remains low • If utilization of EAP can be increased the potential savings to the plans/church are significant • EAP utilization would drive more members to In-Network providers for services beyond the ten session limit

  27. Employee Assistance Program (EAP) • 1,142 members accessed visits without utilizing the 10 FREE EAP visits • 613 were new utilizers in 2007 • However they generated 7,229 visits under the integrated side of the benefit • This equates to $749,000 in paid claims • 387 of the members had less than 10 visits • This equates to $212,000 in paid claims – which could have been free to the plan

  28. Health Advocate Help is only a phone call away! • Additional service provided by the Medical Trust • Complements health coverage • Advocacy and assistance services • No cost • Also available to spouse, dependent children, parents and parents-in-law www.healthadvocate.com

  29. Health Advocate Personal Health Advocates Can Help You… • Find the best doctors & hospitals • Schedule appointments & tests • Secure a 2nd opinion • Sort out claims, help with billing • Explain test results, treatments & medications • Assist with transfer of medical records, x-rays, etc • Arrange for home-care equipment • And so much more…

  30. Vision by EyeMed

  31. MEDEX and HearPO • MEDEX • Peace of mind while traveling • Access to Medex Assistance Corporation • Provides 24/7 Emergency Medical Advocacy • Note: MEDEX is not responsible for medical costs while traveling • HearPO • Access to HearPO network discounts

  32. CIGNA Dental

  33. Dental Plan Pricing

  34. Open Enrollment • Letter from the Medical Trust with instructions on how to access the open enrollment website • Unique password • Review plan documents • Make selections • Review personal and dependent information • Confirm choices • Print confirmation page • Make changes until site closes • After that, please contact Juanita • New selections effective January 1, 2010

  35. Pre-65 Retiree Health Care Program Intent • To provide health coverage for those who retired from the Episcopal Church and are not yet eligible for Medicare • To provide health coverage for pre-65 spouses of CPF retirees, regardless of where they retired from NOTE: It was not intended for those who voluntarily terminate employment to seek other employment or vocational interests. [Extension of Benefit Program serves this purpose.]

  36. Pre-65 Retiree Health Care • 2009 Plans • Group product – zip code rated • Four plan choices • No underwriting required • No limitations for pre-existing conditions • 2010 Plans • Pre-65 retirees will remain with active population • Must choose from plans offered by diocese • Tied to diocese from which employee retires • Diocese will determine eligibility NOTE: Pre-65 retirees may purchase benefits elsewhere unless restricted by diocese to stay with group in order to receive post retirement benefits.

  37. Post-65 Retiree Health Care • To enroll in Medicare Supplement plans you must be 65 or over and retired or on disability • You need to enroll in Medicare Part A and B • Medicare will be your primary insurer and the supplement secondary • Call the Medical Trust and visit your Social Security office 3 months before retirement • You may be eligible for other plans • TRICARE • Coverage from your spouse or a previous employer • Do comparisons

  38. How Medicare works • Your “network” is Medicare • Ask your doctor if he/she takes Medicare assignment • If the answer is no - you can be charged up to 15% more and may even have to handle your own claim • Medicare must approve treatment except where plan has an add-on benefit • United Healthcare handles your claims after they have been to Medicare

  39. Medicare Information • Everything you need to know about Medicare • You receive this publication annually • Look out for changes each year • Medicare website: • www.medicare.gov or call • 1-800-633-4227 • TTY 1-877-486-2048

  40. Medicare 2009 • The standard Part B premium stays the same - income related • Increased premiums for those on higher incomes • Increased Part A and B deductibles and other increased charges

  41. Medicare Part D • Part D is Medicare prescription drug coverage • Most retirees of the Episcopal Church are best to stay in the Medicare Supplement prescription drug plan • Those on low incomes may need to enroll in Part D and have the Medicare Supplement plan without prescription drugs from Medical Trust • Applies to those who are single with less than $15,600 and assets less than $11,990 • Married people must have an income less than $21,000, and assets less than $23,970 • Call us if this is your situation

  42. Medicare Supplement – New for 2010 Administered by United Healthcare (UHC) • New Value-Added Benefits from UHC for all plans! • Health Advisors: enhanced UHC Customer Service team • Medicare Decision Support (MDS): 24/7 RN team dedicated to Medicare participants’ issues • Health Allies: Partners offering 5-50% discounts on non-covered vision, dental, home healthcare and other expenses • Comprehensive and Plus plan benefits remain the same as 2009 • Premium plan benefits enhanced: • Hearing aid benefit doubled: $2,000 per ear every 5 years • Occupational, speech and physical therapy benefits will continue after Medicare benefits for these services are exhausted

  43. 2010 Medicare Supplement Rates For clergy & spouses w/ more than 5/less than 10 YCS For lay retirees w/ more than 5 YCS • Comprehensive Plan with Pharmacy: $265 • Plus Plan with Pharmacy $350 • Premium Plan with Pharmacy $400 All plans are available without pharmacy for those who may wish to participate in Medicare Part D

  44. The Clergy Subsidy from CPF • For all retirees with 10 and more YCS This includes eligible spouse • For those with 20 YCS the subsidy is $265 per person per month • Between 10 and 20 YCS the subsidy is reduced by $2 per missing year per month • Between 5 and 10 YCS – no subsidy • The subsidy from CPF will be reviewed annually

  45. Medicare Supplement Rates 2010 For clergy and spouse with 20 YCS: • Comprehensive plan with pharmacy = $0 (free) • Plus plan with pharmacy = $85 • Premium plan with pharmacy = $135

  46. Annual Open Enrollment • Open enrollment happens each year from mid November to mid December • Online open enrollment was available for the first time in 2008 • When you receive your materials • If no change – do nothing • If change – sign onto web site or return form • Plans all have an effective date of January 1st

  47. 2010 Medicare Supplement Plans

  48. 2010 Medicare Supplement Plans

  49. United HealthCare Website

  50. 2010 Medicare Supplement Pharmacy

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