2014 Medical Plan Information
Need more info? We aim to provide all you need to know on Benefits webpages. But, to talk with someone about Open Enrollment, contact the Benefits Administration office at 877-578-8707. M-F 8am-5pm EST/EDT. To talk with someone about details of the EPC Medical or Pharmacy Plan, contact Highmark at 800-215-7865 M-F 9am-9pm EST/EDT (have Reference Code P0090707 ready).
Table of Contents:
- Open Enrollment
- Future of the EPC Medical Plan
- Premium Rates
- Changes in Plan Options
- Side-by-Side Comparisons
- Benefit Changes
- Service Changes
- Employee Notification by Employer
- Open Enrollment will be November 1-20, 2013. We believe that churches with employees not currently enrolled in the EPC Medical Plan will be attracted to the new premium rates, more Plan options, and improved coverage. Current Plan participants will automatically continue their current status unless they change their 2014 coverage or dependent elections during this enrollment period. For current Plan participants, new rates automatically take effect early – on November 1, 2013. For new Plan participants, coverage and rates are effective January 1, 2014. The age-based rate determined for each participant on each effective date will remain unchanged through December 31, 2014.
- Future of the EPC Medical Plan. Click here for a recent EP News weblog from Stated Clerk Jeff Jeremiah. Click here for a presentation called: Preparing for ACA: Churches' Dilemma of Stewardship vs. Morality. Due to continued uncertainties and potential risks associated with implementation of the Affordable Care Act (ACA), we expect few, if any EPC churches will stop participating in the EPC Medical Plan in 2014. As long as the EPC meets vital Medical Plan goals as outlined below so that enough churches participate to keep it viable, we expect to offer a Medical Plan in 2015 and possibly longer. In fact, despite the uncertainties, we are making substantial changes in 2014 to create greater value now and as long as our Plan exists and meets these goals:
- Access by all eligible employees and dependents
- Coverage options from midrange to comprehensive
- Portable coverage between assignments
- Convenient enrollment, care, and service
- Moral shelter from objectionable contraceptives
- Affordable rates based on cost factors: coverage, location, and age
- Less than 40 years old: Premiums in 2014 will be 50% less than 2013.
- Ages 40-54: Premiums will be 25% less than 2013.
- Ages 55 and older: Premiums will be unchanged from 2013.
- Premium is now named Platinum (91%)
- HDHP is now Gold HSA (86% - including employer’s required HSA contribution)
- Basic is now named Gold (82%)
- Silver is available as of 1/1/14 (74%)
- A new Silver Plan option has been added to help those seeking a lower premium cost alternative.
- Pharmacy benefit management for Platinum, Gold, and Silver will switch from Express Scripts (ESI) to Highmark so all Plan options are administered the same. Highmark uses ESI to fulfill prescription orders so change for most participants will be minimal. Participants will conveniently have one card, one website, and one primary phone number to call.
- All prescription drug costs count toward deductibles and will be paid in full when the combined medical and pharmacy annual maximum out-of-pocket amount is reached. Currently there is no limit on out-of-pocket expenses for prescription drugs.
- Preventive Care – various expansions of coverage plus Women’s Health Addendum. Click here for the list of no-cost 2014 Preventive Care coverage.
- Preventive Care – Mammograms: Women have been covered for one routine mammographic screening annually, beginning at age 40. In 2014, these women will be covered at no cost for an immediate follow up diagnostic mammogram.
- Gold participants’ copayments will count toward the annual deductible.
- All Plans will cover routine care costs for patients participating in clinical trials.
- Maximum HSA contributions were increased in accord with federal regulations.
- Annual maximums for various treatments were eliminated to comply with the Affordable Care Act (ACA).
- For Gold HSA to be consistent with other Plan options, the maximum out of pocket amount was raised by the deductible amount. There is no difference from 2013 in financial impact on participants since the calculation of maximum out-of-pocket has been changed to allow the deductible to count toward it.
- Change in pharmacy benefit manager. Effective January 1, 2014, Highmark will manage our pharmacy benefit program for all Plan options. Highmark has a large network of retail pharmacies and uses Express Scripts for mail order. This change offers more convenience: one ID card for both medical and Rx, one website, and one primary number to call. It also helps cover more prescription expenses for those with greatest Rx needs. Unlike now, Rx costs will combine with medical claims to count toward the annual deductible and out-of-pocket limit, a 2015 ACA mandate that the EPC is providing to participants in 2014. More details will come in the Open Enrollment packet and directly from Highmark.
- Primary benefits administration contact. The administration of our Medical Plan will be outsourced as much as possible to CDS, a professional benefits administrator. (CDS = Central Data Services). CDS will expand its role beyond its current support of enrollment/eligibility records, billing and collection and become the primary contact for all non-claims service. This expanded role will be in place and details will be communicated before Open Enrollment starts on November 1.
Need more info? To talk with someone about Open Enrollment, contact the EPC Benefits Administration office at 877-578-8707. To talk with someone about details of the EPC Medical or Pharmacy Plan, contact Highmark at 800-215-7865 anytime M-F 9am-9pm EST (have Reference Code P0090707 ready).