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
Plan Provision
Network
Non-Network
Annual deductible (single/family)
$0 / $0 NA
Annual out-of-pocket (OOP) maximum (single/family)
$1,500/
$3,000
Office visit copay/coinsurance
$0 Preventive
$20 PCP or
Specialist
Member coinsurance
You pay 0%
Inpatient hospital copay/coinsurance
You pay of $0
Outpatient hospital copay/coinsurance
You pay $20
SLIDE 12: (NEXT: NETWORK ACCESS DIRECTIONS)
NETWORK AND NON-NETWORK DED AND OOP CALCULATED SEPARATELY
NOTE PLUS POINTS: NETWORK DEDUCTIBLES LOWER, $10 PREVENTIVE

5. Kaiser MidOption EPO
Plan Provision
Network
Non-Network
Annual deductible (single/family)
$0 / $0 NA
Annual out-of-pocket (OOP) maximum (single/family)
$2,000/
$4,000
Office visit copay/coinsurance
$0 Preventive
$20 PCP/
$30 Specialist
Member coinsurance
You pay 0%
Inpatient hospital copay/coinsurance
You pay $250
Outpatient hospital copay/coinsurance
You pay $100
SLIDE 12: (NEXT: NETWORK ACCESS DIRECTIONS)
NETWORK AND NON-NETWORK DED AND OOP CALCULATED SEPARATELY
NOTE PLUS POINTS: NETWORK DEDUCTIBLES LOWER, $10 PREVENTIVE

6. Kaiser EPO 80
Plan Provision
Network
Non-Network
Annual deductible (single/family)
$500 / $1,000 NA
Annual out-of-pocket (OOP) maximum (single/family)
$3,000/
$6,000
Office visit copay/coinsurance
$0 Preventive
$25 PCP/
$35 Specialist
Member coinsurance
You pay 20%
Inpatient hospital copay/coinsurance
Outpatient hospital copay/coinsurance
SLIDE 12: (NEXT: NETWORK ACCESS DIRECTIONS)
NETWORK AND NON-NETWORK DED AND OOP CALCULATED SEPARATELY
NOTE PLUS POINTS: NETWORK DEDUCTIBLES LOWER, $10 PREVENTIVE

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. You pay 20%. Subject to copay of $100 per Day/ Max $600 per Admission
Empire BCBS PPO 80/60 at a Glance
Plan Provision
Network
Non-Network
Annual deductible (single/family)
$600 / $1,000
$1,000 / $2,000
Annual out-of-pocket (OOP) maximum (single/family)
$1,500/$3,000
$4,500 / $9,000
Office visit copay/coinsurance
$0 Preventive
$25 PCP
or Specialist
You pay 40%
Member coinsurance
You pay 20%
Inpatient hospital copay/coinsurance
You pay 20%. Subject to copay of $100 per Day/ Max $600 per Admission
Outpatient hospital copay/coinsurance
SLIDE 12: (NEXT: NETWORK ACCESS DIRECTIONS)
NETWORK AND NON-NETWORK DED AND OOP CALCULATED SEPARATELY
NOTE PLUS POINTS: NETWORK DEDUCTIBLES LOWER, $10 PREVENTIVE

10. Empire BCBS HDHP at a Glance
Plan Provision
Network
Non-Network
Annual deductible (single/family)
$2,700 / $5,450
$3,000 / $6,000
Annual out-of-pocket (OOP) maximum (single/family)
$1,500/$3,000
$4,000 / $7,000
Office visit copay/coinsurance
$0 Preventive
You pay 20%
You pay 45%
Member coinsurance
Inpatient hospital copay/coinsurance
Outpatient hospital copay/coinsurance
SLIDE 12: (NEXT: NETWORK ACCESS DIRECTIONS)
NETWORK AND NON-NETWORK DED AND OOP CALCULATED SEPARATELY
NOTE PLUS POINTS: NETWORK DEDUCTIBLES LOWER, $10 PREVENTIVE

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 Plan Single Single Plus Spouse Single Plus Child
Family
% Increase
Kaiser
HighOption
$615
$1,230
$1,107
$1,845 NA
MidOption
$599
$1,198
$1,078
$1,797
EPO 80
$494
$988
$889
$1,482
Empire BCBS PPO 80/60
$669
$1,340
$1,205
$2,008
4.7%
Empire BCBS HDHP/HSA
$510
$1,022
$919
$1,532 2%

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 Standard Empire HDHP Kaiser Retail Mail Order
Annual Prescription Deductible
$50 per person
none
$2,700 per person $5,450 per family (combined with medical deductible)
Copays
Tier 1:
Generic
Up to
$10
$25
You pay 15% after deductible
Up to $10
Tier 2: Formulary
$30
$70
You pay 25% after deductible
Up to $30/$20/
Up to $60/$40/
$50
Tier 3:
Non-Formulary
$120
You pay 50% after deductible NA
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)

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”
Step Therapy – certain meds will be dispensed only if other meds used to treat condition have been tried and failed.

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
Step therapy is the process of initiating drug therapy utilizing evidenced based medicine.
This may mean that a medication that has been available for a number of years is often
just as effective, yet less costly, than the newest drug on the market.
Under step therapy, certain medications will be dispensed only if other medications used
to treat your medical condition have been tried and failed.
Using information on file such as medical history, drug history, age, and gender,
a medication will either be authorized or denied for coverage.
Example: Forteo (osteoporosis) Covered if there has been prior use of Actonel, Fosamax or Boniva.
Some medications are covered only after a prior authorization is granted.
Some authorizations review the need for the medication.
Example: erectile dysfunction medications
qty 6/30 days qty18/90days
Some authorizations review the quantity prescribed
Example : hypnotic medications
qty 21/30 days qty 60/90days

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
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)
Important to note that if provider isn’t cooperative with medco – more work required on member’s part.

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. Achieve Work/Life Balance
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
SLIDE 24:
“… WILL HELP YOU FIND …”
Stories:
Mine, Sylvia’s

25. Employee Assistance Program (EAP)
2007 CBH Data
EAP Utilization – 4%
Web Presentations – 8.6%
2008 CBH Data
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. Help is only a phone call away!
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

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…
SLIDE 26:
If you call, you will be assigned one person, usually a nurse, to help with your issue. These are some of the things you may find you need help with.
(Story: Mary Johnson – makes a business of this for private clients.)
No cost to you to use this service – let them help you!

30. You pay entire balance over $130
Vision by EyeMed
Plan Provision
Network
Non-Network
Eye Exam
You pay $0
Plan pays up to
$30
Lenses
single vision
bifocal
trifocal
You pay
$10
$32
$46
$57
Frames
$130 allowance
20% off balance over $130
$47
Contact Lenses
Conventional
15% off balance over $130
$100
Disposable
You pay entire balance over $130
SLIDE 30: (NEXT: MEDCO/HEARPO)
“WHO IN THIS ROOM HAS HAD AN EYE EXAM IN THE PAST 12 MONTHS?”
YOUR ANNUAL EYE EXAM (INCLUDING DILATION) IS FREE. THIS IS AN IMPORTANT PART OF MAINTAINING YOUR GENERAL GOOD HEALTH.
REVIEW BENEFITS CHART
ADDITIONAL DISCOUNTS: ADDITIONAL DISCOUNTS ON EYEGLASSES, EYECARE SUPPLIES, LASIK PROCEDURES, REPLACEMENT CONTACT LENSES. SEE FLYER IN YOUR WELCOME PACKET

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 Plan Provision Preventive Basic Dental & Orthodontia
Preventive Services
(includes 3 cleanings per year)
100%
Basic Services
80%
85%
Major Services 1%
50%
Orthodontic Services 0%
($1,500 lifetime Max)
Deductible
N/A
$50 / $150
$25 / $75
Non-Network Benefit
(based on network-approved rates)
Same as
In-Network
Annual Benefit Maximum
(in addition to preventive care)
$1,500

33. Dental Plan Pricing Plan Single Single Plus Spouse Single Plus Child
Family
% Increase
Preventive
$18
$32
$50
11.4%
Basic Dental
$90
$141
4.7%
Dental & Orthodontia
$64
$113
$174
2.8%

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:
or call
TTY
What is a Medigap policy?
A Medigap policy is a health insurance policy sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. The front of the Medigap policy must clearly identify it as “Medicare Supplement Insurance.”
In all but three states, Minnesota, Massachusetts, and Wisconsin, there are 10 standardized Medigap plans called “A” through “J.” Each plan A through J has a different set of standardized benefits. Plan A covers only the basic core benefits. These basic benefits are included in all the Plans, A through J. Plan J offers the most benefits. There will be more information about the plans available in Minnesota, Massachusetts, and Wisconsin on a later slide.
When you buy a Medigap policy, you pay a premium to the insurance company. As long as you pay your premium, a policy bought after 1990 is automatically renewed each year. This means that your coverage continues year after year as long as you pay your premium. You still must pay your monthly Medicare Part B premium.
However, in some states, insurance companies may refuse to renew Medigap policies that you bought before The law in these states did not say these policies had to be automatically renewed each year (guaranteed renewable) at the time these policies were sold.

40. The standard Part B premium stays the same - income related
Medicare 2009
You Pay
If Your Annual Income is
Single
Married Couple
$96.40
$85,000 or below
$170,000 or below
$134.90
$85,001-$107,000
$170,001-$214,000
$192.70
$107,001-$163,000
$214,001-$320,000
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
What is a Medigap policy?
A Medigap policy is a health insurance policy sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. The front of the Medigap policy must clearly identify it as “Medicare Supplement Insurance.”
In all but three states, Minnesota, Massachusetts, and Wisconsin, there are 10 standardized Medigap plans called “A” through “J.” Each plan A through J has a different set of standardized benefits. Plan A covers only the basic core benefits. These basic benefits are included in all the Plans, A through J. Plan J offers the most benefits. There will be more information about the plans available in Minnesota, Massachusetts, and Wisconsin on a later slide.
When you buy a Medigap policy, you pay a premium to the insurance company. As long as you pay your premium, a policy bought after 1990 is automatically renewed each year. This means that your coverage continues year after year as long as you pay your premium. You still must pay your monthly Medicare Part B premium.
However, in some states, insurance companies may refuse to renew Medigap policies that you bought before The law in these states did not say these policies had to be automatically renewed each year (guaranteed renewable) at the time these policies were sold.

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
Benefit Type
Medicare
Part A & B
Comprehensive
Plus
Premium
Medical Benefits
Annual out-of-pocket maximum (medical only)
No limit
$2,000
$1,750
$1,500
Medicare inpatient deductible
(days 1-60)
Member Pays $1,068
Member pays $390
Member pays $150
Plan pays 100%
Inpatient co-insurance
(days 61–90)
Member Pays $267/day
(days 90+)
Member Pays $534/day
SNF
(days 21–100)
Member pays $133.50/day
(100 day limit)

48. 2010 Medicare Supplement Plans
Benefit Type
Medicare
Part A & B
Comprehensive
Plus
Premium
Durable Medical Equipment
Member pays 20%
Plan pays 100%
Physician office visits
Member pays $20
Member pays $15
Routine physical
Only first "Welcome to Medicare" visit covered
Plan pays 100% ($200 limit)
Outpatient Hospital/Surgery
Member pays various amounts
Member pays $275
Member pays $175
Diagnostic laboratory services
All other services
Plan pays 70%
Plan pays 80%

49. United HealthCare Website

50. 2010 Medicare Supplement Pharmacy
Benefit Type
Medicare Part A & B
Comprehensive
Plus
Premium
Pharmacy Benefits
Retail Deductible
Not covered
$50
Retail - 30 day supply Generic/
Formulary brand/
Non-formulary brand
$10/$30/$50
$5/$25/$40
Mail - 90 day supply Generic/
$25/$70/$120
$12/$60/$100

51. Value-Added Benefits Vision Benefits Hearing Benefits
Employee Assistance Program
Travel Benefits

52. Vision Benefits For 2010 $0 in network payment for exam
EyeMed Access A Plan
ID CARD - front and back
For 2010
$0 in network payment for exam
$10 for lenses and frames (up to $130 allowance)
Out of network reimbursement schedule
12 month benefit for all services
Contact: (866)

53. Hearing Assistance Benefit
The plans are designed and financially underwritten by the Medical Trust
United Healthcare (UHC) manages the claims
HearPO is the provider network
Contact:
Tel (888)

54. Hearing Assistance Benefit
Diagnostic hearing services
Hearing Aids
Batteries
Other supplies
Comprehensive and Plus Plans:
$1,000 per ear every 5 years
Premium Plan
$2,000 per ear every 5 years

55. Employee Assistance Program (EAP)
Services can be via telephone or face-to-face
17,000 providers nationwide
EAP services are available up to 10 sessions at a time per issue with no copay
There can be multiple episodes of treatment per calendar year
Geographic availability of services
Urban – 99.6% of covered members have access
Rural – 97.2% of covered members have access
As telephone services are available, access to an EAP is virtually 100%

56. Travel Protection United Healthcare (UHC) is the claims processor
Medex is for assistance 100 miles from home and assistance and urgent and emergency medical care abroad
Contact:
(410)

57. Travel Protection Benefit
100% of medically necessary treatment
Inpatient or outpatient
Accidental bodily injury or acute illness
Emergency evacuation
Visitor travel assistance (7+days in hospital)
Repatriation if medically necessary
Trip maximum: $25,000
Lifetime maximum: $200,000
Care must occur outside the U.S.
Travel benefits do not co-ordinate with Medicare

58. Retiree Dental Benefits – 2010
CIGNA is the provider network
3 plans available for purchase through the Medical Trust
Can see non-network dentists on all plans
Network benefits better in most cases
3 preventive cleaning visits per person per year
Not counted toward the $1,500 annual benefit max
Contact CIGNA
(800)

59. Denominational Health Plan

60. National Health Care Conversation
"Vigorous grassroots efforts” are at play — both in support of and in opposition to current reform efforts.
The Senate Finance Committee approved its bill on October 12, with one Republican voting in favor.
The Senate Health, Labor, Education, and Pensions Committee has already approved its bill.
Getting close to full action by the House and Senate.

61. Denominational Health Plan (DHP)
The 76th General Convention passed a Resolution
establishing a church-wide health plan to be
administered by the Medical Trust and fully
implemented by January 1, 2013.
Participation required by all domestic U.S. dioceses, congregations, cathedrals, parishes, missions, chapels.
Guidelines provided for parity between clergy and lay.

62. Denominational Health Plan Attributes
The DHP is a healthcare benefits delivery model for TEC
All domestic U.S. dioceses, including the Virgin Islands, are required to participate, as are cathedrals, parishes, missions and chapels.
Dioceses will determine whether diocesan institutions, schools and agencies will be required to participate.
All clergy and lay employees who are regularly scheduled to work 30 or more hours per week or 1,500 or more hours per year are covered under the DHP.

63. Denominational Health Plan Attributes
The DHP is a healthcare benefits delivery model for TEC (con’t)
Employees who work more than 20 hours per week but less than 30 hours per week may voluntarily participate.
Employers may not opt out of the DHP.
Employees who have comparable healthcare benefits through other approved sources may opt out (e.g. spousal coverage, Tricare, Medicare).

64. Mandatory Lay Pension Plan

65. Mandatory Lay Pension Attributes
Applies to employees of domestic dioceses, parishes, missions, and other official entities of TEC that are scheduled to work at least 1000 hours per year
Other societies, organizations, or bodies in TEC may participate if they meet the CPG guidelines
Initially includes defined benefit and defined contribution plans
Defined benefit plans require the group to contribute 9% - note that the clergy contribution is 18%
Defined contribution plans require the group to contribute 5% and to match the employee’s contributions up to 4%
Groups may keep existing defined benefit plans if they provide the same benefits as the CPG plans, or amend them by January 1, 2012; schools may keep existing TIAA-CREF plans
Fully implemented by January 1, 2012; can start any time

66. Wellness Strategy for the Episcopal Church

67. Focus on Population Based Wellness
Previously:
Health plans focused on disease management
Emphasis was placed on those already ill.
Now the focus is:
Helping the healthy stay healthy
Reducing health risks and encouraging healthier lifestyle choices
Slide 38: (NEXT: RESPONSIBILITY / ICEBERG)
A NEW WAY OF THINKING ABOUT HEALTH CARE: FOCUSING ON WELLNESS, RATHER THAN ILLNESS.
IT’S MUCH EASIER, LESS COSTLY FOR YOU AND YOUR EMPLOYER, AND LESS STRESSFUL TO MAINTAIN GOOD HEALTH THAN IT IS TO GET IT BACK WHEN IT’S LOST.

68. Our Vision and Goal: Well to Serve
Create a culture of wellness that supports Episcopal clergy and lay employees as well as their families in their efforts to start and sustain healthy behaviors to improve or maintain their overall health, well-being, and quality of life, thereby reducing unnecessary healthcare costs and enabling all to be
“ Well to Serve”

69. ECMT Wellness Strategy
Assess & Identify:
The strategy begins by gathering health data obtained though our claims data warehouse.
Gaining an understanding of our overall health status allows us to identify health risks and target programs to address these issues.

70. Wellness Strategy Raise Awareness and Engage Members:
Promote health, wellness and prevention
Educate members:
impact of healthcare costs
impact of behaviors & lifestyle
Provide:
communications on prevention screenings
resources to promote wellness related programs

71. Wellness Strategy Measure and Report: “Well to Serve”
To determine the impact of health and wellness programs/incentives
Track participation in programs
Track utilization of preventive screenings
Provide feedback to the church regarding the health of our clergy and lay employees and our progress toward creating a culture of
“Well to Serve”

72. Can we improve the overall health of TEC?

73. Visible Cost of Health Care
Taking Personal Responsibility
Think like a consumer when using your healthcare benefits.
Take personal responsibility to:
Improve your own health
Manage costs (for yourself and your plan)
Make thoughtful decisions when selecting and using coverage
Visible Cost of Health Care
SLIDE 39: (NEXT: COST DRIVERS)
“As employees of the Episcopal Church, we‘re blessed to have an employer who makes sure that we have access to health care coverage. This means that we pay out of pocket only a small part of the actual cost of our health care services. Like the iceberg, with only about10% of its mass visible, most of us are probably aware of only a tiny portion of the true cost of the care we receive.”
“THIS IS THE ONLY SYSTEM I CAN THINK OF WHERE THE CONSUMER OF THE GOODS IS NOT THE ONE WHO PAYS THE BILL. FOOD FOR THOUGHT: IMAGINE THAT YOUR EMPLOYER AGREED TO PAY THE BILL FOR YOUR GROCERIES … AND THEN IMAGINE WHAT YOUR SHOPPING CART WOULD LOOK LIKE!”
Real Health
Care Costs

74. The Impact of Poor Health
50% of health care costs are preventable
% of all premature deaths/illnesses in the U.S. attributable to unhealthy lifestyle habits
% of costs incurred by those with chronic illness
50% of costs are generally from 5% of membership

75. Risk Factors Smoking Obesity Uncontrolled Hypertension
Untreated Hyperlipidemia (high cholesterol)
Improper Safety Precautions
Couch-Potato Lifestyle
Poor Nutrition
Stress
Our Actions & Inaction Make a Difference

76. Now the Good News…
Smart choices can prolong your life and improve the quality of your life.

77. Health – A Lifelong Journey
What is one thing you can do in the next 24 hours…
that will start you on the path to better health?

78. Focus Plan Designs and Programs
Network preventive care coverage
Preventive care $0 copay
3 annual dental cleanings & oral examinations
Annual eye exam $0 copay
Health fairs, monthly “Health News” mailings
Nutritional counseling, smoking cessation
Partnering with vendors that offer:
World-class informational web access
24 hour nurse lines in all plans
Condition and case management
Health risk assessments
SLIDE 45: (NEXT: CARTOON: LIFELONG JOURNEY, NOT A DESTINATION)
THE MEDICAL TRUST PROVES OUR COMMITMENT TO WELLNESS EVERY DAY. HERE ARE JUST A FEW OF THE WAYS: (REVIEW LIST)
NOTE: I’VE BEEN ASKED WHY WE GIVE AWAY SO MANY SERVICES FREE OR AT LOW COST. THAT’S EASY: WHEN YOU, OUR MEMBERS, ARE HEALTHY, THE COSTS OF EVERYTHING ELSE ARE LOWER, AND YOU’RE BETTER ABLE TO CONTRIBUTE TO YOUR FAMILY, CHURCH AND COMMUNITY … THE ULTIMATE “WIN-WIN”!

79. Questions / Discussion