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Medical Insurance

Plan Documents (pdfs)

Traditional Plan Documents (Cigna Open Access, Anthem PPO 100 & 80)

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Icon2018 CIGNA Open Access Plus Plan

Download 252.09 KB
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Icon2018 Anthem Blue Card PPO 80 Plan

Download 256.71 KB
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Icon2018 Anthem Blue Card PPO 100 Plan

Download 326.95 KB

    Anthem Consumer Directed (High Deductible) Plan Documents

    Note: All individual employers with the fiscal responsibility of funding employee HSA’s should set up an employer funding portal.

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    IconHSA Contribution Options

    Download 59.10 KB
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    Icon2018 Anthem Consumer Directed Plan - 20
    Health Savings Account

    Download 253.55 KB
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    IconConsumer Directed Health Plan Fact Sheet

    Download 133.92 KB

      Dental and Behavioral Plan Documents

      See Mental Health/Substance Abuse tab below for additional information on coverage.

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      Icon2018 Dental Preventive Plan

      Download 374.51 KB
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      Icon2018 Dental Basic Plan

      Download 295.29 KB
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      Icon2018 Dental & Orthodontics Plan

      Download 295.49 KB
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      IconBehavioral Health Pdf

      Download 59.84 KB

        Other Information

        Pharmacy/Prescriptions

        PHARMACY/PRESCRIPTIONS benefit is included along with Anthem BlueCard PPO 100, Anthem BlueCard PPO 80 and CIGNA medical plans

        The provider is Express Scripts

        PRESCRIPTIONS PLAN through Express Scripts

        All plans continue to provide prescriptions through Express Scripts, therefore members may continue using their current Express Scripts card for Pharmacy/Prescriptions.

        Policy numbers

        RxBIN 610014
        RxGroup EPISCPL
        Issuer 9151014609

        Customer Service number 800-841-3361

        Drug Tier

        Retail

        Home Delivery

        Deductible

        None

        None

        Generic

        Up to $10 copay

        Up to $25 copay

        Preferred Brand-Name

        Up to $40 copay

        Up to $100 copay

        Non-Preferred Brand-Name

        Up to $80 copay

        Up to $200 copay

        Dispensing Limits

        Up to 30-day supply

        Up to 90-day supply

         

        • Express Scripts for members enrolled in Anthem Consumer-Directed Health Plan- CDHP–20/H.S.A.

         

        Drug Tier

        Retail and Home Delivery

        Deductible (combined with medical deductible)

        $2,700 individual / $5,450 family

        Generic

        15% coinsurance after deductible

        Preferred Brand-Name

        25% coinsurance after deductible

        Non-Preferred Brand-Name

        50% coinsurance after deductible

        Dispensing Limits

        Up to 30-day supply (retail) or 90-day supply (home delivery

         

        Employee Assistance Program

        Employee Assistance Program

        The Employee Assistance Program (EAP), offered through Cigna Behavioral Health, is a free, confidential 24-hour a day service that assists members and their covered dependents with information, educational materials, resources, referrals, and ongoing support. The plan covers unlimited telephone consultations and up to 10 face-to-face counseling sessions per issue at no member cost.

        We encourage you to promote this valuable service to your employees. You may also contact this program for advice on how to handle a workplace situation, or to find resources for helping people cope with a variety of disasters and challenging situations, such as floods and hurricanes.

        The trained professional EAP staff can provide:

        • 24/7 phone access for behavioral health issues
        • Referrals for in-person counseling (including up to 10 sessions, per topic or issue, with no copay)
        • Legal consultations
        • Tips for balancing work and family
        • Resources for more help in your community.

        There are also online resources on such issues as:

        • Emotional well-being and life events
        • Family and care-giving
        • Health and wellness
        • Daily living
        • Disaster Resource Center

        To access EAP services, call (866) 395-7794, 24 hours a day, 7 days a week, or sign in to the website Cigna Behavioral Health (password: episcopal).

        Behavioral Health Benefits (Mental Health/Substance Abuse)

        Benefit is provided/managed by CIGNA.

        Accessing Benefits
        Contact Cigna Behavioral Health at (866) 395-7794, 24/7
        Log into cignabehavioral.com
        Password/ID is: Episcopal

        There are no cards provided.

        Employee Assistance Program (EAP) provided through Cigna Behavioral Health (see separate tab).

        Provided through Anthem BCBS
        • Individual, family, couples, group therapy

        • Applied Behavioral Analysis

        • Inpatient Benefits
        Contact Anthem at the number on your ID card, 24/7
        Log into www.anthem.com.
        Preauthorization is required for inpatient services and some extensive outpatient services.

        Employee Assistance Program (EAP) provided through Cigna Behavioral Health (see separate tab).

        Lifetime Maximum Benefit

        The Annual and Lifetime Benefit Maximum has been eliminated.

        Dependent Children Coverage

        Children remain eligible for coverage to age 30.

        Now they do NOT have to:

        • Live at home
        • Be full time students
        • Be unmarried
        • Have no dependents of their own

        Value-Added Benefits

        The healthcare plans offered by the Medical Trust offer value –added benefits for participants, they include:

        Health Advocate

        A member needs help resolving an insurance claim, understanding a complex medical condition, or finding services for an elderly parent. How can you help?

        Direct him or her to Health Advocate, where professional advocates, typically registered nurses backed by a team of experts, help members navigate the health care system.

        This free, confidential service can help members:

          • Find the best hospitals, doctors, and other health care providers

          • Obtain second opinions

          • Schedule appointments with hard-to-reach specialists

          • Resolve benefits claims and issues

          • Correct billing mistakes

          • Better understand their condition

        Call (866) 695-8622, 24 hours a day, 7 days a week. Normal business hours are Monday through Friday, 8 a.m. to 9 p.m. ET.or sign in to the website Health Advocate (password: episcopal).

         

         

        Vision

        EyeMed Vision Care

        In 2018 vision benefits will be provided through EyeMed Vision Care’s Insight Network.

        Insight Network offers:

        • More generous frames and contact lenses allowance
        • Enhanced benefits for progressive lenses
        • Fewer providers than in EyeMed’s Access Network

        Is your provider in the Insight Network? Call (866) 723-0513, or visit www.eyemedvisioncare.com/ecmt.

        Your EyeMed Benefits

        $0 copays for annual eye exams with in-network providers*

        • Annual allowance for contacts or frames, plus discounts if you go over your allowance when using network providers
        • Additional eyewear purchases at 40% off
        • Non-prescription sunglasses at 20% off
        • 20% off remaining balances beyond plan coverage limits Savings on prescription eyeglasses or contact lenses
        • Discounted LASIK or PRK surgical procedures

        In-Network

        There are two ways to find in-network providers and schedule exams

        Out-of-Network

        • Consult Summary of Benefits for information on reimbursement for covered services
        • Mail an itemized bill from your provider with the claim form to EyeMed Claim form on: www.cpg.org

        •Claims processing may take 3–4 weeks

        Hearing

        Medical Trust health plans include a hearing discount plan, which provides discounts on hearing exams and supplies.

        Hearing Discounts

        Hearing discounts are offered through HearPO for Medical Trust plans.

        The HearPO network offers discounts for hearing aids and supplies through more than 1,400 HearPO affiliates across the U.S. These discounts are also available to extended family members. To access these discounts, family members simply mention that they are related to the member and identify themselves as a member of an Episcopal Church Medical Trust health plan.

        HearPO provides:

        • Testing performed by licensed hearing-care professionals
        • Comprehensive follow-up services at no cost for one year
        • Savings on all styles of hearing instruments and all levels of technology
        • Discounts on hearing aid repairs
        • 60-day trial period with a money-back guarantee
        • Free demonstrations of the latest available technologies

        Travel Medical Assistance

        FrontierMEDEX provides emergency medical and travel assistance for Medical Trust plan members traveling at least 100 miles from home, either in the U.S. or abroad, 24 hours a day, 7 days a week. With FrontierMEDEX's assistance, members have access to worldwide medical and dental referrals, emergency medical treatment, replacement of travel documents and other services.

        The program includes:

        • Assistance in obtaining medical treatment. FrontierMEDEX's staff will help make the arrangements for local referrals for treatment or evacuation due to a medical emergency.
        • Assistance with providing insurance information and medical records for treatment
        • Replacement of prescriptions, medical devices and corrective lenses
        • Emergency travel arrangements and replacement of lost or stolen travel documents
        • Emergency fund transfers

        FrontierMEDEX is not responsible for the member's medical costs.

        Diocesan Benefits Coordinator

        Ms. Sara Saavedra
        Convention Officer, Assistant Secretary of Convention, Diocesan Benefits Coordinator, Secretary to the Standing Committee

        Telephone: 212-316-7423
        Fax: 212-316-7420
        ssaavedra@dioceseny.org

        Group Policy Number Quick Reference

        Anthem medical plans

        For both Anthem Plans (BlueCard PPO 100 and BlueCard PPO 80) Group Policy Number is:

        003330125
        Plan Code 834/332

        Customer Service number 1-844-812-9207

        Anthem
        3000 Goffs Falls Road, Manchester, NH 03111-0001.
        www.anthem.com

        CIGNA Open Access Plus             

        Group Policy # 3328261

        CIGNA
        P O Box 182223
        Chattanooga, TN 37422-7223
        Phone: 1-800-244-6224
        www.cigna.com     

        PRESCRIPTIONS PLAN through Express Scripts

        All plans continue to provide prescriptions through Express Scripts, therefore members may continue using their current Express Scripts card for Pharmacy/Prescriptions.

        Policy numbers

        RxBIN 610014
        RxGroup EPISCPL
        Issuer 9151014609

        Customer Service number 800-841-3361

        Vision Care for Eyeglasses is provided by EyeMed Vision Care’s Insight Network

        Group Policy Number 9682527

        1-866-723-0513
        www.eyemedvisioncare.com

        Mental Behavioral through CIGNA

        No cards provided

        Employer ID: Episcopal

        www.cignabehavioral.com
        (866) 395-7794         

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