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The Episcopal Diocese
of New York

1047 Amsterdam Avenue
New York, NY 10025
Tel: (212) 316-7400
info@dioceseny.org
 


Medical Insurance


Plan Documents (pdfs)

2020 Plans

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

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

        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.

          Dental and Behavioral Plan Documents

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

            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 BenefitsContact Cigna Behavioral Health at (866) 395-7794, 24/7Log into cignabehavioral.comPassword/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, 24/7Log 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

            Office: 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