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Medical Insurance


Plan Documents (pdfs)

2020 Plans

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2020 Employee Medical and Dental Enrollment Form

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2020 Dental ECMT DPPO DDPV

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2020 Dental ECMT DPPO DD50

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2020 Dental ECMT DPPO DD25

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2020 Cigna CDHP20 HSA

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2020 Anthem CDHP20 HSA

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2020 Cigna PPO 100

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2020 Cigna PPO 80

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2020 Anthem BlueCard PPO 80

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2020 Anthem BlueCard PPO 100

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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.

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      HSA Contribution Options

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      Consumer 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.

          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