Pick your plan: After fall of insurance education, covered clergy and…

By Jessica Brodie

It’s decision time.

By Nov. 16, clergy and laity covered by United Methodist conference insurance will need to make an educated choice about which insurance plan they wish to enroll in for the coming year. And if conference benefits leaders have their way, every person will make that choice confident and fully aware of exactly what kind of coverage they need and can afford.

A new array of health options was approved at Annual Conference, and the plans will go into effect Jan. 1. Existing conference insurance will be replaced by a full UMC-designed group health plan with six different HealthFlex medical plans (paired with prescription drug and optional dental and expanded vision plans) that enable participants to choose a plan that fits their personal medical needs and budget. All six of the plans feature the same health plan partners (Blue Cross Blue Shield of Illinois, OptumRX, United Behavioral Health, VSP for vision, with the additional of Cigna for optional dental coverage), and there will be no need to change doctors, hospitals or pharmacies. The plans will also include more customer support and the same wellness incentives currently offered.

The changes do not affect retirees 65 and older.

“It’s a new way to think about insurance: as a means to manage financial risk of health costs,” said the Rev. David Anderson, conference pensions and health benefits officer, at one of 26 workshops held September and October in all 12 districts of the South Carolina Conference. “We’re living in a dynamic time right now, and the market is changing hour by hour.”

Anderson said that between the workshops, two online tools (ALEX Benefits Counselor and MyChoice, both on the HealthFlex/Wespath website at www.wespath.org) and a telephone counselor at 844-688-1375, he hopes people will take the time to learn and select the best choice for them. If they do not select a plan, a default plan will be selected for them, but Anderson’s goal is that everyone plays an active role in selecting the best plan for his or her unique situation. The tools are simple and user-friendly, he said—and necessary.

“It is my opinion that 90 percent of those covered under conference insurance were over-insured,” Anderson said.

The new plan choices will help local churches and clergy and lay employees control costs and have an array of options.

Plans and prices

There are six plans from which to choose. All plans cover 100 percent wellness visits. Churches will each be billed $966/month regardless of which plan their pastor chooses. Individual participants will receive a defined contribution credit by tier: $611 participant only, $1,233 participant plus one and $1,646 participant plus family. (For early retirees, younger than 65, it’s $100 participant only, $200 participant plus one and $100 per dependent for participant plus family.)

The plans are designated gold, silver or bronze. Gold plans have higher premiums but lower deductible/out-of-pocket costs. Silver plans have lower premiums but higher deductible/out-of-pocket costs. Bronze plans have lowest premiums but highest deductible/out-of-pocket costs.

Plans and prices for active participants are as follows (early retirees younger than age 65 must contact the conference benefits office at 803-786-9486 for their rates):

PPO B1000 P1—Gold Plan. This is a traditional PPO plan with co-pays; it is the most expensive option for monthly premiums but offers the lowest deductible and out-of-pocket costs. Deductible is $1,000 individual/$2,000 family. Office visits are a $30 copay, then the plan pays 100 percent. Other medical services require meeting the deductible; then the plan pays 80 percent. For preferred brand prescription drugs, the participant pays 20 percent co-insurance. There is no health account funding. The out-of-pocket maximum is $5,000 single/$10,000 family. Participant monthly cost: $304/participant only, $602 participant plus one and $865 participant plus family.
CDH C2000 P2 (Default Plan)—Gold Plan. This is a consumer-driven health plan, with moderate deductible and out-of-pocket costs and allows participants to use a Health Reimbursement Account. Deductible is $2,000 individual/$4,000 family. Office visits and other medical services require meeting the deductible; then the plan pays 80 percent. For preferred brand prescription drugs, the participant pays 25 percent co-insurance. HRA is $1,000 single/$2,000 family. The out-of-pocket maximum is $6,000 single/$12,000 family. Participant monthly cost: $260/participant only, $597 participant plus one and $793 participant plus family.
HDH H1500 P3—Gold Plan. This is a high-deductible health plan that allows participants to use a Health Savings Account. Deductible is $1,500 individual/$3,000 family (or if any dependents covered). Office visits and other medical services require meeting the deductible; then the plan pays 80 percent. For preferred brand prescription drugs, the participant pays the deductible, then 25 percent co-insurance. HSA is $750 single/$1,500 family. The out-of-pocket maximum is $6,000 single/$12,000 family. Participant monthly cost: $252/participant only, $497 participant plus one and $721 participant plus family.
CDH C3000 P2—Silver Plan. A consumer-driven health plan, this has lower-priced premiums with moderate deductible and out-of-pocket costs and allows participants to use an HRA. Deductible is $3,000 individual/$6,000 family. Office visits and other medical services require meeting the deductible; then the plan pays 50 percent. For preferred brand prescription drugs, the participant pays 25 percent co-insurance. HRA is $250 single/$500 family. The out-of-pocket maximum is $6,500 single/$13,000 family. Participant monthly cost: $139/participant only, $270 participant plus one and $410 participant plus family.
HDH H2000 P4—Silver Plan. A high-deductible health plan, this allows participants to use an HSA and features lower-priced premiums. Deductible is $2,000 individual/$4,000 family (or if any dependents covered). Office visits and other medical services require meeting the deductible; then the plan pays 70 percent. For preferred brand prescription drugs, the participant pays the deductible, then 25 percent co-insurance. HSA is $500 single/$1,000 family. The out-of-pocket maximum is $6,500 single/$13,000 family. Participant monthly cost: $179/participant only, $347 participant plus one and $517 participant plus family.
HDH H3000 P5—Bronze Plan. A high-deductible health plan, this allows participants to use an HSA and features the lowest-priced premiums. Deductible is $3,000 individual/$6,000 family (or if any dependents covered). Office visits and other medical services require meeting the deductible; then the plan pays 40 percent. For preferred brand prescription drugs, the participant pays the deductible, then 60 percent. HSA is through participant contributions only. The out-of-pocket maximum is $6,500 single/$13,000 family. Participant monthly cost: $71/participant only, $132 participant plus one and $222 participant plus family.

Optional dental

Participants also have the option to enroll in dental plans and vision plans regardless of which medical plan they choose.

There are three dental plans:

1) Dental Passive PPO 2000 (monthly cost is $56/participant only, $113 participant plus one and $158 participant plus family).

2) Dental PPO (monthly cost is $46/participant only, $92 participant plus one and $129 participant plus family).

3) Dental Passive PPO 1000 (monthly cost is $42/participant only, $83 participant plus one and $116 participant plus family).

For each plan, preventive and diagnostic care are covered at no charge, but basic restorative care (e.g. fillings, anesthesia, root canals, etc.), major restorative care and orthodontia are covered at a percentage depending on the plan chosen.

Optional vision

For vision, there are three plans:

1) Vision Core (free; every participant is automatically covered by this).

2) Vision Full Service (monthly cost is $5.62/participant only, $9.06 participant plus one and $14.32 participant plus family).

3) Vision Premier (monthly cost is $14.38/participant only, $23.32 participant plus one and $37.02 participant plus family).

For each plan, a WellVision Exam costs a $20 copay. Beyond that, the free Vision Core plan has no coverage, but for the other two plans, prescription glasses, frames, lens details and lens enhancements are covered at varying price points based on the plan selected.

Annual Election Nov. 1-16

Every person must make a selection during Annual Election between Nov. 1-16 at www.wespath.org.