Plans

For 2020, there are two medical plans offered. Option 1, has an in-network $2,000 individual deductible and a $4,000 family deductible, and Option 2 has an in-network $4,500 individual deductible and a $9,000 family deductible. These are traditional plans that also have co-pays for doctors visits, out-patient behavioral health visits, ER visits, prescription drugs and co-insurance until your out-of-pocket maximum has been met.

Who is Covered

To be eligible to enroll as a subscriber, you must work 30 or more hours a week for the Cumberland Presbyterian Church, it’s boards or agencies, and satisfy the new employee eligibility period of 30 days which is required by the employer.

Medical Continuation

If your employment has been terminated, except for gross misconduct, or a reduction in the number of hours worked by the subscriber no longer makes you eligible for coverage, you have the right to continue coverage for a limited time under the terms of the Consolidated Omnibus Budget Reconciliation Act of 1985 or better known as COBRA. COBRA is a continuation of the present health plan of the CP Church, but administered through Blue Cross Blue Shield. Find out more by going to the BCBST website.

Also included in our continuation plan is the spouse of a minister who has elected Medicare by their 65th birthday. If a spouse needs to continue coverage, but the subscriber has elected Medicare, the spouse can continue coverage under COBRA for up to 36 months. It’s important to take advantage of this option at the time the subscriber turns 65 or else eligibility might be lost.

Any plan participant 55 years or older who has been continuously covered under the Cumberland Presbyterian group health insurance plan for 5 or more years prior to the date coverage would have ended due to no longer meeting eligibility requirements or due to illness, injury or medical condition, may continue coverage as a “retired employee” on a contributory basis. Permiums for this coverage include the subsidies provided by the Premium Stabilization Reserve. Life insurance is not available for this coverage. Coverage will continue until the participant attains age 65 or otherwise becomes Medicare Eligible. Dependents may also be offered coverage with the retiree until age 65 of Medicare Eligible, children until age 26, only if the employee is enrolled in the retiree coverage. This coverage is subject to the terms of the current group policy.

Doctor Visits

For In-network office visits, Blue Cross Blue Shield has a co-pay. Amounts vary depending on the Plan option you choose. For out-of-network office visits, there are no co-pays but your deductible applies. It is always best to use in-network doctors and facilities. Find out more by going to the website www.BCBST.com

Preventive Care

The PPAC Act ( Health Care Reform) in 2010 has made many preventive care services 100% payable by your insurance provider if performed in-network. Annual preventive care check ups enable the detection and treatment of health issues before they become life-threatening. Find out more by going to the website www.BCBST.com.

Prescription Drugs

Prescription and maintenance medications can be used using options. You can fill your prescriptions at a local pharmacy or you can get a 90 day supply through mail order with Express Scripts. You can do your order on-line or telephone. There may be other options available for home delivery in your area , plus you might have a need for specialty medications including high-cost injectable or oral medication that have special handling and distribution requirements. You may call 1-800-565-9140 to find out more about your prescription benefits or go to the BCBST website.

Outpatient Care

The medical plan options cover many outpatient procedures and care including surgeries and test. Some test and scans, such as CAT, PET or MRIs usually need prior authorization. You or your provider should call
1-800-565-9140 for help to see if prior authorization is needed. Find out more by going to the website www.BCBST.com.

Behavioral Health

Services for inpatient and outpatient treatment are available. See the Summary of Benefits or go to www.BCBST.com for more details.

Therapeutic Services

Depending on the type of therapy needed, you have available a limited number of annual benefit period per therapy type. See the Summary of Benefits or go to www.BCBST.com for more details

Skilled Nursing Facility and Rehabilitation Facility Services

Services limited to number of visits. See the Summary of Benefits or go to www.BCBST.com for more details

Home Health Services

Available for up to 60 visits per annual benefit period. Prior authorization may be required to obtain services. See the Summary of Benefits or go to www.BCBST.com for more details

Dental and Vision Program

The Dental and Vision program is a voluntary program through the Guardian Life Insurance Company. There are two plans to chose from and like the medical plans, you have an in-network PPO or you may use an out-of-network provider but with a higher cost for service. Another feature of the dental plan is that a designated amount may be rolled over to the following year if you qualify by not using your full benefit amount in a given year. You may also find information on the website www.guardiananytime.com.

Accidental Death and Dismemberment Policy

Included with your health insurance policy is a $10,000 AD and D policy. The AD and D benefits are designed to help ease the financial burden on you and your family at the time of your death or accident. You may also find information on the website www.usablelife.com.