Frequently Asked Questions for Pension and Health Benefits
Additional Information:
I would like to take this opportunity to correct a comment I made to The Advocate. I was excited about offering the Consumer Driven High Deductible Plan as a cost reduction plan and accidently led the editor to state that the Board approved offering the Consumer Driven High Deductible Plan as optional for 2012 to change everyone to this plan in 2013. That is not the case. The Board approved ONLY offering this plan as an option. Much further analyses will have to occur to move everyone to the plan and that would not happen in the foreseeable future.
Also, on page 31, line 2 of your Pre-Conference Material there is a date: August 31, 2010 that should read August 31, 2011.
1. What will be the cost to participants for the new percent pay pharmacy? Will the deductible change for participants for 2012?
The cost to participants is varied by the individual. The main shift is from a fixed copayment for the drugs in tiers 1, 2, & 3 to a percentage copayment for the same drugs. Specific information is found in your per conference materials. There has been no change in deductibles on the Medical portion of the Health Plan for 2012. The retail pharmacy deductible is not in effect under the 2012 percentage copayment plan. The Consumer driven high deductible plan does have $2,000 deducible but also has a funded Health Reimbursement Account (HRA) of $1,000.
2. Why can the conference not divide clergy into lifestyle pools? We have clergy who are actively engaging in healthy lifestyles while others don’t seem to care.
In group health plans it is administratively impractical to have lifestyle pools. Currently, the Conference utilizes the incentives and disincentives to separate those who actively engage in healthy lifestyles and those who don’t.
3.Is this plan of percentage co pay for tiers 2 and 3 drugs not discriminating against those with mental illness and other medical problems in which the physicians have prescribed non-preferred or brand named drugs?
The plan is not discriminating against any one with any diagnoses. The plan simply states that the tier 2 and 3 are those pharmaceutical companies that negotiate with the Pharmacy Plan Manager.
4. You keep saying that the Board is cognizant of the cost to the churches. What about to the clergy who have no control of their salary?
The Board spends a great deal of time analyzing and debating the impact of plan changes and how it impacts the participants of the program. But, when all is said and done the decision on benefits payments is made by the local church based on the amount of resources available. That is the same resource pool that the church has available for clergy salaries and other ministries.
5. Under the new optional High Deductible Consumer Drive Plan, after the higher deductible is met are the medical expenses paid at 100%?
After meeting the deductible, the plan pays a benefit of 80% of covered charges. There is an annual out-of-pocket limit of $5,000 per individual/$10,000 per family. This includes annual deductible and co-insurance. However, preventive services are covered at 100%. The Pharmacy Plan is the same as the standard plan.
6. If the emergency room visit results in admission to hospital does the $200 co-pay still apply?
The Emergency room visit co-pay is waived if you are admitted from the Emergency Room.
7. What is the anticipated savings to the conference by switching to the % co pay program?
The anticipated savings from the switch to the % co-pay for Pharmacy savings between 1.5 and 2 per cent.
8. Does the P2 pharmacy plan annual out-of-pocket retail pharmacy $2500/person +Medco by mail $2500/person mean the total out-of-pocket can be as high as $5000/person?
In tier 1 and 2 the out-of –pocket maximum is a combination of both retail and Medco by Mail. Tier 3 drugs do not count toward out-of-pocket maximum.-
9. What page of the pre-conference booklet is the Blue Print for Health Plan stated?
Page 30 lines 59 through 62 indicate that South Carolina Annual Conference is participating in the General Board of Pension and Health Benefits Healthflex Incentive Program. The “Blueprint for Wellness” is a part of that plan. Details have been mailed to Participants. It is also found on the General Board’s web-site. www.gbophb.org
10. Are associate pastors benefits included in the churches’ pension and benefit payment to the conference--particularly if they are retired pastors from another church?
The Direct billing payment for a church with an appointed associate pastor is determined by the category of the Associate Pastors. Active Provisional and full members, Local Pastors, are included and there billing is delineated on the direct billing statement. If the Pastor is a retired supply then in most cases there would be no billing for pension and insurance. In a very few cases, retired supply pastors, paid at above the threshold for CPP benefits, are direct boiled for insurance.
11. Give us an example of some of the calculations on the insurance chart.
This question is unanswerable. If you want to look over the material regarding each of our plans including side-by-side comparisons we will have them available during Annual Conference at the Conference Board of Pension Table throughout the sessions.
12. Please further explain high risk option to choose deductible and cost savings.
The details of the Consumer Driven High Deductible Plan are in the Pre-Conference Material. In addition, at 9:30 a.m. on June 8, 2011, there will be a presentation by the General Board. Also, a side-by-side comparison will be available during Annual Conference at the Conference Board of Pension Table throughout the sessions.
Open Hearts, Open Minds, Open Doors. The People of The United Methodist Church.
