Synod of the Pacific 2017-2018 Open Enrollment Audio Dial in - PowerPoint PPT Presentation

Synod of the Pacific 2017-2018 Open Enrollment Audio Dial in Information: 1.855.842.6063 Access Code: 994 805 376

Benefits Overview  Eligibility  Evaluating your Benefit Options  Medical Options  Sutter Health Plus HMO and DHMO  Kaiser HRA, HMO  Dental Plan Options: High & Low  Vision Plan Options: Core & Buy-Up  Making Changes to your Benefits  Questions and Contact Information 2

Eligibility  Who Is Eligible for Benefits?  Churches and organizations within the bounds of Synod of the Pacific are eligible to offer all of the Synod of the Pacific’s Benefit Services to lay employees working twenty (20) or more hours per week, and Dental/Vision/Voluntary Benefit Plans to ordained clergy. You Qualify! Your employer may pay up to 100% of the employee only premium. If you choose to cover your spouse or dependent children you may pay the cost of the dependent premium on a pre-tax basis by payroll deduction. Domestic Partner premium is paid on a post-tax basis. Dependent Children can be covered on the medical, dental and vision plans up until they turn age 26. Employees interested in benefits should check with the Benefit Administrator at their church or organization to determine which plans are available to them and if there are any costs in participating. 3

Summary of Benefits S UTTER H EALTH P LUS Medical Plans  -HMO  -DHMO 4

The Sutter Health Plus Difference  The nationally recognized Sutter Health Plus network includes some facilities with 100+ years in Northern California  Sutter Health and Sutter’s Valley Area were named by Truven Health Analytics as two of the Top 5 performers in the nation among large health care systems  Six Sutter Health Plus network physician organizations earned Elite status from CAPG  Comprehensive medical benefits  A full range of pharmacy benefits  A 24/7 nurse advice triage line  Wellness and care management programs  Preventive care services, such as annual well visits and immunizations  Coverage for emergency care anywhere in the world; 36 urgent care locations in California regions 5

Sutter Health Plus Network – Bay Area 6

Sutter Health Plus Network – Valley 7

How to Find a Provider sutterhealthplus.org/providersearch Search for:  Doctors  Specialists  Hospitals  Urgent care centers 8

Member Portal Easy access from your smartphone, tablet or computer to:  View, print or request a member ID card  Change your primary care physician  View your eligibility, benefits, copays, account balances and deductibles  Update your member portal profile www.shplus.org/memberportal 9

My Health Online* • Schedule appointments online • Email your doctor's office • View lab and most test results • Access records via secure mobile apps 10 *Not offered by all providers

Summary of Benefits Sutter Health Plus - California HMO $20 - $0 Deductible None Primary Care Physician Required Yes Office Visit Copay $20 Copay per visit Specialist $20 Copay per visit Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $20 Copay/No Copay Inpatient Hospitalization $250/day, per admission (3 day max) Emergency Room $100 per visit (waived if admitted) Mental Health Outpatient $20 Copay per visit Prescription Drugs $10 Copay Generic $30 Copay Brand Name $60 Copay Brand Name Non-formulary ( 30-day supply ) 11

Summary of Benefits Sutter Health Plus - California Deductible HMO $20 - $1000/20% Deductible $1,000/Member; $2,000/Family Primary Care Physician Required Yes Office Visit Copay $20 Copay per visit (deductible waived) Specialist $20 Copay per visit (deductible waived) Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $20 Lab/$10 X-Ray; (deductible waived) Inpatient Hospitalization 20% Coinsurance (after deductible) Emergency Room 20% Coinsurance (after deductible) Mental Health Outpatient $20 Copay per visit (deductible waived) Prescription Drugs $10 Copay Generic (deductible waived) $30 Copay Brand Name (deductible waived) $60 Copay Brand Name Non-formulary ( 30-day supply ) (deductible waived) 12

Summary of Benefits Medical Plans  HMO  HRA  NW HMO 13

Summary of Benefits Kaiser Permanente - California Traditional HMO $30 Copay Deductible None Primary Care Physician Required Yes Office Visit Copay $30 Copay per visit Specialist $30 Copay per visit Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $10 Copay per encounter Inpatient Hospitalization $500 per admission Emergency Room $150 per visit (waived if admitted) Mental Health Outpatient $30 Copay per visit Prescription Drugs $15 Copay Generic $35 Copay Brand Name ( 30-day supply ) 14

Summary of Benefits Kaiser Permanente - California HRA Plan SYNOD Contribution (allocated on 11/1/2017) $1,000/individual $2,000/family Deductible $2,000 per member/ $4,000 per family Primary Care Physician Required Yes Office Visit Copay $20 Copay per visit ( after deductible ) Specialist $20 Copay per visit (after deductible) Preventative/Wellness Visits No Copay (deductible waived) Outpatient Lab & X-ray $10 per encounter (after deductible) Inpatient Hospitalization 20% (after deductible) Emergency Room 20% (after deductible) Mental Health Outpatient $20 Copay per visit (after deductible) Prescription Drugs (deductible waived) $10 Copay Generic $30 Copay Brand Name ( 30-day supply ) Unused HRA funds will roll over for the next year to help offset future out-of-pocket costs 15

Summary of Benefits Kaiser Permanente - NW HMO $15 Copay Deductible None Primary Care Physician Required Yes Office Visit Copay $15 Copay per visit Specialist $25 Copay per visit Preventative/Wellness Visits No Copay Outpatient Lab & X-ray $15 Copay per encounter Inpatient Hospitalization $250 per admission Emergency Room $150 per visit (waived if admitted) Mental Health Outpatient $25 Copay per visit Prescription Drugs $15 Copay Generic $30 Copay Brand Name ( 30-day supply ) 16

Summary of Benefits Dental Plans  High Plan  Low Plan Synod of the Pacific’s Dental Plans remain self-funded plans. However, we are switching dental carriers from Assurant to Anthem due to a larger number of In-Network providers available to our members. 17

Summary of Benefits Anthem Dental – High Plan - California and all states In Network Out of Network Annual Deductible $50 $50 Waived for Preventive Yes Yes Calendar Year Benefit Maximum $1,500 (both in & out of network)  Preventive Services  Office visits/cleanings/fluoride treatments 100% 100% Diagnostic Services   Oral exams/x-rays/consultations 100% 100%  Restorative Services  Fillings/oral surgery/extractions/root canal Endodontics/Periodontics 90% 80%  Major Services (after six months of continuous dental coverage)  Prosthondontics/removable and fixed implants 60% 50%  Orthodontia 50% 50%  Lifetime Benefit Maximum $1,500 (both in & out-of-network) 18

Summary of Benefits Anthem – Low Plan - California and all states In Network Out of Network Annual Deductible $50 $50 Waived for Preventive Yes No Calendar Year Benefit Maximum $1,000 (both in & out of network)  Preventive Services Office visits/cleanings/fluoride treatments 100% 80%  Diagnostic Services  Oral exams/x-rays/consultations 100% 80%   Restorative Services Fillings/oral surgery/extractions/root canal  Endodontics/Periodontics 80% 60%  Major Services (after six months of continuous dental coverage) Prosthondontics/removable and fixed implants Not Covered Not Covered   Orthodontia Not Covered Not Covered 19

Finding a Dental PPO Provider Internet Access: www.anthem.com/ca/mydental  Select “Find Dental Provider”  Select “Dental Complete” under Network  Enter search criteria based on the desired search you wish to perform 20

Resource Advisor  All employees that enroll in one of our Dental Plans will automatically receive this benefit.  Counseling  Legal  Receive 3 counseling sessions for yourself and  A telephone or face to face consultation with family members per issue. a local attorney, plus a discount off the Face-to-face counseling hourly rate.  Online counseling Will   Family law  Real Estate  Personal Injury   Other Services Available Financial Planning  To make a confidential appointment, Identity Theft  Call Resource Advisor at: Beneficiary Support  888-209-7840 24 hours a day 7 days a week www.ResourceAdvisorCA.anthem.com Program name: ResourceAdvisor 21

Group Term Life Insurance All employees that enroll in one of our Dental Plans will automatically receive this benefit. Anthem Blue Cross  Group Term Life and AD& Benefit Amount: $15,000  For more information on this plan and current rates, please go to www.synodpacific.org and click on “Benefits”. 22

Security For Your Family Reliance Standard Voluntary Benefits  Additional Voluntary Life and Accidental Death benefits are available through Reliance Standard.  If employee is not a new hire, benefit amount is subject to Evidence of Insurability.  For more information on this plan and current rates, please go to www.synodpacific.org and click on “Benefits”. 23

Summary of VSP Vision Benefits VSP Vision Plan  Core Plan  Buy-Up Plan 24