An individual must work at least 30 hours per week or 1500 a year for a congregation or covered institution to be eligible for any of the insurance coverage offered through the diocesan group.
Effective date of coverage
Same-sex partner coverage
Mental Health and Behavioral Coverage If you are enrolled in the following medical plans: AETNA, United Healthcare, Empire Anthem BC/BS 70/90, CIGNA Open Acces Plus, CIGNA Open Acces In-Network; your Mental Behavioral Health Coverage is managed by CIGNA. If you are enrolled in Prescription Drug Benefits 2015
Our pharmacy plans provide members with options for saving on the cost of their prescription drugs.
- All Medical Trust self-funded health plans include a comprehensive prescription drug benefit through Express Scripts. Groups may offer either the standard or premium pharmacy plan. The member’s prescription medication costs will depend upon which plan your group offers.
- For those with an Empire BlueCross BlueShield High Deductible Health Plan, pharmacy benefits are embedded in the medical plan.
Mail Order – required for maintenance medications after three retail fills
Members who want to buy maintenance medications at a retail pharmacy may do so up to three times (one original and two refills). After three retail refills, maintenance medication must be refilled by mail order.
Saving with Generic Drugs
In addition to saving with mail order benefits and Express Scripts/Medco retail discounts, members can manage costs by using generic drugs or medications on Express Scripts/Medco’s preferred formulary list. We encourage members to take this list to their physicians to ask whether Tier 1 or Tier 2 drugs may be satisfactory alternatives.
While members and their doctors decide on whether or not to use generics, if a member purchases a brand name medication when a generic equivalent is available, the plan will cover only up to the cost of the generic drug.
Visit Medco’s website OR call Express Scripts Services at (800) 841-3361
Vision Benefits 2015
The following services are provided once per calendar year:
- Eye exam: $0 copay in network
- Frames: in network, $130 allowance and 20% off remaining balance
- Lenses: $10 copay
- Contact lens: costs vary depending on lens
The plan offers the following value-added features:
- 40% discount on the purchase of additional complete pairs of eyeglasses once the initial benefit has been used
- 15% discount on conventional contact lenses once the initial benefit has been used
- 20% off retail price for eye care supplies purchased at network providers
- Online ordering for replacement contact lenses at below-retail price
EyeMed’s network includes local, private practitioners and retail chains such as:
- Sears Optical
- Target Optical
- Pearle Vision
- JCPenney Optical
Significant life changes
The Lay Compensation Guidelines mandate that congregations at least provide access to the insurance for their eligible lay employees.