The Diocesan Benefits Administrator’s Office maintains the group insurance plans offered by the Diocese of New York through the Episcopal Church Medical Trust to clergy and lay employees of our congregations and related institutions. Details of these plans are provided in the following pages.
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.
There are very important deadlines with respect to this coverage. Employees must enroll in the coverage they want within 30 days of the date of employment.
If an employee misses this deadline, enrollment in a managed care plan for medical insurance will have to wait until the next annual open enrollment period. The Medical Trust will effect enrollment in other kinds of insurance only on approval of health statements.
Effective date of coverage
Your coverage will be effective on the first day of the first full month of your employment. If your hire date is July 1 (or the first working day in July), your coverage will be effective July 1. If your hire date is July 10, your coverage will be effective on August 1. The effective date of coverage is not up to the employer or the employee; it is based without exception on the employee’s date of hire.
Same-sex partner coverage
The diocesan group plans include coverage for the same-sex partners of eligible employees. There are affidavits and supporting documentation that must be submitted to the Diocesan Benefits Administrator’s office if you would like this coverage. Please contact us for further information.
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 may order up to three months of medication at one time, usually at a significant cost savings.
More than 60,000 participating retail pharmacies offer discounts with Express Scprits / Medco ID card. Prescriptions may also be filled at any non-participating retail pharmacy.
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
All enrolled members in AETNA, United Healthcare, Empire BC BS , CIGNA are eligible to participate in the Vision benefits plan, offered through EyeMed.
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
If you experience a significant life change during the year (e.g., marriage, divorce, birth or adoption of a child, loss of spousal coverage), you may make changes outside of the open enrollment period as long as (1) you file the necessary paperwork within 30 days of the event, and (2) there is no break in coverage.
The Lay Compensation Guidelines mandate that congregations at least provide access to the insurance for their eligible lay employees.