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Medical Insurance


Plans


All counties except Sullivan and Ulster



    • United Healthcare Choice Plus PPO


    • AETNA HMO Network Only



All counties



    •  Anthem (Empire) Blue Cross and Blue Shield 90/70 PPO


    •  Anthem (Empire) BC BS High Deductible (HSA)


    •  Anthem (Empire) High Opt MS PPO for Medicare Secondary Payer Plan


    • Anthem (Empire) 100 EPO for Medicare Secondary Payer Plan


    •  CIGNA POS Open Access Plus and CIGNA Open Access Plus in Network




Lifetime Maximum Benefit


The Annual and Lifetime Benefit  Maximum has been eliminated.


Dependent Children


Children remain eligible for coverage to age 30.


Now they do NOT have to:



    • Live at home


    • Be full time students


    • Be unmarried


    • Have no dependents of their own




Managed Care Plans


The UHC Choice Plus, Aetna HMO, Empire BC/BS 90/70, EmpireHigh Opt MS PPO   and CIGNA plans are all managed care plans.


Aetna- AETNA HMO


Tel: (877) 380-8584



    1. Go to www.aetna.com/docfind


    1. Click on the “continue to DocFind” icon


    1. Complete required items on General Search


    1. In the Select Plan window, AETNA plans are sorted under subheadings.

      For AETNA HMO, select HMO under Aetna Standard Plans.


    1. Click START SEARCH



You need to choose a PCP and get referrals for in-network specialist visits. 



United Healthcare Choice Plus


Tel: (866) 204-8533



    1. Go to www.myuhc.com


    1. Under Links and Tools (upper right) select Find Physician, Laboratory or Facility


    1. Select Search for Physician


    1. For Selecta Plan, choose: UnitedHealthcare Choice Plus


    1. Enter your zip code and click CONTINUE


    1. Select a specialty and click  CONTINUE



You do not need to choose a PCP or get referrals for in-network specialist visits. We strongly suggest, however, that you choose for yourself an United Healthcare doctor to coordinate and oversee your care. Like all managed care plans, United Healthcare requires that you or your doctor pre-certify many services such as hospital admissions, surgical procedures, and many diagnostic tests.


Anthem (Empire) Blue Cross Blue Shield


Tel: (800) 352-3152



    1. Go to www.empireblue.com/medicaltrust


    1. Click on Find A Doctor


    1. Click on Across The Country


    1. A new window will open Under Select a Plan, choose the PPO/EPO option and continue with the directions on the screen, entering your geographic information.



Cigna Medical & Dental


Tel: (800) 244-6224




    • Click on Find A Doctor


    • Select the health care professional you need, fill in your city zip code, then click NEXT.If searching for medical providers: OAP/OAP-IN plan members select Open Access Plus, then select TYPE and SPECIALTY (optional), and click SEARCH.If searching for dental providers:

        • Select dentist instead of provider.


        • Click on Across The Country. A new window will open.


        • Uunder Select a Plan, choose the PPO/EPO option


        • Continue with the directions on the screen, entering your geographic information.






Out of Network Options - All Plans


All plans except AETNA HMO, Anthem Blue Cross and Blue Shield, EPO 100 Plan and CIGNA Open Access in Network also permit you to seek services outside the managed-care network.


You must file claims for these out-of-network services and meet substantial deductibles and co-insurance percentages. Many out-of-network services also require pre-certification before you seek the services. Please be careful to check so you obtain pre-certification of the service when required.



Value-Added Benefits


The healthcare plans offered by the Medical Trust offer value –added benefits for participants, they include:


Vision


The health plan includes a vision benefit, which offers in-network annual eye-exam, eyeglasses and contact lenses benefits are also included. For more information, please see Vision Benefits.


Hearing


Medical Trust health plans include a hearing discount plan, which provides discounts on hearing exams and supplies.


Hearing Discounts


Hearing discounts are offered through HearPO for Medical Trust plans.


The HearPO network offers discounts for hearing aids and supplies through more than 1,400 HearPO affiliates across the U.S. These discounts are also available to extended family members. To access these discounts, family members simply mention that they are related to the member and identify themselves as a member of an Episcopal Church Medical Trust health plan.


HearPO provides:



    • Testing performed by licensed hearing-care professionals


    • Comprehensive follow-up services at no cost for one year


    • Savings on all styles of hearing instruments and all levels of technology


    • Discounts on hearing aid repairs


    • 60-day trial period with a money-back guarantee


    • Free demonstrations of the latest available technologies




Mental Health/Substance Abuse (Inc. Employee Assistance Program)


All medical plans include mental health benefits for emotional, physical, family and legal needs. For more information, please see Mental Health.


Mental Behavioral – Therapy/Counseling


All members in the Aetna, United Healthcare Empire BC BS, and CIGNA Health Plans are receiving their benefits for Mental Behavioral supplemental through Cigna Behavioral Health.


You can contact CBH at 1-866-395-7794 and they will assist you in utilizing your mental health benefits.

If you have questions you can call the Episcopal Medical Trust at 1-800-441-7118.


 Employee Assistance Program


The Employee Assistance Program (EAP), offered through Cigna Behavioral Health, is a free, confidential 24-hour a day service that assists members and their covered dependents with information, educational materials, resources, referrals, and ongoing support. The plan covers unlimited telephone consultations and up to 10 face-to-face counseling sessions per issue at no member cost.


We encourage you to promote this valuable service to your employees. You may also contact this program for advice on how to handle a workplace situation, or to find resources for helping people cope with a variety of disasters and challenging situations, such as floods and hurricanes.


The trained professional EAP staff can provide:



    • 24/7 phone access for behavioral health issues


    • Referrals for in-person counseling (including up to 10 sessions, per topic or issue, with no copay)


    • Legal consultations


    • Financial services and referrals


    • Tips for balancing work and family


    • Resources for more help in your community



There are also online resources on such issues as:



    • Emotional well-being and life events


    • Family and care-giving


    • Health and wellness


    • Daily living


    • Disaster Resource Center



To access EAP services, call (866) 395-7794, 24 hours a day, 7 days a week, or sign in to the website Cigna Behavioral Health (password: episcopal).



Health Advocate


A member needs help resolving an insurance claim, understanding a complex medical condition, or finding services for an elderly parent. How can you help?


Direct him or her to Health Advocate, where professional advocates, typically registered nurses backed by a team of experts, help members navigate the health care system.


This free, confidential service can help members:



    • Find the best hospitals, doctors, and other health care providers


    • Obtain second opinions


    • Schedule appointments with hard-to-reach specialists


    • Resolve benefits claims and issues


    • Correct billing mistakes


    • Better understand their condition



Call (866) 695-8622, 24 hours a day, 7 days a week. Normal business hours are Monday through Friday, 8 a.m. to 9 p.m. ET.or sign in to the website Health Advocate (password: episcopal).




Travel Medical Assistance


FrontierMEDEX provides emergency medical and travel assistance for Medical Trust plan members traveling at least 100 miles from home, either in the U.S. or abroad, 24 hours a day, 7 days a week. With FrontierMEDEX’s assistance, members have access to worldwide medical and dental referrals, emergency medical treatment, replacement of travel documents and other services.


The program includes:



    • Assistance in obtaining medical treatment. FrontierMEDEX’s staff will help make the arrangements for local referrals for treatment or evacuation due to a medical emergency.


    • Assistance with providing insurance information and medical records for treatment


    • Replacement of prescriptions, medical devices and corrective lenses


    • Emergency travel arrangements and replacement of lost or stolen travel documents


    • Emergency fund transfers



FrontierMEDEX is not responsible for the member’s medical costs.


Diocesan Benefits Administrator