ELCA Benefit Program Description ELCA Pension and Other Benefits Program» Effective Jan. 1, 2014

Transcription

1 ELCA Benefit Program Description 2014 ELCA Pension and Other Benefits Program» Effective Jan. 1, 2014

2 ELCA Benefit Program Description Effective Jan. 1, 2014 Revised Feb. 17, 2014 About This Document This document, in conjunction with the summary of each plan, forms the summary plan description for each plan in the ELCA Pension and Other Benefits Program. This document describes eligibility, enrollment, and how professional and life changes affect your benefits, effective Jan. 1, Use these two documents together as a reference when you have questions about the ELCA benefit program. The most current version of each plan s summary and this document are available by contacting the Portico Service Center or by signing in to myportico (myportico.porticobenefits.org). About Portico Benefit Services For over 25 years, Portico Benefit Services has offered health, retirement, and other benefits designed to enhance the well-being of those who serve. Because we focus on those who serve through the Evangelical Lutheran Church in America and other faith-based organizations, we can tailor our benefits to include advantages and options suited just for our membership. As part of the ministry community and as experienced professionals, we are qualified to design and manage all aspects of the ELCA s benefit plans. Portico serves more than 7,000 congregations and organizations, and more than 50,000 people across the ELCA during their working years and in retirement including pastors, associates in ministry, diaconal ministers, deaconesses, lay employees, retirees, and their family members. About Our Plans The ELCA Pension and Other Benefits Program provides health, flexible spending, retirement, disability, and survivor benefits presented as one comprehensive program to members. Benefit plans are governed and administered individually through separate plan documents. The ELCA Board of Pensions, doing business as Portico Benefit Services, maintains the following plans: the ELCA Retirement Plan, the ELCA Disability Benefits Plan, the ELCA Survivor Benefits Plan, the ELCA Health Benefits Plan (which includes post-retirement medical benefits, an obligation of the ELCA), and the ELCA Flexible Benefits Plan. We also maintain three group retirement plans for ELCA-affiliated social ministry organizations the ELCA Master Institutional Retirement Plan, the ELCA Retirement Plan for The Evangelical Lutheran Good Samaritan Society, and the ELCA 457(b) Deferred Compensation Plan. The assets of each plan are held in various trusts and therefore do not allow one plan to fund a shortfall of another plan. Portico Benefit Services plans are not subject to the Employee Retirement Income Security Act (ERISA). The health and disability plans and the retiree survivor benefit are self-insured and are not protected through any type of insurance program. Our ability to pay self-insured claims is dependent on continued contributions and market performance. The basic, supplemental, and dependent life insurance benefits are offered by Minnesota Life Insurance Company. Product guarantees are backed by the financial strength and claim paying ability of Minnesota Life Insurance Company. Premiums are not guaranteed to remain unchanged. Portico Benefit Services does not assume any responsibility or liability for the obligations of

3 Minnesota Life Insurance Company under the insurance policies. Portico Benefit Services is not affiliated with Minnesota Life Insurance Company. We reserve the right to change any of the terms of the plans at any time through the amendment or termination process described in each plan s summary plan description.

4 This document, paired with the various plan descriptions, forms the summary plan description for each ELCA benefit plan. This program description outlines eligibility, enrollment, and how professional and life changes affect your benefits, while the plan descriptions lay out plan rules and benefits. Use these two documents together as a reference when you have questions about the ELCA benefit program. The plan descriptions are available by contacting the Portico Service Center. This ELCA Benefit Program Description, effective Jan. 1, 2014, replaces and supersedes all previous materials. Contents About the ELCA Benefit Program... 1 Church-Sponsored Program Supports Ministry... 1 Employers Eligible to Participate... 2 Online Benefit Administration... 3 Program Eligibility... 5 Those Eligible to Enroll in the Program... 5 Eligible Family Members... 5 Enrolling in the Program... 6 Timely Enrollment... 6 Late Enrollment... 7 Annual Open Enrollment... 7 Opportunity for Employees Not Enrolled in a Timely Manner... 9 Waiving Health Coverage... 9 Paying for Benefits When You re Sponsored in the ELCA Benefit Program When You re Not Sponsored in the ELCA Benefit Program When Contributions Aren t Paid When a Call or Employment Change Affects Your Benefits If You Change Call or Employment If Your Employment Ends If You Go On Leave From Call If Your Interim Assignment Ends If You re a Missionary Sponsored by ELCA Global Mission If You Leave the Roster and Aren t Sponsored If You Become Sponsored by Multiple Employers If You and Your Spouse Both Become Sponsored If Your Employer No Longer Sponsors You... 30

5 If You re Called to Serve in the Military When a Life Change Affects Your Benefits If You Get Married If You Become a Parent If You Get Divorced If You re a Former Spouse If Your Covered Adult Child Reaches Age If Family Members Are Eligible for Different Health Benefits If You Retire If You Turn Age 65 and Continue to Be Sponsored If You Become Disabled If You Die If You Become a Surviving Spouse Glossary Contact Information ELCA Philosophy of Benefits... 60

6 About the ELCA Benefit Program The ELCA Pension and Other Benefits Program, also called the ELCA benefit program, is designed to help ELCA congregations and organizations provide an efficient, wellness-oriented bundle of benefits to those they sponsor. This document describes how the program is designed to work for a typical sponsored member: The benefits it includes The types of sponsoring employers and individuals eligible to participate The enrollment process Contribution rates and bill paying rules We then describe how eligibility for benefits changes when you experience life changes: A life change like marriage, divorce, or turning age 65 A professional change like changing call or employment, working for multiple employers, or ending a call Church-Sponsored Program Supports Ministry Through the ELCA benefit program, Portico strives to empower our members to live well physically, financially, and emotionally for life. Our comprehensive benefit program supports members throughout their lives and ministry, from first call or hiring through retirement. We believe that by living well as whole people of God, we can better enhance the lives of others doing God s work in Christ s name for the sake of the world. For more than 25 years, foundational principles have helped Portico design the ELCA benefit program in alignment with church values. The ELCA Philosophy of Benefits articulates these principles and affirms the importance of benefits to the health and wellness of this whole church as it engages in ministry. See ELCA Philosophy of Benefits, page 60. The ELCA benefit program includes five benefit plans. Combined, they offer resources to help you and those you care about live well, so you re better able to enhance the lives of others. ELCA Medical and Dental Benefits Plan (ELCA Health Benefits Plan) Benefits to manage your health medical, mental health, dental, prescription drugs, and 24/7 nurse line - ELCA-Primary Health Benefits for most members under age 65 before Medicare is your primary health coverage - ELCA Medicare-Primary Health Benefits for most members after age 65 when Medicare is your primary health coverage - Aetna International Health Benefits for missionaries sponsored by ELCA Global Mission ELCA Flexible Benefits Plan Flexible spending accounts (FSAs) and health savings accounts (HSAs) for setting aside pretax dollars for eligible health care and dependent (day) care expenses ELCA Survivor Benefits Plan Benefits to help family members take care of financial obligations in the event of a death - Life insurance for sponsored members, spouses, and children - Lump-sum benefit for retired members ELCA Disability Benefits Plan Provides eligible disabled members monthly income, ELCA Retirement Plan contributions, and health and survivor benefits ELCA Retirement Plan A defined contribution retirement plan to help save for retirement Page 1

7 We describe how you use these benefits online at myportico. They are also described in plan descriptions found on myportico. These five plans are bundled together as a package. Employers sponsor their plan members in the ELCA benefit program and cannot purchase individual ELCA benefit plans separately. A comprehensive benefit program serves our ministry community by: Helping protect rostered leaders and lay employees against significant financial loss from a variety of risks before and after retirement Saving administrative time for sponsoring employers, freeing them to focus on ministry Providing consistency throughout this church, which helps enable rostered leaders to serve wherever they are called without the inconvenience of having to change health plans Designating clergy retirement plan distributions as eligible for the housing allowance exclusion from federal gross income Supporting the physical and financial well-being of those serving as missionaries through ELCA Global Mission Note the following exceptions to the bundled program: Plan members who qualify may waive ELCA health benefits while participating in the rest of the ELCA benefit program. See Waiving Health Coverage on pages 9 11 for more information. Plan members have certain choices within the ELCA benefit program about which of the optional benefits they wish to use. For example, contributing to an FSA or HSA is optional. While plan members who lose their sponsored status are no longer eligible for the comprehensive ELCA benefit program, they may be eligible to continue coverage under some ELCA benefit plans. In some cases, coverage is available for a limited period of time. ELCA institutions and non-elca organizations sponsoring eligible employees in only the ELCA Retirement Plan on Dec. 31, 2002, may continue to sponsor eligible employees in the ELCA Retirement Plan, provided at least one employee remains enrolled. Employers Eligible to Participate The following are ELCA employers eligible to participate in the ELCA benefit program. Some are required to participate. The ELCA synods, seminaries, and other ministries of the ELCA churchwide organization (except for the ELCA publishing house, Augsburg Fortress) are required to sponsor all their eligible employees in the ELCA benefit program. However, they are not required to sponsor temporary employees or non- ELCA pastors. ELCA congregations may sponsor any or all of their pastors, rostered laypersons, and other eligible employees. ELCA institutions not subject to the coverage requirements of the Tax Reform Act of 1986 may sponsor any or all of their eligible employees. These institutions generally include elementary and secondary schools, day care centers, camps, and conference centers. ELCA institutions subject to the coverage requirements of the Tax Reform Act of 1986 may sponsor any or all of their eligible ELCA pastors, and all or none of their eligible rostered laypersons and other employees. These institutions generally include ELCA-affiliated social ministry organizations, colleges and universities, nursing homes, and hospitals. Page 2

8 Other employers may sponsor pastors and rostered laypersons in the ELCA benefit program if they fall into one of these categories: Other tax-exempt organizations (referred to as 501(c)(3) organizations): - Former ELCA congregations that sponsored at least one eligible employee on or after Jan. 1, 2005, may sponsor any or all eligible employees. - A congregation or qualified church-controlled organization of a non-elca church body that has common religious bonds with the ELCA and has petitioned to and been approved by Portico to be the church body s sole benefits provider may sponsor any or all eligible employees. - Ecumenical partner congregations (full communion partners) may sponsor any or all ELCA pastors or rostered laypersons serving under call to a non-elca ministry. - Other tax-exempt organizations may sponsor any or all ELCA pastors serving under call to a non- ELCA ministry. They may also sponsor ELCA rostered laypersons serving under call, but then must sponsor all those eligible. These organizations include social ministry organizations, ecumenical agencies, non-ecumenical congregations, and pastoral care organizations. Taxable organizations (non-501(c)(3) organizations) may sponsor any or all ELCA pastors serving under call to a non-elca ministry. These organizations include government agencies and for-profit organizations. An eligible employer can also be an individual who performs service in the exercise of his or her ministry. This individual is considered by Portico to be his or her own employer, and can either be an ELCA ordained minister who is self-employed or one who is employed by a 501(c)(3) organization but is not sponsored by his or her employer. Online Benefit Administration To steward benefit resources, our goal is to move nearly all benefit transactions online, replacing the need for paper forms and improving the speed and accuracy with which we process requests. Portico offers a customized web experience for plan members and sponsoring employers. Both are asked to register and sign in to Portico s website to take required steps like Open Enrollment and viewing bills and statements. By signing in, they can see personalized benefit information, receive timely alerts, and conduct many benefit transactions on Portico s website. One-time registration is required. Plan members Visit myportico (myportico.porticobenefits.org) and register using a seven-digit Member ID, three-digit Security Validation Code (SVC), and address. Sponsoring employers Visit EmployerLink (EmployerLink.PorticoBenefits.org) and register using the organization s 11-digit Access Code and an address. NOTE: Registration on myportico is not currently available for spouses or other family members. Eligible plan members who ve registered on myportico can do the following online: Make benefit elections during annual Open Enrollment Update their personal profile Review defined compensation Review retirement account balance, statements, and fund performance Review employer contributions to your retirement account Change retirement account investment choices Use online retirement planning tools through Fidelity s NetBenefits Change pretax retirement contributions Review household health coverage for yourself and family members Review tax-advantaged account elections and make qualifying changes Page 3

9 Review and change HSA contributions Pay monthly benefit bill, for those on coverage continuation Set up recurring payments View life insurance selections View Advice of Deposit View a summary of all your benefits Sponsoring employers who have registered on EmployerLink can do the following online on behalf of their organization: Choose annual health benefit option Complete annual Open Enrollment Review employee benefit elections Change your profile and organization profile information View or edit the organization s payroll frequency Pay the monthly benefit bill and explain any over- or under-payment View what health benefit options members have elected Report changes in a plan member s defined compensation Report employee count and tax identification number as required by Medicare View employee payroll withholdings per pay period for benefits offered through Portico taxadvantaged accounts, pretax contributions, supplemental and dependent life insurance, and health coverage buy-up costs Determine the cost of benefits for new and changing employees Page 4

10 Program Eligibility The ELCA benefit program is a bundled collection of five benefit plans health, flexible benefits, survivor, disability, and retirement. The following eligibility criteria apply to those enrolling in the program as sponsored members. Those Eligible to Enroll in the Program You re eligible to enroll in the ELCA benefit program when you are sponsored as: A pastor or rostered layperson serving under call, employed by an eligible employer, and scheduled to work at least 15 hours per week for six or more months per year or A lay employee employed by an eligible employer, scheduled to work at least 20 hours per week for six or more months per year, and have completed any probationary period specified by your employer (not to exceed 90 days) You re eligible to enroll in the ELCA benefit program when you are a self-sponsoring ELCA pastor and are: Called to a non-elca ministry and your employer chooses not to sponsor you in the ELCA benefit program or Called to a ministry in which you are considered self-employed in accordance with Internal Revenue Code 414(e)(5)(A)(i) NOTE: Non-sponsored and self-employed individuals are not eligible to participate in the flexible spending accounts (FSAs) offered through the ELCA Flexible Benefits Plan. Members receiving disability benefits are eligible to enroll in a health FSA, but not a dependent care FSA. Members enrolled in an ELCA-Primary Health Silver+ or Bronze+ benefit option may be eligible to enroll in a heath savings account. Eligible Family Members When you re sponsored in the ELCA benefit program, the following family members are eligible to enroll in the ELCA health plan: Your spouse or eligible same-gender partner (ESGP) A child under age 26 who falls within one of three categories: 1. Your or your spouse s natural child, legally adopted child, or a child placed in your home for adoption 2. Your never-married grandchild or a child for whom you are a guardian if he or she is: Living in your household and Receiving primary support from you and Claimed by you as a tax dependent for federal income tax purposes 3. The natural or legally adopted child of your ESGP When you re sponsored in the ELCA benefit program, the following family members are eligible for dependent life insurance as long as you purchase supplemental life insurance for yourself: A spouse or ESGP Eligible children up to age 26, including: Your biological children, legally adopted children, children placed in your household as a step toward legal adoption by you, stepchildren, or natural or legally adopted children of an ESGP or grandchildren living in your household Children not living in your household who are unmarried and dependent on you for more than 50% of financial support Page 5

11 Enrolling in the Program Plan members are typically enrolled in the ELCA benefit program by an eligible sponsoring employer. Once a year, members and sponsoring employers make annual benefit selections for the coming plan year during Portico s annual Open Enrollment. In the event that a member is no longer sponsored, Portico maintains the member s ELCA retirement account and offers the opportunity to continue health and life insurance coverage at his or her own expense, if eligible. In some cases, coverage is available for a limited period of time. Timely Enrollment If you and your employer complete your enrollment within 60 days of meeting the ELCA benefit program s eligibility criteria, and the first date of your coverage falls within this 60-day period, you re enrolled in a timely manner. Health Your health coverage takes effect for you (and your family) on the date designated by your employer or the date you were hired if you are employed by a synod, seminary, or ministry of the ELCA churchwide organization. Flexible Spending Accounts You are eligible to enroll in the health flexible spending account (FSA) the first day you are sponsored in the ELCA benefit program if you are a sponsored employee who: Enrolls in the ELCA-Primary Platinum+ or Gold+ health benefit option Enrolls in the ELCA-Primary Silver+ or Bronze+ options but isn t eligible for an HSA due to age Enrolls in the ELCA Medicare-Primary Standard health benefit option Waives health benefits All sponsored members are eligible to enroll in a dependent (day) care FSA, except those who: Have Aetna International health benefits Receive ELCA disability benefits Are self-sponsored Your FSA enrollment must be completed within 60 days of your eligibility. Your participation begins the first day of the month following enrollment in an FSA. Life Insurance If you enroll within 60 days of eligibility: You ll be automatically enrolled in the basic group life insurance benefit when you enroll in the ELCA benefit program, and your sponsoring employer will pay the associated benefit contribution. Basic group life insurance begins the date your employer sponsors you in the ELCA benefit program, subject to the active work requirement. You cannot be denied basic group life insurance coverage (no EOI required). You can purchase supplemental and dependent life insurance without needing to provide evidence of insurability (EOI). Disability If you enroll within 60 days of the date you meet the eligibility criteria of the ELCA benefit program, you are entitled to receive disability benefits under the ELCA Disability Benefits Plan. You will not be entitled to receive Page 6

12 disability benefits if you become partially or totally disabled within the first six months after enroll and the disability is caused by a condition diagnosed or treated in the six-month period immediately before your enrollment date. Retirement Upon enrollment, all employer contributions to the ELCA Retirement Plan are 100% vested. Late Enrollment If you and your employer don t complete your enrollment within 60 days of meeting the ELCA benefit program s eligibility criteria, you re subject to late enrollment rules. Health If your enrollment application is not submitted within 60 days of meeting the ELCA benefit program s eligibility criteria, you and your family will have to wait 90 days to enroll in health benefits. Exceptions: You enroll during the annual Open Enrollment period in November with health coverage effective the next Jan. 1 or You had a valid waiver within 60 days prior to enrolling The 90-day waiting period begins the day your enrollment is completed. No health plan contribution is due during this waiting period. If you enroll late, health coverage takes effect for you (and your family) the last day of the 90-day waiting period or Jan. 1 of the following year, whichever is earlier. If you re eligible to enroll but don t enroll in a timely manner, you can enroll during annual Open Enrollment in November without a 90-day waiting period for health coverage. Coverage begins Jan. 1 of the following year. Flexible Spending Accounts If your FSA enrollment isn t completed within 60 days of your eligibility, you must wait until the next plan year to participate unless you experience a qualifying election change event. Life Insurance Basic group life insurance begins the date your employer sponsors you in the ELCA benefit program, subject to the active work requirement. You cannot be denied basic group life insurance coverage (no EOI required). If you enroll in supplemental and/or dependent life insurance outside the 60-day eligibility period, you will be required to provide EOI. The EOI must be approved by Minnesota Life. Your coverage will not be effective until your EOI is approved. Disability If your enrollment application is submitted more than 60 days after meeting the ELCA benefit program s eligibility criteria, you are not entitled to receive any disability benefits under the ELCA Disability Benefits Plan if you become partially or totally disabled within the first 18 months after enrolling and the disability is caused by a pre-existing condition diagnosed or treated in the six-month period prior to your enrollment date. Annual Open Enrollment Portico requires members and employers to confirm or change their benefit options for the coming plan year during annual Open Enrollment in November. Eligible spouses, eligible same-gender partners (ESGPs), and eligible children may also be enrolled during this period. Benefits elected during Open Enrollment are effective Page 7

13 Jan. 1 of the next year and continue throughout the year. You make decisions about some or all of the following benefits depending on your eligibility. Health The ELCA-Primary health benefit option you choose during Open Enrollment for the coming year applies for the entire plan year, unless you re no longer sponsored or you become eligible for ELCA Medicare-Primary health benefits. If you have other valid health coverage, you can waive health benefits for you and family members. You can add or remove family members for health benefits. If you re eligible for ELCA Medicare-Primary health benefits and are sponsored, you will be enrolled in the ELCA Medicare-Primary Standard option. If you are not sponsored, you can enroll in an ELCA Medicare-Primary health benefit option through Mercer, the ELCA Medicare Supplement benefit administrator. Flexible Spending Accounts If eligible, you enroll in the FSA each year during annual Open Enrollment by electing annual pretax contribution amounts for the health FSA and/or the dependent (day) care FSA. Your FSA election(s) remains in effect Jan. 1 Dec. 31 unless you experience a qualifying election change event. If you enroll during Open Enrollment, your FSA begins the next Jan. 1. If you don t make an election for the health FSA or the dependent care FSA during the annual enrollment period, you are not eligible to participate until the next plan year unless you experience a qualifying election change event. Health Savings Account If eligible, you decide whether to make a pretax contribution to your HSA. You can start or change your contribution amount throughout the year. Life Insurance During Open Enrollment, you can purchase on an after-tax basis: Supplemental life insurance for yourself Dependent life insurance for your spouse or ESGP and eligible children if you also purchase supplemental life insurance for yourself Retirement During Open Enrollment, you decide whether to have a pretax retirement contribution withheld from your paycheck by your employer and how much to contribute. You can also start, change, or stop this contribution throughout the year. How Open Enrollment Works Your sponsoring employer signs in to EmployerLink to learn about the health benefit options Platinum+, Gold+, Silver+, or Bronze+. You sign in to myportico to learn about your benefit options. On EmployerLink, your employer selects one health benefit option to offer. If Silver+ or Bronze+ is selected, your employer can also select to contribute money to your health savings account (HSA). Page 8

14 You make the following benefit decisions, and enter them online by signing in to myportico: - Required if you have ELCA-Primary benefits: Whether to enroll in the health benefit option your employer selected, buy up to a higher priced option and pay the difference, or waive health benefits, if you qualify (see below for waiver details) - Optional: Whether to contribute to flexible spending accounts, if you re eligible, to help pay for eligible out-of-pocket health care costs and/or day care expenses - Optional: Whether to contribute to a health savings account, if you re eligible, to help pay for eligible out-of-pocket health care costs - Optional: Whether to purchase supplemental life insurance, if you re eligible, for yourself and/or dependent life insurance for your spouse, ESGP, or children - Optional: Whether to start or change a pretax retirement contribution In 2014, Portico bills your employer for your health benefit buy-up costs, contributions to flexible spending accounts, health savings account, pretax retirement contributions, and supplemental and dependent life insurance premiums. Your employer then withholds these amounts from your paycheck. NOTE: If eligible, you can periodically begin or change health savings account contributions, supplemental or dependent life insurance, and pretax retirement contributions not only during Open Enrollment. Opportunity for Employees Not Enrolled in a Timely Manner Eligible employers who don t enroll eligible employees in the ELCA benefit program in a timely manner can enroll them in November without a 90-day waiting period for health coverage. If your employer enrolls you in November, your benefits will start Jan. 1 of the following plan year. You re eligible to enroll during this time if: Your employer didn t enroll you in a timely manner You waived coverage in the ELCA health plan and your other coverage was terminated for more than 60 days You re enrolled and want to enroll an eligible spouse or ESGP and eligible children This opportunity is not available to individuals whose eligibility period to elect coverage continuation under the health plan has lapsed (former spouses, surviving spouses, or individuals who previously terminated coverage, except retirees). Waiving Health Coverage As a sponsored member of the ELCA benefit program, you can waive (decline) ELCA-Primary or ELCA Medicare-Primary health benefits while continuing to participate in the flexible benefits and retirement plans and receive coverage under the disability and survivor plans. When waiving health coverage, your spouse or eligible same-gender partner and children: If you are sponsored or receiving disability benefits Must also waive ELCA benefits If you are an ELCA pastor or rostered layperson on leave from call Can continue ELCA benefits at their own expense If you are retired Can continue ELCA benefits for a limited time at their own expense If you are retired, you can waive benefits for your spouse or dependents without having to waive coverage for yourself. Page 9

15 To ensure that you can activate benefits for family members at a later date without a 90-day waiting period, you must first enroll them as waived members in the ELCA Health Benefits Plan. To avoid late enrollment consequences, you need to notify the Portico Service Center of any change in family status while you are waiving coverage marriage, birth, divorce, loss of eligibility for a dependent, and death. To waive, you must meet one of the two criteria described below. If you don t meet these criteria and don t enroll in ELCA health benefits, you are no longer enrolled in the bundled ELCA benefit program. 1. You have other valid health coverage provided by one of the following: An employer other than your sponsoring employer, provided that this employer is not an ELCA congregation, seminary, synod, or ministry of the ELCA churchwide organization An employer or former employer of your eligible spouse or ESGP, as a result of your spouse s employment Your former employer, as a result of your previous employment Your (or your spouse s) employer or former employer if you are a retired member Your (or your spouse s) employer or former employer if you are on leave from call Your parent s employer or former employer (if you are a child) A government-sponsored program outside the United States Federal Medicaid and state-sponsored Medicaid-like medical assistance programs A post-secondary educational institution attended by a coverage continuation member, eligible spouse, or eligible child A Medicare health plan option under Medicare Advantage The U.S. Department of Veterans Affairs 2. You purchase coverage through a state, federal, or state/federal partnership health insurance exchange and receive a premium tax credit (also called a subsidy) in accordance with the Patient Protection and Affordable Care Act of If you choose to waive ELCA health benefits, your waiver of coverage will take effect the date Portico receives your waiver request or on any future date you designate. If you enroll in other valid health coverage, contact the Portico Service Center for a certificate of group health coverage (Health Insurance Portability and Accountability Act creditable coverage notice). You may need this certificate to confirm prior coverage. Activating Health Coverage After Waiving If you previously waived ELCA health coverage, you can activate it during annual Open Enrollment or at any time during the plan year as long as you can document that you met waiver criteria and meet the plan s eligibility criteria. If you are: Sponsored and eligible for ELCA-Primary health benefits You can accept the ELCA-Primary health benefit option selected by your employer or buy up to a higher priced option. However, if you ve already been sponsored during the current plan year and you reactivate coverage after waiving, you must reactivate in the same benefit option you chose during your first period of sponsorship. Not sponsored and eligible for ELCA-Primary health benefits You can select from one of the four ELCA-Primary health benefit options. Sponsored and eligible for Medicare You are eligible for the ELCA Medicare-Primary Standard health benefit option. Retired or continuing coverage and eligible for Medicare You can choose from three ELCA Medicare-Primary health benefit options. Page 10

16 Disabled and eligible for Medicare You are eligible for the ELCA Medicare-Primary health Standard benefit option. On leave from call and eligible for Medicare You are eligible for the ELCA Medicare-Primary Standard option. Page 11

17 Paying for Benefits When You re Sponsored in the ELCA Benefit Program Benefits Paid by Your Sponsoring Organization In accordance with the ELCA Philosophy of Benefits, your sponsoring employer is billed for the contribution amount for your participation in the ELCA benefit program, including the full cost of the health benefit option it selected during annual Open Enrollment for you and any covered family members. Most contribution rates are expressed as a percentage of your defined compensation. This helps our ministry community support each other in mission by sharing benefit costs between sponsoring organizations of greater and lesser means. Contribution rates are typically approved annually by Portico s board of trustees and announced in the fall for the next plan year. Your sponsoring organization is billed monthly and can estimate its contribution amount online using the 2014 Benefit Costs Calculator on EmployerLink. Health contributions Your employer s health contribution rate is based on a percentage of your defined compensation (subject to a minimum and maximum) and the following: The health benefit option provided by your sponsoring organization Eligible family members you choose to cover: you, your spouse or ESGP, and your children Your sponsor s assigned rate class (all sponsoring organizations within a synod are assigned a rate class that reflects the region s average health care costs; seminaries are grouped into a separate rate class) Your age The size of your sponsoring employer if you have ELCA Medicare-Primary health benefits (see page 43). NOTE: If you are eligible and decide to waive ELCA health benefits, your employer does not pay a health contribution. Health savings account contributions If you are eligible for an HSA and your employer selects the Silver+ or Bronze+ health benefit option and chooses to contribute money to your HSA during annual Open Enrollment, Portico bills your employer monthly for this contribution and directs it to your HSA once it s received from your employer. Survivor contributions In 2014, your employer pays 0.8% of your defined compensation to provide you with basic group life insurance and accidental death and dismemberment (AD&D) protection. Disability contributions Your employer pays a percentage of your defined compensation to provide you with disability benefit protection. In 2014, your employer is not being charged for your disability coverage due to the strong financial position of the ELCA Disability Benefits Trust. Employer retirement contributions Your employer pays a percentage of your defined compensation to help you save for retirement. Once Portico receives it, we credit your employer s contribution to your ELCA Retirement Plan account. The percentage of defined compensation can differ depending on your employer and whether you re a rostered leader or lay employee. - If you are employed by an ELCA synod, seminary, or ministry of the ELCA churchwide organization, your employer must contribute a minimum of 10% of your defined compensation. - If you are a sponsored pastor or rostered layperson, your sponsoring organization must contribute a minimum of 10% of your defined compensation. Page 12

18 - If you are lay employee and not sponsored by an ELCA synod, seminary, or ministry of the ELCA churchwide organization, your sponsoring organization must contribute a minimum of 6% of your defined compensation. - Your employer may choose to contribute more than the required amount, subject to contribution limits described in the ELCA Retirement Plan Summary Plan Description. - If you participated in a predecessor plan on Dec. 31, 1987, were at least age 45 on that date, and have continuously participated in an ELCA retirement plan since Jan. 1, 1988, your employer must contribute at least 11%. - If you are an eligible self-sponsoring pastor, you pay the employer contribution of at least 10% of your defined compensation. - If you are a lay employee of an ELCA institution or a non-elca organization, your employer must contribute the same percentage for all non-clergy sponsored members and it can t be less than 6% of defined compensation, as determined by your employer. Housing equity retirement contributions Your employer may choose to pay additional amounts toward your ELCA Retirement Plan account if you are a pastor sponsored by a congregation, synod, seminary, or ministry of the ELCA churchwide organization. Housing equity contributions are retirement plan contributions made by an employer for pastors living in church-owned housing. Housing equity contributions are made in addition to employer retirement contributions. Your employer decides the effective date and the contribution amount (either a percentage of your defined compensation or a flat dollar amount), subject to contribution limits described in the ELCA Retirement Plan Summary Plan Description. Retiree support contributions In 2014, your employer pays 0.7% of your defined compensation to help the ELCA provide health coverage for certain retired members who served a predecessor church body. Benefits Paid by You While Sponsored You can elect to pay for optional benefits. Portico includes your costs on your sponsoring employer s monthly bill. Your employer is responsible for deducting the appropriate amount from your paycheck and remitting it to Portico on your behalf. Your sponsoring employer can sign in to EmployerLink to review details about payroll withholdings. Health buy-up costs If you chose to buy up to a higher priced health benefit option than the one your sponsoring employer selected during annual Open Enrollment, you are responsible for paying the cost difference. Your employer deducts this amount from your paycheck on a pretax basis. Health FSA contributions If eligible, you may set aside money to help you manage eligible out-ofpocket health care expenses. Your employer deducts this amount from your paycheck on a pretax basis. Portico credits your contribution to your health FSA once it s received from your employer. Your total annual election is available to you on the date your health FSA is effective. Dependent (day) care FSA contributions If eligible, you may set aside money to pay for day care that enables you and your spouse to work or seek work. Your employer deducts this amount from your paycheck on a pretax basis. Portico credits your contribution to your dependent (day) care FSA once it s received from your employer. Your contributions are not available to you until they are credited to your account. HSA contributions If eligible, you may set aside money to help you manage eligible out-of-pocket health care expenses. Your employer deducts this amount from your paycheck on a pretax basis. Portico deposits your contribution into your HSA once it s received from your employer. Your contributions are not available to you until they are deposited into your account. Life insurance premiums If eligible, you may purchase supplemental life insurance for yourself and dependent life insurance for your spouse or ESGP and children. Your employer deducts this amount from your paycheck on an after-tax basis. Page 13

19 Pretax retirement contributions You may set aside money to help you save for retirement. Your employer deducts this amount from your paycheck on a pretax basis. Portico credits your contribution to your ELCA Retirement Plan account once it s received. When You re Not Sponsored in the ELCA Benefit Program When you are not sponsored in the ELCA benefit program by an eligible employer, you pay the contribution amount for any benefits you continue. This is referred to as coverage continuation. In some cases, benefits are available for a limited period of time. Coverage continuation must be elected within 60 days of eligibility for coverage continuation. If eligible, you and family members can continue ELCA-Primary or ELCA Medicare-Primary health benefits when you: Retire Become disabled and entitled to benefits from the ELCA Disability Benefits Plan and your employer is not making health contribution payments for the first two months of your disability Begin on leave from call status Terminate employment (other than for reasons of gross misconduct) Experience a reduction in hours of employment that causes you to lose eligibility for coverage under the ELCA health plan or your employer no longer sponsors you in the ELCA benefit program Take a leave of absence without pay Are called to military service Rates are typically approved annually by Portico s board of trustees and announced in the fall for the next plan year. Coverage is billed monthly using current coverage continuation rates. You ll find your bill online around the 20 th of each month. You can estimate your contribution amount online by visiting the Coverage Continuation Rates page in the Overview & Life Changes section on myportico. Health contributions If eligible, you can purchase ELCA-Primary or ELCA Medicare-Primary health benefits for you and/or eligible family members. In 2014, your rate depends on the following variables: - Your health benefit option - Eligible family members you choose to cover: you, your spouse or ESGP, and your children - Your age, if you re covered - Your spouse or ESGP s age, if he or she is covered Health FSA contributions If you have a positive balance (you ve contributed more than you ve been reimbursed) at the time your sponsored employment ends, you can continue your health FSA contributions for the remainder of the plan year by setting up after-tax contributions with Portico. Your after-tax contributions must be the same as your pretax health FSA election for the plan year (unless you have a qualifying election change event). Portico bills you monthly for amounts you elected for the plan year. If you don t pay these after-tax contributions or you decide not to continue after-tax contributions, you will forfeit the balance in your account. Dependent (day) care FSA contributions You can t continue your dependent care FSA contributions when your sponsored employment ends. HSA contributions If eligible, you can contribute money after-tax to an HSA to help you manage eligible out-of-pocket health care expenses. Portico bills you monthly for your contribution and deposits it into your HSA once it s received. Your contributions are not available to you until they are deposited into your account. Page 14

20 Life insurance premiums You re eligible to continue basic group life insurance with accidental death and dismemberment (AD&D) protection by contacting Minnesota Life Insurance Company. You are billed by Minnesota Life. If you purchased supplemental and dependent life insurance while sponsored, you can continue this coverage by contacting Minnesota Life Insurance Company. You are billed by Minnesota Life. Disability contributions If you are an interim pastor or interim rostered layperson serving under a term call from a synod council and between assignments after completing an interim or term call from your synod council, you can purchase up to 12 months of limited disability benefit coverage at your own expense. In 2014, this rate is $25 per month per $1,000 of coverage. When Contributions Aren t Paid If the contributions for your benefits are not paid in full, Portico begins a process 60 days after the due date to collect the outstanding balance. During this process, your sponsoring employer (or you, if you have coverage continuation) must pay the balance in full or agree to a payment plan with Portico or your benefits will end. Portico notifies you of your benefit termination date. You (and your family) may reactivate coverage at a later date if you are eligible for coverage and if the unpaid amount is paid in full. You will be subject to the 90-day waiting period for health coverage unless you reactivate coverage during annual Open Enrollment or had other valid coverage or health insurance coverage purchased on a state, federal, or state/federal partnership exchange from which you receive a subsidy within 60 days prior to reenrolling. You will also be subject to a longer exclusion period for pre-existing conditions under the ELCA Disability Benefits Plan. Page 15

21 When a Call or Employment Change Affects Your Benefits If You Change Call or Employment If you leave one call or position and accept another with an eligible ELCA employer, notify Portico of your change of call or employment as soon as possible. If you contact us within 60 days of the date you become eligible for ELCA benefits and your new employer begins sponsoring you within this period, your employer will be responsible for paying all benefit contributions effective the date of your new sponsorship. If we aren t notified within 60 days of the date you become eligible, you and your dependents will have a 90-day waiting period for health coverage and you ll be subject to an 18-month pre-existing condition exclusionary period under the ELCA Disability Benefits Plan. Health Your employer selects one ELCA-Primary health benefit option during annual Open Enrollment. Unless you waive health benefits, you enroll in that option or buy up to a higher priced option, and retain it while sponsored during the plan year. NOTE: If you re sponsored and over age 65, see page 43 for health benefit details. If you start a new call or position midyear, expect the following: You will continue the health benefit option you originally chose for the year, unless you are eligible and opt to waive ELCA health benefits. (See pages 9 11 for details about waiving health benefits.) You ll keep your progress toward your 2014 deductible and out-of-pocket limit. If your new employer offers a lower priced option than you chose for the year, you re responsible for paying the health contribution difference. If your new employer offers a higher priced option than you chose for the year, you will continue to have the option you originally selected. If you bought up to a higher priced option during Open Enrollment and your new employer offers that option or an even higher priced option, you continue to have the option you originally selected but are no longer charged the buy-up cost. If you had chosen the Silver+ or Bronze+ option and your new employer offers one of them, you ll receive the HSA contribution selected by your new employer and can continue to make contributions to your HSA if you re eligible for an HSA. If you have a gap between employers of more than 31 days, you can choose a different option while on coverage continuation at your own expense. Then, if you re again sponsored during the same plan year, you ll return to the health benefit option you originally chose for the year. You can continue to earn wellness dollars up to the annual maximum allowed. EXAMPLES: Your prior employer selected Gold+ and you enrolled in it during 2014 Open Enrollment. If your new employer provides Silver+, you continue to have the Gold+ option and pay the buy-up costs through payroll deduction. If your new employer provides Platinum+, you continue to have Gold+. Page 16

22 Your prior employer selected Silver+, you enrolled in it during 2014 Open Enrollment and are eligible for an HSA. If your new employer also offers Silver+, you continue to have Silver+ but you receive the employer HSA contribution level that the new employer provides. If your new employer offers Gold+, you continue to have Silver+ and no longer receive employer HSA contributions. Your prior employer selected Bronze+ and you bought up to Silver+ during 2014 Open Enrollment. If your new employer offers the Platinum+ or Gold+ options, you continue with Silver+ and are no longer charged the buy-up cost. When your employment ends with an eligible employer, your ELCA health benefits terminate. If you re sponsored by another eligible employer with 31 days, coverage for you (and your family) will be retroactively reinstated after Portico receives notice of your change of call from your new employer. Portico provides health coverage during this time for up to 31 days at no additional cost to you or your employers. Contact Portico shortly before your call ends for help coordinating this process in order to potentially avoid a situation where a claim is denied. If there are more than 31 days between the dates your current call ends and your next call begins, you re responsible for the cost of continuing health benefits while between calls. Before your employment ends, let the Portico Service Center know your choice of health benefit option. Flexible Spending Accounts If you are a sponsored member and have 31 days or fewer between eligible employers, you are required to continue your FSA with the same annual election you chose prior to changing employment (unless you have a qualifying election change event that allows you to change your election). If you are a sponsored member and have more than 31 days between eligible employers, your participation in the plan terminates. Your employer must withhold FSA contributions through your last scheduled paycheck. Health FSA If you have a positive balance at the time your call or employment ends, you can: - Submit any claims incurred prior to the date your call or employment ends, or forfeit the balance in your account. Expenses incurred after the date of termination are not eligible to be reimbursed. - Continue your health FSA contributions until your next call or employment begins by setting up after-tax contributions with Portico. Your after-tax contributions must be the same as your pretax health FSA election for the plan year (unless you have a qualifying election change event). Portico bills you monthly for amounts you elected for the plan year. If you don t pay these after-tax contributions, you will forfeit the balance in your account. When your next call or employment begins, the maximum health FSA contribution you can elect is the annual contribution limit less the amount you previously contributed in the plan year. Dependent (day) care FSA You can t continue your dependent care FSA contributions. You must submit any claims incurred prior to the date your call or employment ends, or forfeit the balance in your account. Expenses incurred after the date of termination are not eligible to be reimbursed. When your next call or employment begins, the maximum dependent care FSA contribution you can elect is the annual contribution limit less the amount you previously contributed in the plan year. Health Savings Account If you had chosen the Silver+ or Bronze+ option and your new employer offers one of them, you ll receive the HSA contribution selected by your new employer and can continue to make contributions to your HSA if you re eligible for an HSA. Page 17