Health. The Seminary Student Option of the Concordia Health Plan for Broad Coverage and Great Value for Students and their Families

Transcription

1 Health The Seminary Student Option of the Concordia Health Plan for Broad Coverage and Great Value for Students and their Families

2 What s The Inside preferred health plan of most LCMS employers is also your health plan. This is your overview of the Seminary Student Option of the Concordia Health Plan Option CSS. Good health is a blessing we want everyone in our church to enjoy including those preparing for a life of service in The Lutheran Church Missouri Synod. Students at Concordia Seminary and Concordia Theological Seminary have the same comprehensive health coverage enjoyed by workers throughout the LCMS. Search Concordia Plan Services on Facebook, Twitter, YouTube, Pinterest and LinkedIn for the latest news, information and links. This brochure provides a summary of the benefits provided by Concordia Plan Services. Your employer determines the benefit package available at your location, which may not include everything covered in this guide. Every effort has been made to ensure the accuracy of this summary; however, if there is any conflict between the information in this summary and the actual terms and conditions of the Plans, as stated in the Official Plan Documents that control the Plans, the latter will govern. 2 Concordia Plan Services The Seminary Student Option of the CHP

3 The Concordia Health Plan provides peace of mind We are pleased to offer the comprehensive benefits of the CHP to our students. While the cost is comparable with other insurance plans, the CHP covers so much more: Medical care, including preventive services, well-child care and routine exams Dental care Prescription drug coverage Mental health and substance abuse care An employee (student) assistance program Health and wellness programs Vision care Discounts on hearing care We offer you these benefits not only to protect you against the financial burden of illness and serious injury, but also to help you and your loved ones enjoy the best of health. The Concordia Health Plan enrollment guidelines All students in residential programs taking seven credit hours or more are required to have health coverage while attending school. Coverage is also required during vicarage, internship, foreign study, residential S.T.M., as well as by Ph.D. students carrying six or more credit hours, full-time residential students working on a dissertation or preparing for exams and international students. Students spouses and dependent children are also eligible for coverage. Students may opt out of the CHP only if covered under another health plan, as described below: A spouse s group health plan (coverage by virtue of employment, including military service) A parent s group health plan (coverage by virtue of employment, including military service) A former employer s group health plan A current, non-lcms employer s group health plan A military retiree health plan A Medicare supplemental plan A governmental medical assistance program for low-income persons (e.g., Medicaid) A foreign country plan while studying outside the United States A group health plan of an LCMS employer located in the state of Hawaii Healthcare coverage through a Health Insurance Marketplace made available by the Affordable Care Act. Concordia Plan Services The Seminary Student Option of the CHP 1

4 Transition of care for new members and dependents If you or your family members are currently receiving medical treatment under a different health plan, we will work with you to ensure that care continues once you are enrolled in the CHP. Coverage starts the first day of the month that classes begin. Students and their eligible family members who are already enrolled in the CHP do not need to re-enroll for the plan year. New students who are enrolling themselves for the first time will need to complete the enclosed Seminary Student Enrollment Form. Those enrolling new dependents or making changes to their existing coverage will need to submit a Seminary Student Open Enrollment Application, Seminary Student CHP Special Enrollment Application Form or Seminary Student Request for Membership Change form depending on your situation. You will find these forms at ConcordiaPlans.org under Health > Member Health Benefits > Seminary Student. If your current care provider is a member of the Blue Cross Blue Shield network, you can receive network benefits. Once your CHP coverage is effective, be sure to tell your doctor that your plan has changed and present your new ID card. Also, provide the Blue Cross Blue Shield phone number ( ) so that your doctor can verify your benefits. If you are currently receiving care from a provider not in the Blue Cross Blue Shield network, call Blue Cross customer service at for assistance in creating a transition plan. Exceptional coverage now and in the future The CHP brings together companies known for providing high levels of customer service: Blue Cross Blue Shield for medical benefits; Cigna for mental health and substance abuse care, dental benefits and wellness programs; Express Scripts for prescription drug benefits; and Vision Service Plan for vision care. By joining the CHP now, you and your family can take advantage of the many benefits these programs offer and maintain those benefits after graduation. You may continue your CHP coverage for up to 15 months after you or your eligible family members no longer qualify for the seminary student option of the CHP. If you accept a call or take a job with an employer that offers the CHP and there is no lapse in coverage, your coverage will continue without interruption and any amounts you ve paid toward your deductible or coinsurance maximum during the current calendar year will be carried over. Concordia Health Plan advantages for seminary students The CHP delivers benefits and value for today s seminary students and their families. The Concordia Health Plan is: Comprehensive. Under the CHP, students and their families have access to a broad range of benefits, including 100% coverage for preventive care services. The plan also covers prescription drugs, as well as dental, vision, hearing, as well as mental health and substance abuse services. It provides a variety of health and wellness programs, too. 2 Concordia Plan Services The Seminary Student Option of the CHP

5 Portable with an LCMS employer. Following seminary, if you accept a call or take a job with an employer that offers the CHP, your coverage may continue without interruption. Any amount you ve paid toward your deductible in that calendar year will carry over as well, provided there is no break in coverage. Available post-seminary. Coverage for students and eligible family members may be extended up to 15 months following graduation in the event employment with an LCMS employer does not begin right away. Guaranteed. All eligible seminary students and eligible family members, regardless of age, gender or health status, are guaranteed coverage through the CHP. Family-friendly. Enrolled dependent children can remain enrolled until age 26. Also, should the need arise, dependent spouses and children would be eligible to purchase extended coverage through the CHP. Fair for all. The CHP costs are based on community rating, so your contribution rates do not fluctuate on the basis of age, gender or health status. Responsive. You ll find a wealth of information and helpful resources online at ConcordiaPlans. org. If you have questions about your plan, select Contact Us on the website to send us an . Or you can call us at , Monday Friday, 7 a.m. 5 p.m., Central Time. We re here to help you! Getting the most from your health plan To maximize your CHP benefits and enjoy the greatest savings, you ll want to select network providers for your care. To find a network doctor, hospital or facility, go to bluecrossmn.com/concordia, select Find a Doctor, and search the National BlueCard PPO network (enter Alpha prefix: CND) or call Blue Cross at For network dentists, vision care specialists and mental health professionals, visit ConcordiaPlans.org and click on Who We Are > Service Providers. You ll find a directory of benefits administrators, with phone numbers and links you can use to access network provider information. Express Scripts maintains an extensive network of retail pharmacies, including large chain pharmacies, grocers and discount retailers. Once you are enrolled in the CHP, you can visit Express-Scripts.com to find a complete listing of network pharmacies in your area or you can call Express Scripts at for more information. Concordia Plan Services The Seminary Student Option of the CHP 3

6 Option CSS Medical Benefits Administered by Blue Cross Blue Shield of Minnesota NETWORK NON-NETWORK Plan Year Deductible $500 per person; $1,000 per family $1,000 per person; $2,000 per family Coinsurance 80% 60% Plan Year Coinsurance Maximum $3,000 per person; $6,000 per family $7,000 per person; $14,000 per family Preventive Care 100% Not covered Primary Care Physician Office Visit Copay $25 $50 Specialty Physician Office Visit Copay $25 $50 Inpatient Hospital Coinsurance 80% after deductible 60% after deductible Outpatient Hospital Coinsurance 80% after deductible 60% after deductible Emergency Room Copay $100 (no copay if admitted into hospital within 24 hours) Prescription Drug Benefits Administered by Express Scripts Retail Pharmacy Short-term Drugs (up to 30-day supply) Home Delivery for Maintenance/Longterm Drugs* (90-day supply) *See details on pg. 5 Generic Drugs $10 $20 Formulary Brand Drugs $25 $50 Non-formulary Brand Drugs $50 $100 Dental Benefits Administered by Cigna Dental 800-CIGNA24 ( ) NETWORK NON-NETWORK Plan Year Maximum Benefit $1,500 Plan Year Deductible Preventive Care $50 per person 100% (no deductible, not subject to plan maximum benefit) 90% (no deductible, not subject to plan maximum benefit) Diagnostic Care 100% (no deductible) 90% (no deductible) Basic Restorative Services 80% after deductible 70% after deductible Major Restorative Services 50% after deductible Orthodontia for Dependent Children 50% up to a lifetime maximum of $1,250 Mental Health/Substance Abuse and Employee (Student) Assistance Programs Administered by CignaBehavioral Health Be Well Serve Well Health & Wellness Programs Vision Benefits Administered by Vision Service Plan Hearing Discount Program Administered by HearUSA Lifetime Maximum for Concordia Health Plan Benefits Includes inpatient and outpatient care for mental health/substance abuse issues, as well as assistance with behavioral health and everyday life concerns (e.g., stress, family matters, legal issues) Includes Concordia Total Health Coach, Omada, Vitality, Doctor On Demand, 24- Hour Nurse Line, Healthy Pregnancies/Healthy Babies Program and Cancer Support Program Includes coverage for eye exams and corrective eyewear/contact lenses Includes discounts for testing, hearing aids and hearing aid maintenance/repair Unlimited For more details about your coverage, visit ConcordiaPlans.org. 4 Concordia Plan Services The Seminary Student Option of the CHP

7 Save on your prescription drugs If you or your dependents take medication on a regular basis, you can save money and trips to the pharmacy with home delivery through Express Scripts. This mail-order service delivers a 90-day supply of medication to your home for the same cost as a 60-day supply from the retail pharmacy. It s like getting one free refill every three months! *After four (4) fills within one hundred twenty (120) days of the same prescription at a network retail pharmacy, starting with the fifth (5th) fill, you will pay 50% of the eligible cost or the appropriate copay, whichever is greater. Some exceptions may apply if the drug (A) is not available for purchase through the Express Scripts home delivery program, (B) cannot be provided through the mail due to law, or (C) is considered a controlled substance by Express Scripts. Special Note: Specialty drugs are covered by the Plan only if purchased from the specialty-drug home delivery pharmacy specified by Express Scripts. Broad coverage, great value With the CHP, you and your family are protected by coverage that includes medical (with preventive care), prescription drugs, dental, vision, hearing, mental health and substance abuse care, as well as employee (student) assistance and wellness programs all for about the same cost as more limited health plans. This chart reflects your cost for the CHP coverage Rate Self Only Self & Spouse Self & Children Family $265 per month $624 per month $597 per month $955 per month For payment information, refer to the cover letter provided by the Seminary. Next steps 1. Already enrolled, making no changes to your coverage? No further action is necessary. 2. Enrolling in or making changes to your CHP coverage? Review the directions and deadlines for enrollment outlined in the cover letter from the seminary, which accompanied this brochure. Complete the enclosed enrollment form. Return it to the designated representative at the seminary as directed in the cover letter. If you or your dependent enroll in the CHP, a welcome kit from Concordia Plan Services and ID cards from Blue Cross Blue Shield of Minnesota and Express Scripts will be mailed to the address indicated on the enrollment form. Concordia Plan Services The Seminary Student Option of the CHP 5

8 Grandfathered Status Notice Concordia Plan Services believes the Concordia Health Plan (CHP) is a grandfathered health plan under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that the CHP may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement to provide an internal and external appeal review process. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to Concordia Plan Services at You may also contact the U.S. Department of Health and Human Services at HealthCare.gov. The information included in this booklet is a brief summary of the Concordia Health Plan for seminary students. It does not include every detail. In the event of a conflict between the information included here and the terms of the plan as stated in the official plan document, the plan document will govern. The Lutheran Church Missouri Synod 1333 South Kirkwood Road St. Louis, MO ConcordiaPlans.org info@concordiaplans.org