Continuing Coverage at Termination of Eligible Service For Teaching Elders in Pastor s Participation

Transcription

1 Continuing Coverage at Termination of Eligible Service For Teaching Elders in Pastor s Participation

2 If any discrepancy exists between this booklet and the official Benefits Plan document, the official plan document governs. Copies of the official Plan document are available from the Board of Pensions online at pensions.org, or by calling the Board at (800-PRESPLAN). PLN-205 8/17

3 Continuing Coverage at Termination of Eligible Service As a member with Pastor s Participation coverage under the Benefits Plan of the Presbyterian Church (U.S.A.), you may elect to continue coverage on a self-paid basis under the plan when you terminate eligible service. If you do not enroll for coverage within 60 days from the date your current employer-paid benefits terminate, you lose your right to continue coverage through the Benefits Plan as a terminated member. To enroll and activate coverage, you must complete a form and return it to the Board. If you have not received a form, you may request one by calling the Board at (800- PRESPLAN). Send your completed form to: The Board of Pensions of the Presbyterian Church (U.S.A.) 2000 Market Street, Philadelphia, PA You may be eligible to: continue Benefits Plan participation under transitional participation coverage if you are in Pastor s Participation when your employer-paid benefits terminate and have the required verification that you are seeking a new church service. Use the Transitional Participation Coverage Enrollment form, available on pensions.org, for this purpose. s who reach their maximum eligibility for continuing benefits under transitional participation coverage are then eligible to continue healthcare benefits under Medical continuation coverage; continue healthcare benefits by enrolling in medical continuation coverage; use the Medical Continuation Subscription or Waiver form for this purpose; continue healthcare benefits by enrolling in the Medicare Supplement Plan if you and/or your spouse are over age 65 and participate in Part A and Part B of Medicare; use the Medicare Supplement Subscription, Waiver, or Withdrawal form for this purpose; or initiate or defer your retirement pension if you meet current eligibility rules. Call the Board for more retirement information. Check the letter accompanying this booklet to make sure that the Board has the correct date for the termination of your employer-paid benefits (the last day your employer pays for your participation in the Benefits Plan). This date for benefits purposes may be different from your last day worked (for example, if you are eligible for benefits coverage during a severance period). If you do NOT want to continue coverage for you or your eligible family members following termination of service, do nothing. If you are starting a new, eligible church service on or before the termination of any no-cost coverage period for which you may be eligible, your employer must report your new service to the Board of Pensions within 60 days of the effective date of new service by submitting a Service Change form. 1

4 For benefits costs, forms, or additional information, please visit pensions.org, call us at (800-PRESPLAN), or us at General Information Benefits Termination Date Service Termination Date No-Cost Coverage Short (or no) Gap in Service The last date through which your church/employer pays for your benefits (including any severance coverage but excluding any no-cost coverage). The last date that you worked. Teaching elders receive 30 days of no-cost healthcare coverage after the benefits termination date. Teaching elders may also receive no-cost death coverage for 90 days after the benefits termination date. If you will start a new eligible service on or before the date that no-cost coverage ends and were participating in pension or supplemental death benefits as of your service termination date, you must remit payment to continue participation in the Pension Plan and to maintain supplemental death benefits during the gap. Severance Agreements Severance payments with or without a continuation of employer-paid benefits are part of effective salary and are dues bearing. Relocating after Termination Severance payments with a continuation of employerpaid benefits extend the benefits termination date. Benefits provided during any severance period must continue at the same level of participation in effect at termination of service. You must notify the Board immediately of your new address and its effective date to avoid interruption of coverage. 2

5 Continuing Coverage under Transitional Participation Coverage Transitional participation coverage is available to members in Pastor s Participation who are actively seeking church service; enrolled for full-time church-related studies; or subject to a disciplinary process that leads to a temporary leave or unemployment. At a minimum, benefits continuation under transitional participation coverage is available for 24 months for teaching elders in Pastor s Participation and graduated seminary student members whose presbyteries verify their status. Longer periods are available to members enrolled for fulltime church-related studies or who are subject to a disciplinary process. Contact the Board for details. Eligible members may elect to continue most coverage in effect on the date that eligible service terminated. Please note that if you meet the Rule of 70 and elect not to continue medical and/or death benefits coverage, you may lose the opportunity to enroll for continued medical benefits and lose your eligibility for Retiree Death Benefits upon retirement. When enrolling for transitional participation coverage, a member chooses whether to pay for coverage using the congregational teaching elder s median salary participation basis or his or her most recent effective salary (subject to the minimums/maximums). The choice may affect benefits received during transitional participation. For example, if the member pays based on the congregational teaching elders median salary participation basis for pension and death and disability coverage, pension credit accruals, and disability benefits will be based on that selection and not on the member s last effective salary, which might be the greater figure. Deductibles and copayments may also be affected. A member enrolling for transitional participation whose effective salary is greater than the congregational teaching elders median salary participation basis should carefully consider the benefits of choosing to pay for coverage using the former versus the lower costs of coverage based on the latter. See also the Continuing Optional Coverage section. s who reach their maximum eligibility for continuing benefits under transitional participation coverage are then eligible to continue healthcare benefits under medical continuation coverage for at least 18 months. Conversion from Couple If your spouse has healthcare coverage in the Benefits Plan as a result of her/his employment, you are eligible to receive healthcare benefits as a spouse. If you meet the transitional participation coverage eligibility requirements and elect to be covered as a spouse for healthcare, you may remit payment to continue pension and/or death and disability coverage in effect on the date of benefits termination. 3

6 Within 60 days of your termination, your spouse may: apply for supplemental death coverage for you and your eligible children. You are not subject to medical underwriting up to the level of coverage you were enrolled for as a member. add you and your eligible children or enroll as a new enrollee for dental coverage. For information on the benefit limitations that apply, call the Board at (800- PRESPLAN). Please see Your Benefits as a Couple. 4

7 Medical Continuation Program Eligibility Covered Services Enrollment Deadline Deductibles and Copayment Maximum Dues Limitation Continuous Coverage Requirement Waiver of Continuous Coverage Requirement s terminating employer-paid coverage who are not seeking church service, members retiring before age 65, members terminating participation under transitional participation coverage, surviving spouses, former spouses, children who are no longer dependents, and seminary student members not seeking church service following termination of studies may enroll. s and eligible children covered before termination may subscribe even if the member does not. Identical to coverage as an active member or as the spouse or child of an active member. You must enroll and pay the initial cost within 60 days following your benefits termination date. The deductible and maximum copayment amounts are based on the applicable median salary. Your deductible will be reduced only if you have not satisfied your deductible based on your effective salary. The amount you pay to continue coverage for the member and eligible family members is based on the coverage level you select. If you are otherwise eligible for transitional participation coverage but elect medical continuation or Medicare Supplement coverage first, you may not subsequently elect transitional participation coverage. You may not elect medical continuation or Medicare Supplement coverage in the future if you do not maintain continuous coverage in the PC(USA) Medical Plan or have a waiver (see below). You or your spouse may be eligible to waive continuous coverage if you meet the Rule of 70 at the time of termination and are covered by another qualified health plan. To waive coverage, you must return the completed waiver section of the Medical Continuation Subscription or Waiver form. The waiver will be in effect for the duration of the medical continuation eligibility period. 5

8 Medical Continuation Program Eligibility and Duration Reason for loss of coverage Eligible Duration of coverage s employment terminates (before age 55 or at any age if not vested) 18 months (29 months if member is disabled during first 60 days of medical continuation coverage) 18 months (29 months if spouse is disabled during first 60 days of medical continuation coverage) 18 months (29 months if child is disabled during first 60 days of medical continuation coverage) s disability status ends and 18 months termination status starts 18 months 18 months s death Surviving 36 months (includes 12 months of no-cost coverage) 36 months or until loss of eligibility (includes 12 months of no-cost coverage) Divorce/Dissolution Former 36 months Employment terminates for vested member at age 55 or older who meets the Rule of 70 and retirement is deferred; eligible to waive the continuous coverage requirement with other qualified health plan coverage Early retirement for vested member at age 55 or older who meets the Rule of 70; eligible to waive the continuous coverage requirement with other qualified health plan coverage Early retirement for vested member at age 55 or older who does not meet the Rule of months or until loss of eligibility Until eligible for Medicare and Medicare Supplement Until eligible for Medicare and Medicare Supplement Until loss of eligibility Until eligible for Medicare and Medicare Supplement Until eligible for Medicare and Medicare Supplement Until loss of eligibility 18 months 18 months 18 months loses eligibility because of age 36 months Employer withdraws employment classification from plan participation. No one Not available 6

9 Medicare Supplement Program Eligibility and Duration Medicare Supplement coverage requires enrollment in Medicare Parts A and B. Reason for loss of coverage Eligibility Duration terminates employment at age 65 or later with less than five Not eligible for Medicare Supplement years of plan participation Not eligible for Medicare Supplement Eligible for 18 months of medical terminates employment or disability at age 65 or later with five or more years of plan participation. (Note: Eligible to waive continuous coverage requirement with other qualified health plan coverage or enrollment in a Medicare Advantage plan or Tricare)* terminates medical continuation coverage at age 65 (had five years of plan participation while under active plan participation). Note: Eligible to waive continuous coverage requirement with other qualified health plan coverage or enrollment in a Medicare Advantage plan or Tricare* s disability status ends at age 65 or later. does not have five years of plan participation s death Surviving (eligible to waive if covered by qualified health plan) continuation coverage Medicare Supplement Medicare Supplement at age 65 (or upon disability) Medical continuation coverage if under age 65 Medical continuation coverage until loss of eligibility Medical continuation coverage if under age 65 then Medicare Supplement at age 65 (or upon disability) Medical continuation coverage if under age 65 then Medicare Supplement at age 65 (or upon disability) Medical continuation coverage until loss of eligibility 18 months of medical continuation coverage 18 months of medical continuation coverage 18 months of medical continuation coverage Medicare Supplement at age 65 (or upon disability) Medical continuation coverage if under age 65 Medical continuation coverage until loss of eligibility (continued) 7

10 Medicare Supplement Program Eligibility and Duration (continued) Medicare Supplement coverage requires enrollment in Medicare Parts A and B. Reason for loss of coverage Eligibility Duration Divorce or dissolution of marriage Employer withdraws all employees from plan participation Ex- (eligible to waive if covered by employersponsored coverage) Not available Medicare Supplement at age 65 (or upon disability) Medical continuation coverage if under age 65 Medical continuation coverage until loss of eligibility Not available * Special re-enrollment rules apply. Please contact the Board of Pensions at (800- PRESPLAN) for more information. 8

11 Continuing Optional Coverage Supplemental Death Benefits Dental Benefits Retirement Savings Plan Supplemental Disability s with supplemental death benefits for themselves, spouses, and/or children at termination of current eligible service may continue participation only if they: continue death and disability coverage under transitional participation coverage, or initiate their retirement pensions and are not yet age 70. If you drop coverage following your benefits termination date, you may reapply within 60 days of the start of a new service or, if you are continuing benefits under transitional participation coverage, during annual enrollment. Retirees may continue supplemental death benefits until age 70. s with dental coverage for themselves, a spouse, and/or a child(ren) at termination of eligible service may continue participation through transitional participation coverage. If there is a break in dental benefits coverage due to unemployment, you may elect optional dental coverage within 60 days of beginning a new service that includes participation in the Benefits Plan. If there is no break between services and there are no changes to the plan options available to you, your dental benefits continue automatically at your new service. If a move has changed the plan options available to you, the Board will contact you. s may not continue contributions after their benefits termination date. To reactivate participation, you must submit a new salary deferral agreement form to your employer once you begin a new eligible service. s may not continue this coverage unless they are actively at work and meet the income eligibility requirement. 9

12 Other Considerations Activating Coverage Payments USERRA Within 60 days of your benefits termination date, the Board must be notified of the coverage you have selected: Medical continuation, Medicare Supplement, or transitional participation coverage. You will be billed on the first of the month in advance. The payment due date is the 20th of the month. If the Board does not receive payment in full before the last business day of the month that is not a bank holiday, coverage is suspended. One missed payment results in suspension of coverage; two consecutive missed payments result in the termination of coverage with no opportunity for reinstatement. Under USERRA (the Uniformed Services Employment and Reemployment Rights Act of 1994), employees called to military duty in the uniformed services have the rights to employment leave, job restoration, and continuation of certain benefits during military leave. Church employers and church plans are not exempt from the obligations of USERRA. A member who returns to any Presbyterian Church (U.S.A.)-related employer is entitled to USERRA benefits even if he or she returns to a different church or employer within the Presbyterian Church (U.S.A.). Any member who returns to another Presbyterian Church (U.S.A.) after military leave should ask the employer to notify the Board of Pensions of USERRA entitlement. All benefits provided under the Benefits Plan of the Presbyterian Church (U.S.A.) are protected. 10