ELCA Benefit Program Description 2015 ELCA PENSION AND OTHER BENEFITS PROGRAM» Effective JUNE 1, 2015
ELCA Benefit Program Description Effective June 1, 2015 About This Document This program description, in conjunction with the summary of each plan, forms the summary plan description (SPD) 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 June 1, 2015. Use these two documents together as a reference when you have questions about the ELCA benefit program. Together they replace and supersede all previous versions. The ELCA Benefit Program Description is available by contacting the Portico Customer Care Center or by signing in to myportico (myportico.porticobenefits.org) and visiting the Plan page. Each ELCA benefit plan has its own plan document, which is the full, legal description of each plan. Your rights under each plan are governed by the plan document. If this summary is found to be inconsistent with the plan documents, the plan documents will be considered the controlling documents. Copies of the plan documents are available from the Portico Customer Care Center. Portico reserves the right to change any term of the plans through the amendment or termination process described later in the plan summaries. 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 Medical and Dental Benefits Plan (which includes the ELCA post-retirement medical benefits obligation), 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. The plans are church plans, as defined in section 414(e) of the Internal Revenue Code, and 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 fully insured by Securian Life Insurance Company. Life insurance product guarantees are based on the financial strength and claim paying ability of Securian Life Insurance Company. Premiums are not guaranteed to remain unchanged. Portico does not assume any responsibility or liability for the obligations of Securian Life Insurance Company under the insurance policies. Portico is not affiliated with Securian 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.
This document, paired with each plan summary, 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 summaries 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 summaries are available by signing in to myportico (myportico.porticobenefits.org), or contacting the Portico Customer Care Center. This 2015 ELCA Benefit Program Description, effective June 1, 2015, replaces and supersedes all previous materials. Contents About the ELCA Benefit Program... 1 Church-Sponsored Program Supports Ministry... 1 Employers Eligible to Participate... 3 Online Benefit Administration... 5 Program Eligibility... 6 Those Eligible to Enroll in the Program... 6 Eligible Family Members... 6 Enrolling in the Program... 8 Late Enrollment... 9 Annual Open Enrollment... 10 Opportunity for Employees Not Enrolled in a Timely Manner... 12 Waiving Health Coverage... 13 Paying for Benefits... 15 When You re Sponsored in the ELCA Benefit Program... 15 When You re Continuing Coverage (Not Sponsored) in the ELCA Benefit Program... 17 When Contributions Aren t Paid... 19 When a Call or Employment Change Affects Your Benefits... 20 If You Change Call or Employment... 20 If Your Employment Ends... 23 If You Go On Leave From Call... 25 If Your Interim Assignment Ends... 28 If You re a Missionary Sponsored by ELCA Global Mission... 30 If You Leave the Roster and Aren t Sponsored... 31 If You Become Sponsored by Multiple Employers... 33 If You and Your Spouse Both Become Sponsored... 36 If Your Employer No Longer Sponsors You... 41 If You re Called to Serve in the Military... 43
When a Life Change Affects Your Benefits... 46 If You Get Married... 46 If You Become a Parent... 48 If You Get Divorced... 50 If You re a Former Spouse... 52 If Your Covered Adult Child Reaches Age 26... 53 If Family Members Are Eligible for Different Health Benefits... 55 If You Retire... 56 If You Turn Age 65 and Continue to Be Sponsored... 59 If You Become Disabled... 61 If You Die... 64 If You Become a Surviving Spouse... 66 Glossary... 71 Contact Information... 81 ELCA Philosophy of Benefits... 85
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. The ELCA benefit program includes: ELCA Medical and Dental Benefits Plan (ELCA Health Plan) ELCA Flexible Benefits Plan ELCA Survivor Benefits Plan ELCA Disability Benefits Plan ELCA Retirement Plan 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 on page 82. The ELCA benefit program offers 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 Plan) Medical, mental health, dental, and prescription drugs Page 1
- ELCA-Primary health benefits for most members under age 65 before Medicare becomes your primary health coverage. Each health benefit option provides a nearly identical list of ELCA-Primary benefits: Medical and mental health benefit Prescription drug benefit Dental benefit Employee assistance program 24/7 ELCA NurseLine SM Fitness center discount Wellness dollars Health care advocacy team Hearing discount program Mayo Clinic health assessment, web Health support programs portal, and health coaching - ELCA Medicare-Primary health benefits for most members after age 65 when Medicare becomes your primary health coverage - Aetna International health benefits for missionaries sponsored by ELCA Global Mission ELCA Flexible Benefits Plan Tax-advantaged accounts help members set aside pretax dollars to pay for eligible health care and dependent (day) care expenses - Health flexible spending account (FSA) - Dependent (day) care FSA - Health savings account (HSA) - Limited-purpose health FSA ELCA Survivor Benefits Plan Benefits to help family members take care of financial obligations in the event of a death - Life insurance Employer-paid basic life insurance Optional supplemental life insurance Optional dependent life insurance - 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 - Ernst & Young financial planning assistance - Fidelity retirement planning - Lutheran Social Services (LSS) debt and financial coaching Long-Term Care Insurance Optional individual policy purchased directly from a thirdparty vendor to help manage the costs of potential future medical, social service, or chronic care needs Learn about how to use these benefits online by signing in to myportico at myportico.porticobenefits.org. Employers sponsor their plan members in the ELCA benefit program and can t purchase individual benefits separately. A comprehensive benefit program serves our ministry community by: Helping minimize the risk to 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 Page 2
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 13 14 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, it s optional to purchase supplemental life insurance. 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. They may also be eligible to convert purchased insurance policies to individual policies. 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. Discounts available through the collective buying power of our members include: - Long-term care insurance coverage An optional purchase of an individual policy at a discounted rate with simplified underwriting. Available through ACSIA Partners LLC, and underwritten by Transamerica. - Hearing discount program A discount on hearing tests and hearing aids. Administered by HearPO. - Fitness center discount Work out the minimum times a month at a participating gym to have a portion of your membership dues credited back to you. Administered by Blue Cross and Blue Shield. 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. Page 3
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. 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. NOTE: 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. ELCA pastors are eligible to sponsor themselves in the ELCA benefit program when they are: Called to a ministry and the employer chooses not to sponsor the pastor in ELCA benefits Called to a ministry in which the pastor is considered self-employed in accordance with Internal Revenue Code 414(e)(5)(A)(i) ELCA pastors are not eligible to sponsor themselves in the ELCA benefit program when they are employed by: The ELCA ELCA synods ELCA seminaries ELCA churchwide units Page 4
ELCA congregations Ecumenical partner organizations Former ELCA congregations Online Benefit Administration Portico offers a customized web experience for plan members and sponsoring employers. Both must 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 email alerts, and conduct many benefit transactions on Portico s website. Plan members Visit myportico at myportico.porticobenefits.org and register using a sevendigit Member ID, three-digit Security Validation Code (SVC), and email address. Sponsoring employers Visit EmployerLink (EmployerLink.PorticoBenefits.org) and register using the organization s 11-digit Access Code and an email address. NOTE: Registration on myportico is available for spouses but not for other family members. Page 5
Program Eligibility 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 re 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 re a self-sponsoring ELCA pastor and are: Called to a ministry and your employer chooses not to sponsor you in the ELCA benefit program or Called to a ministry in which you re considered self-employed in accordance with Internal Revenue Code 414(e)(5)(A)(i) ELCA pastors are not eligible to sponsor themselves in the ELCA benefit program when they are employed by: The ELCA ELCA synods ELCA seminaries ELCA churchwide units ELCA congregations Ecumenical partner organizations Former ELCA congregations 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 or to purchase life insurance. Members receiving disability benefits are eligible to enroll in a health FSA (but not a dependent care FSA) and can t purchase supplemental or dependent life insurance. Members enrolled in an ELCA-Primary Silver+ or Bronze+ health 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) (see Glossary) Page 6
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 other 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 optional dependent life insurance as long as you purchase supplemental life insurance for yourself: A spouse or ESGP Eligible children up to the end of the month in which the child attains 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, if they are unmarried and dependent on you for more than 50% of their financial support A child for whom a plan member is a guardian or grandparent, if he or she is living in the plan member s household, is receiving primary support from the plan member, and is claimed by the plan member as a tax dependent for federal tax purposes Page 7
Enrolling in the Program Plan members are typically enrolled in the ELCA benefit program by an eligible sponsoring employer. You and your employer must complete your enrollment within 60 days of meeting the ELCA benefit program s eligibility criteria. If you enroll after 60 days, you re subject to late enrollment rules, which may include waiting periods for benefits and other penalties. Once each 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 member 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. 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 re employed by a synod, seminary, or ministry of the ELCA churchwide organization. Flexible Spending Accounts You re eligible to enroll in the health flexible spending account (FSA) the first day you re sponsored in the ELCA benefit program if you re a sponsored employee who: Enrolls in the ELCA-Primary Platinum+ or Gold+ health benefit option Enrolls in the ELCA-Primary Silver+ or Bronze+ option but isn t eligible for an HSA due to age Enrolls in the ELCA Medicare-Primary Standard health benefit option Waives health benefits Self-sponsored and non-sponsored members are not eligible to contribute to a health FSA. 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. Health Savings Account If you turn age 65 within the three full months after your enrollment, you won t be eligible for an HSA. You can enroll in a health FSA. Page 8
Limited-Purpose Health Flexible Spending Account You are eligible to enroll in a limited-purpose health FSA if you are a sponsored member enrolled in the ELCA-Primary Silver+ or Bronze+ health benefit option AND enrolled in an HSA. 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 evidence of insurability [EOI] required). You can purchase optional supplemental and dependent life insurance without needing to provide EOI. Disability If, as a sponsored member, you enroll within 60 days of the date you meet the eligibility criteria in the ELCA benefit program, you re subject to a six-month pre-existing condition period under the ELCA Disability Benefits Plan. During this period, you will not be entitled to receive disability benefits if you become partially or totally disabled and the disability is caused by a condition diagnosed or treated in the six-month period immediately before your enrollment date. Retirement All 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 health plan enrollment isn t completed within 60 days of your eligibility, 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 of health coverage 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. Page 9
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. Limited-Purpose Health Flexible Spending Account If your limited-purpose health 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 don t have to take separate action to enroll in this benefit. It s included in your ELCA benefit program benefits. If you enroll in optional supplemental and/or dependent life insurance outside the 60-day eligibility period, you will be required to provide evidence of insurability (EOI). The EOI must be approved by Securian Life. Your coverage will not be effective until your EOI is approved. Disability If you don t complete your enrollment within 60 days of your eligibility, you re 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 each fall. Eligible spouses, eligible same-gender partners (ESGPs), and eligible children may also be enrolled during this period. Benefits elected during Open Enrollment are effective 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. Page 10
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 re 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 re not eligible to participate until the next plan year unless you experience a qualifying election change event. Limited-Purpose Health Flexible Spending Account If eligible, you enroll in a limited-purpose health FSA each year during annual Open Enrollment by electing annual pretax contribution amounts to cover eligible 2015 dental and vision care expenses. After you meet the plan deductible, you can also use the account for post-deductible medical, mental health, and vision expenses. Your limited-purpose health FSA election 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 re 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 the following optional benefits on an after-tax basis: Supplemental life insurance for yourself (with evidence of insurability) Dependent life insurance for your spouse or ESGP and eligible children (with evidence of insurability) 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. Page 11
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 at myportico.porticobenefits.org to learn about your benefit options. On EmployerLink, your employer selects one health benefit option to offer to its sponsored plan members and their eligible family members. If Silver+ or Bronze+ is selected, your employer chooses one of three health savings account (HSA) contribution levels: Level A: $1,200 single coverage or $2,400 family coverage Level B: $600 single coverage or $1,200 family coverage Level C: $0 single coverage or $0 family coverage You make the following benefit decisions, and enter them online by signing in to myportico at myportico.porticobenefits.org: - Required if you or eligible family members 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 eligible children - Optional: Whether to start or change a pretax retirement contribution 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, optional supplemental or dependent life insurance with evidence of insurability, long-term care insurance, and pretax retirement contributions not only during Open Enrollment. Opportunity for Employees Not Enrolled in a Timely Manner An employer who enrolled an eligible employee in the ELCA benefit program more than 60 days after he or she met the ELCA benefit program s eligibility criteria can enroll the employee during Open Enrollment without the member being subject to a 90-day waiting period for health coverage. If your employer enrolls you during Open Enrollment, your benefits will start Jan. 1 of the following plan year. 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). Page 12
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 if you have other valid health coverage. 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 re a retired member Your (or your spouse s) employer or former employer if you re on leave from call Your parent s employer or former employer (if you re 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 individual health 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 2010. 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. When waiving health coverage, your spouse or ESGP and children: If you re sponsored or receiving disability benefits Must also waive ELCA benefits If you re an ELCA pastor or rostered layperson on leave from call Can continue ELCA benefits at their own expense If you re retired Can continue ELCA benefits subject to eligibility for coverage at their own expense If you re retired, you can waive benefits for your spouse or dependents without having to waive coverage for yourself. Page 13
To ensure that you can activate benefits for eligible family members at a later date without a 90-day waiting period, you should first enroll them as waived members in the ELCA Health Plan. To avoid late enrollment consequences, you need to notify the Portico Customer Care Center of any change in family status while you re waiving coverage marriage, birth, divorce, loss of eligibility for a dependent, and death. 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 health 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. Disabled and eligible for Medicare You are eligible for the ELCA Medicare-Primary health Standard benefit option. Disabled and not eligible for Medicare Generally, you are eligible for the ELCA-Primary Gold+ health benefit option (see If You Become Disabled on page 61) On leave from call and eligible for Medicare You are eligible for the ELCA Medicare- Primary Standard option. Page 14
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 (see page 82), 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 (see Glossary). 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 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 are eligible for Medicare (see page 59). NOTE: If you re eligible and decide to waive ELCA health benefits, your employer does not pay a health contribution. Health savings account contributions If you re 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 Your employer pays a percentage 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. 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 Page 15
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 re employed by an ELCA synod or seminary, or ministry of the ELCA churchwide organization, your employer must contribute a minimum of 10% of your defined compensation. - If you re a sponsored pastor or rostered layperson, your sponsoring organization must contribute a minimum of 10% of your defined compensation. - If you re a 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 re an eligible self-sponsoring pastor, you pay the employer contribution of at least 6% of your defined compensation. - If you re 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. Housing equity retirement contributions Your employer may choose to pay additional amounts toward your ELCA Retirement Plan account if you re 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 Your employer pays a percentage 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-of-pocket health care expenses. Your employer deducts this amount from your paycheck on Page 16
a pretax basis. 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-ofpocket 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. Limited-purpose health FSA contributions If eligible, you may set aside money to help you manage eligible out-of-pocket dental and vision care expenses. Your employer deducts this amount from your paycheck on a pretax basis. Your total annual election is available to you on the date your limited-purpose health FSA is effective. Life insurance premiums If eligible, you may purchase optional 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. 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. Long-term care insurance Sponsored members and their eligible family members can apply for discounted long-term care insurance through ACSIA Partners (underwritten by Transamerica). You pay for an individual policy directly. When You re Continuing Coverage (Not Sponsored) in the ELCA Benefit Program When you re 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) Page 17
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 page in the Overview & Life Changes section on myportico at myportico.porticobenefits.org. Health contributions If eligible, you can purchase ELCA-Primary or ELCA Medicare- Primary health benefits for you and/or eligible family members. 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 (your year-to-date contributions exceed your year-to-date reimbursements) 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. Submit any eligible claims incurred prior to your termination date within four months of the date of termination, or forfeit the balance in your account. Expenses incurred after the date of termination are not eligible to be reimbursed. Dependent (day) care FSA contributions You can t continue your dependent care FSA contributions when your sponsored employment ends. Submit any eligible claims incurred prior to your termination date within four months of the date of termination, or forfeit the balance in your account. Expenses incurred after the date of termination are not eligible to be reimbursed. 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. Limited-purpose health FSA contributions If you have a positive balance (your year-todate contributions exceed your year-to-date reimbursements), at the time your sponsored employment ends, you can continue your limited-purpose 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 Page 18
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 aftertax contributions, you will forfeit the balance in your account. Life insurance premiums You re eligible to continue basic group life insurance with accidental death and dismemberment (AD&D) protection by contacting Securian Life Insurance Company. You are billed by Securian Life. If you purchased optional supplemental and dependent life insurance while sponsored, you can continue this coverage by contacting Securian Life Insurance Company. You are billed by Securian Life. Disability contributions If you re 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. 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 re 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 re-enrolling. You will also be subject to a longer exclusion period for pre-existing conditions under the ELCA Disability Benefits Plan. Page 19