You may fill your prescriptions at any Express Scripts participating pharmacy by showing your Express Scripts ID card. For maintenance medications, you are required to use home delivery after three pharmacy fills (once for the original prescription and two refills). Express Scripts' home delivery system permits up to a three-month supply of medication at once, typically at a cost savings.

Prescription drugs may be ordered from Kaiser Pharmacies, the mail-order program, or online at kp.org, for members in Kaiser Permanente plans.

The Medical Trust offers three levels of dental coverage through Cigna Dental:

• Preventive Dental PPO
• Basic Dental PPO
• Dental & Orthodontia PPO

Talk to your benefits administrator to determine which, if any, your employer offers.

Your coverage includes behavioral health benefits for individual and family needs, both inpatient and outpatient. You have access to an integrated behavioral health program that includes behavioral health, substance use disorder, and employee assistance program benefits.

• Refer to your plan documents for more details
• Learn more about the Cigna Employee Assistance Program (EAP)

A Church-wide program of healthcare benefit plans authorized by General Convention and administered by The Church Pension Fund (CPF), with benefits provided through The Episcopal Church Medical Trust (The Medical Trust).

For details, see questions about DHP below.

The price of your medication depends on whether you are purchasing a generic, preferred, non-preferred, or specialty drug and whether you are getting your medication through home delivery or at a pharmacy. 

Choosing generic (Tier 1) and then preferred (Tier 2) drugs will keep costs down, along with using the home delivery prescription service. Discuss these options with your physician when you receive prescriptions.

A deductible is the amount you must pay for healthcare before a plan begins to pay. 

Most of the plans offered by the Medical Trust have an embedded deductible.

• Once each member of your family has met the individual deductible, this Plan will begin to provide benefits for that individual. The individual deductible is also credited toward the family deductible. Once the family deductible has been met, all covered members of your family will receive benefits, whether or not they have met the individual deductible.

The Anthem CDHP-15 provides a non-embedded deductible and out-of-pocket limit.

• If you have single coverage, then the Plan will begin to provide benefits once you have met the individual deductible. If you have spousal or family coverage, then the family deductible must be met before the Plan begins to pay for benefits for any covered family member, and the family out-of-pocket limit must be met before the Plan begins to pay 100% for any covered family member.

A copayment is the fixed dollar amount that you pay for each healthcare service (for example, a doctor's office visit or a prescription).

Coinsurance is an amount (usually a percentage) that you may be required to pay as your share of the cost of services after deductibles have been met until you meet the out-of-pocket maximum.

Health Advocate, included in your health insurance coverage, can help you resolve insurance claims. This benefit is included in your coverage. Call (866) 695-8622 or visit the Health Advocate website.

Annual enrollment is a designated period each year when members may enroll in, or make changes to, healthcare coverage for themselves and/or their dependents. Annual enrollment usually occurs in the fall. Plan selections become effective on the first day of the following plan year.

Yes, you may change your coverage if you experience a significant life event, such as the death of a spouse, marriage, divorce, or retirement. Keep in mind that your coverage change must be directly related to your significant life event. For example, if you get married, you may add your new spouse to your coverage.

All The Medical Trust health plans* include:

• Pharmacy
• Behavioral Health/Substance Use Disorder
• Employee Assistance Program
• Vision care
• Hearing exams and aids
• Health Advocate

* Certain additional plan benefits may not be available to members participating in fully insured plan options offered on a regional basis (Hawaii Medical Service Association and Kaiser Permanente Washington).

You can enroll the following dependents on your medical plan:

• Your spouse
• Your domestic partner, if elected by the participating group
• Your child who is 30 years of age or younger
• Your disabled child, 30 years of age or older, provided the disability began before the age of 25.

Adding dependents to your health plan may add to the cost. Please contact your benefits administrator for more information.

EyeMed has providers at more than 14,000 locations nationwide. To find one near you, visit EyeMed online or call EyeMed at (866) 723-0596.

This program is available to help you with work/life balance issues. The plan covers telephone consultations and up to 10 free in-person visits with a Cigna counselor per issue. Licensed clinicians can provide resources and referrals on issues such as coping with stress, child and senior care, legal/financial matters, substance use disorder, and emotional and physical health.

A Church-wide program of healthcare benefit plans authorized by General Convention and administered by The Church Pension Fund (CPF), with benefits provided through The Episcopal Church Medical Trust (the Medical Trust). Find out more about the DHP.

Employers are required to provide all eligible clergy and lay employees with equal access to and parity of funding for healthcare benefits, to be provided through the Medical Trust. Under the terms of this resolution, an eligible employee is someone who is scheduled for at least 1,500 hours of compensated work annually for any domestic diocese, parish, mission, or other ecclesiastical organization or body subject to the authority of the Church.

Clergy and lay employees required to participate in the Medical Trust’s health plans are those who are scheduled to work at least 1,500 compensated hours per year for any domestic diocese, parish, mission, or for any other ecclesiastical organization or body subject to the authority of the Church (and whose diocese has determined it must participate.)

The Medical Trust’s eligibility rules relating to part-time employees currently remain the same as before the formation of the DHP. This means that clergy and lay employees of any Episcopal institution who are regularly scheduled to work between 1,000 and 1,499 hours per year are eligible to participate voluntarily.

Currently, non-stipendiary clergy are not eligible to participate in the Medical Trust Plans, with a few exceptions as noted in the administrative guidelines.

Non-parochial clergy employed by Episcopal institutions that offer healthcare benefits through the Medical Trust are eligible to participate if they are regularly scheduled to work at least 1,000 hours per year. Non-parochial clergy (working more than 1,500 compensated hours annually) employed by diocesan institutions may be eligible or required to participate at the option of the diocese.

Each diocese will decide individually whether or not to offer healthcare benefits to same-sex domestic partners, opposite-sex domestic partners, or both.

The DHP does not address seminarian healthcare benefits coverage. Seminaries traditionally obtain their student coverage outside of diocesan medical plans. Many Episcopal seminaries use the Medical Trust’s seminarian program.

Although the Medical Trust plans are exempt from the Employee Retirement Income Security Act of 1974, as amended (ERISA), we do offer an Extension of Benefits (EOB) program that will cover existing employees receiving COBRA benefits through the end date that is currently in place at the time they transition to the Medical Trust Plans. Once an employer participates with the Medical Trust, the EOB program will be available to departing employees.

No. Only medical benefits are required under the DHP. The Medical Trust does offer three dental plans using the Cigna dental network.

The DHP requires that each diocese establish, on a diocesan-wide basis, the minimum required employer cost-sharing policy for healthcare benefits. That means that a diocese can require employers to cover all or a portion of the contribution (premium) for employees and their families. “Parity” refers to the requirement that the diocesan policy regarding employer cost-sharing must be the same for all eligible clergy and lay employees scheduled to work at least 1,500 compensated hours per year. In other words, all clergy and lay employees who are scheduled to work at least 1,500 compensated hours per year must receive the same minimum level of funding — such as a percentage of the premium cost, a flat dollar amount, or a coverage level (i.e., single, family, etc.) — for healthcare benefits.

January 1, 2013 was the deadline for full implementation of the DHP.  The deadline for parity was extended to December 31, 2015 by Resolution B026 passed at the 77^th General Convention.

Examples of canons/resolutions or policies that other dioceses have developed are available upon request from your IBAMS Account Manager.

No. By December 31, 2015, all clergy and lay employees who are scheduled to work at least 1,500 compensated hours per year must be treated equally with regard to cost-sharing of the medical plan premiums, no matter when they were hired.

Yes. The DHP requires that all clergy and lay employees who are scheduled to work at least 1,500 compensated hours per year be treated equally with regard to the cost-share of medical plan premiums. Employers are free to provide a different cost-share to their part-time employees.

The diocese is the primary partner in implementing the DHP within that diocese. The diocese must establish canons, policies, rules, or guidelines to determine:

• Whether institutions under its authority (schools, day care facilities, social service agencies, etc.) are required to participate
• Whether the diocese wishes to provide healthcare benefits to domestic partners
• A cost-sharing policy that is the same for clergy and eligible lay employees
• Which Medical Trust plans will be offered in that diocese. The diocese makes this decision annually.

The rules governing the ECCEBT’s status as a VEBA require that only eligible employees of Episcopal institutions be allowed to participate in the Medical Trust’s plans. The Medical Trust has developed a document, “Questions to Consider When Determining if an Organization is Subject to the Authority of the Church,” to assist dioceses in determining which of its diocesan institutions are considered Episcopal institutions, according to these stipulations.

No, but the Medical Trust will work with all employers to find plans that are economically viable for their specific situations and populations. It is important that all required groups participate with the Medical Trust to ensure optimal leverage in negotiating services from our contracted vendors.

Participation in a Medical Trust plan is required by the canon enacted by the General Convention of The Episcopal Church and is enforced in the same manner that any canon is enforced. It is the individual diocese’s responsibility to ensure compliance with Resolution A177, as it is with all canons. The Medical Trust will not enforce compliance.

Before the annual enrollment period begins, the diocese should communicate specific information to its parishes and other participating institutions regarding its plan selections, associated rates, and plan design changes so that employees can make informed decisions about their specific healthcare options. During annual enrollment, the Medical Trust communicates directly with employees to provide information about how to review their plan selection choices, the resources and references available to them.

Under the terms of the DHP, clergy and lay employees who have medical benefits through approved sources will be allowed to waive medical coverage under the DHP (“opt out”) and choose to maintain their medical benefits through the approved source. Examples of approved sources include coverage through a spouse’s or partner’s employment, medical benefits through a government-sponsored program such as Medicaid or TRICARE, or coverage from a previous employer. The list of approved sources is subject to change based on the federal healthcare reform law.

An employee may elect to waive coverage at the initial point of employment, during annual enrollment, or at the time of any significant life event. The employee will need to reaffirm the election to waive coverage on an annual basis, as determined by the Medical Trust.

Declaration of the individual waiver will occur on an annual basis during annual enrollment. The employee will need to reaffirm the election to waive coverage on an annual basis.