Left Navigation

 

Forms & Publications

 

You can ask for a paper copy of your Summary of Benefits and Coverage (SBC) at any time, free of charge. Go to Forms and Publications. Check the box next to the Summary you want and then click on Mail It to Me. You can also call Client Services at (800) 480-9967 Monday - Friday 8:30AM to 8:00PM ET (excluding holidays) to request a copy.

The Medical Trust can also provide an SBC in a Spanish, Chinese, Tagalog, and Navaho. Please see our Notice of Nondiscrimination policy page or call Client Services for more information.

 

To request a copy by mail, check the box next to the title and click 

Active Clergy & Lay Employee Health Plan Information - 2019

  Title What is This For? Pgs
Anthem BCBS Handbook - 2019 Handbook of plan details

118

Cigna Handbook - 2019 Handbook of plan details

110

Health-Kaiser Handbook - 2019 Handbook of plan details

120

Annual Enrollment Guide - 2019 Information about 2019 health plans and making a plan selection

26

Anthem BCBS BlueCard PPO 100 - 2019 Summary of benefits

6

Anthem BCBS BlueCard PPO 90 - 2019 Summary of benefits

6

Anthem BCBS BlueCard PPO 80 - 2019 Summary of benefits

6

Anthem BCBS BlueCard PPO 70 - 2019 Summary of benefits

6

Anthem BCBS CDHP-15/HSA - 2019 Summary of benefits

6

Anthem BCBS CDHP-20/HSA - 2019 Summary of benefits

6

Anthem BCBS CDHP-40/HSA - 2019 Summary of benefits

6

Cigna Open Access Plus PPO 100 - 2019 Summary of benefits

6

Cigna Open Access Plus PPO 90 - 2019 Summary of benefits

6

Cigna Open Access Plus PPO 80 - 2019 Summary of benefits

6

Cigna Open Access Plus PPO 70 - 2019 Summary of benefits

6

Cigna Open Access Plus CDHP-15/HSA - 2019 Summary of benefits

6

Cigna Open Access Plus CDHP-20/HSA - 2019 Summary of benefits

6

Cigna Open Access Plus CDHP-40/HSA - 2019 Summary of benefits

6

Kaiser High EPO - 2019 Summary of benefits

6

Kaiser EPO 80 - 2019 Summary of benefits

6

Kaiser CDHP-20 - 2019 Summary of benefits

6

CDHP/HSA Fact Sheet for Members - 2018-2019 Information for members on Consumer Directed Health Plans (CDHP) and Health Savings Account (HSA) for 2018-2019

7

Prescription Drug Benefit Fact Sheet 2019 The Medical Trust Pharmacy Benefit Fact Sheet

4

N/A Understanding Health Plan Options for Employees Age 65+ To help employers and employees understand health plan coverage options for active clergy or lay employees, or those returning to work after retirement

5

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Retired Clergy Health Plan Information - 2019

  Title What is This For? Pgs
Medicare Supplement Handbook - 2019 Plan Handbook

128

N/A 2019 Annual Enrollment-Retiree Subsidy Letter Announcing Annual Enrollment dates and medicare supplement information for retirees

8

N/A 2019 Annual Enrollment-Retiree Non-Subsidy Letter Announcing Annual Enrollment dates and medicare supplement information for retirees not eligible for Subsidy

8

N/A Medicare & You 2019 The official US Government Medicare Handbook

120

N/A Medicare Comparison Chart 2019 Medicare costs and Medicare Supplement plan comparisons

2

Prescription Drug Benefit Fact Sheet for Retirees 2019 The Medical Trust Pharmacy Benefit Fact Sheet for Retirees

5

N/A Understanding Health Plan Options for Employees Age 65+ To help employers and employees understand health plan coverage options for active clergy or lay employees, or those returning to work after retirement

5

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Seminarians Health Plan Information - 2019

  Title What is This For? Pgs
Anthem BCBS BlueCard PPO 80 - 2019 Summary of benefits

6

Anthem BCBS BlueCard PPO 70 - 2019 Summary of benefits

6

Anthem BCBS CDHP-40/HSA - 2019 Summary of benefits

6

Anthem BCBS CDHP-20/HSA - 2019 Summary of benefits

6

Cigna Open Access Plus PPO 80 - 2019 Summary of benefits

6

Cigna Open Access Plus PPO 70 - 2019 Summary of benefits

6

Cigna Open Access Plus CDHP-40/HSA - 2019 Summary of benefits

6

Cigna Open Access Plus CDHP-20/HSA - 2019 Summary of benefits

6

CDHP/HSA Fact Sheet for Members - 2018-2019 Information for members on Consumer Directed Health Plans (CDHP) and Health Savings Account (HSA) for 2018-2019

7

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Medicare Secondary Payer (SEE) Forms

Title What is This For? Contact Information
Medicare Secondary Payer Eligibility Certification Form Eligibility for the Episcopal Health Plan for Qualified Small Employer Exception Members (the SEE Plan)

The Episcopal Church Medical Trust
19 East 34th Street,
New York, NY, 10016
or fax to (212) 251-8891

Back to Top

To request a copy by mail, check the box next to the title and click 

Medicare Secondary Payer  (SEE) Publications

Title What is This For? Pgs
Medicare Secondary Payer SEE Member Fact Sheet Medicare Secondary Payer - Small Employer Exception

5

Medicare Secondary Payer SEE Letter to Members Letter sent to members explaining Medicare Secondary Payer See program

1

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Dental Plan Information - 2019

  Title What is This For? Pgs
Cigna Dental Handbook - 2019 Handbook of plan details

76

Cigna Preventive Dental PPO - 2019 Summary of benefits

6

Cigna Basic Dental PPO - 2019 Summary of benefits

6

Cigna Dental & Orthodontia PPO - 2019 Summary of benefits

6

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Denominational Health Plan

  Title What is This For? Pgs
N/A DHP Annual Report 2018 - English 2018 Annual Report on the Denominational Health Plan

4

N/A DHP Annual Report 2018 - Español 2017 Annual Report on the Denominational Health Plan

4

N/A DHP Annual Report 2017 - English 2017 Annual Report on the Denominational Health Plan

4

N/A DHP Annual Report 2017 - Español 2017 Annual Report on the Denominational Health Plan

4

N/A DHP Annual Report 2016-English 2016 Annual Report on the Denominational Health Plan

1

N/A DHP Annual Report 2016-Español 2016 Annual Report on the Denominational Health Plan (Español)

1

N/A DHP Annual Report 2015 - English 2015 DHP Annual Report (English)

3

N/A DHP Annual Report 2015 - Español 2015 DHP Annual Report (Español)

4

N/A DHP Annual Report (English) 2014 DHP Annual Report (English)

8

N/A DHP Annual Report (Español) 2014 DHP Annual Report (Español)

7

DHP Canon, Resolutions A177 and B026 and Model Denominational Health Plan

6

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Additional Benefits

  Title What is This For? Pgs
N/A 100 Reasons to Call the Employee Assistance Program 100 Reasons to call EAP

4

N/A Employee Assistance Program (EAP) Get 24/7 help with behavioral health, family, and personal issues

2

N/A Employee Assistance Program (EAP) For Clergy For clergy to get 24/7 help with behavioral health, family, and personal issues

2

United Healthcare Global Assistance Brochure Emergency assistance available when traveling

6

N/A Health Advocate Brochure A personal health advocate service to help you with healthcare and insurance issues

6

EyeMed Insight Network EMT Brochure and Summary of Benefits EyeMed Insight Network benefits for the Episcopal Church Medical Trust

2

U.S. Medical Glossary Understand common healthcare terms

4

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Regulatory Notices

  Title What is This For? Pgs
Children’s Health Insurance Program (CHIP) Information Children's Health Insurance Program

3

HIPAA Notice of Special Enrollment Rights HIPAA Notice of Special Enrollment Rights

1

HIPAA Privacy Notice HIPAA Notice of Privacy Practices

4

Notice of Nondiscrimination Notice of Nondiscrimination

2

Women’s Health and Cancer Rights Act (WHCRA) Notice Women’s Health and Cancer Rights Act Notice

1

Back to Top

 

To request a copy by mail, check the box next to the title and click 

Health News

  Title What is This For? Pgs
Health News, Spring 2018 Exploring strength in community

1

Health News, Winter 2018 Inspiration to meet your goals

1

Health News, Fall 2017 Fall colors: The changing seasons of life. Preparing for the times ahead.

1

Health News, Summer 2017 Summer wellness: what to do when the heat is on!

1

Health News, Spring 2017 Planting the Seeds for Your Tomorrow

1

Health News, Winter 2017 Being SMART about the New Year

1

Back to Top

 

 


* Our online documents are available for immediate download and viewing using Adobe's FREE Acrobat Reader.

Health benefits are offered through plans maintained by Church Pension Group Services Corporation (doing business as The Episcopal Church Medical Trust), 19 East 34th Street, New York, NY 10016.

The Episcopal Church Medical Trust Disclaimer