Forms & Publications

Don't see what you need on this page?

Visit our Forms and Publications Library for all CPG documents.

 

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.

Active Clergy & Lay Employee Health Plan Information - 2023
Title
What is this for?
Pages
Mail It
Anthem BCBS BlueCard PPO 100 - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 90 - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 80 - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 70 - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP15 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP20 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP40 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 100 - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 90 - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 80 - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 70 - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP15 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP20 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP40 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Kaiser Permanente CDHP - 2023
Summary of Benefits and Coverage (SBC)
6
Kaiser Permanente High EPO - 2023
Summary of Benefits and Coverage (SBC)
6
Kaiser Permanente EPO 80 - 2023
Summary of Benefits and Coverage (SBC)
6
2022-2023 CDHP/HSA Fact Sheet for Members
Information for members on Consumer Directed Health Plans (CDHP) and Health Savings Account (HSA)
6
Active Clergy & Lay Employee Health Plan Information - 2022
Title
What is this for?
Pages
Mail It
Anthem BCBS BlueCard PPO 100 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 90 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 80 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 70 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP15 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP20 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP40 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS Handbook 2022
Handbook of plan details
115
Cigna PPO 100 Summary 2022
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 90 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 80 Summary 2022
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 70 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP15 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP20 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP40 HSA Summary 2022
Summary of Benefits and Coverage (SBC)
6
Cigna Handbook 2022
Handbook of plan details
110
Kaiser High EPO Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Kaiser EPO 80 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Kaiser CDHP Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Kaiser Handbook 2022
Handbook of plan details
188
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
N/A
2021-2022 CDHP/HSA Fact Sheet for Members
Information for members on Consumer Directed Health Plans (CDHP) and Health Savings Account (HSA)
6
N/A
Retired Clergy & Lay Employee Health Plan Information - 2023
Title
What is this for?
Pages
Mail It
Plan Guide 2023
A guide to the 2023 UnitedHealthcare® Group Medicare Advantage (PPO) plan
84
2023 Retiree Annual Enrollment Letter
Group Medicare Advantage Annual Enrollment information for retirees/post-65 former employees
4
N/A
2023 Kaiser Retiree Annual Enrollment Letter
Kaiser Annual Enrollment information for retirees
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
N/A
Retired Clergy Health Plan Information - 2022
Title
What is this for?
Pages
Plan Guide 2022
A guide to the 2022 UnitedHealthcare® Group Medicare Advantage (PPO) plan
100
UnitedHealthcare Group Medicare Advantage - 2022 Quick Start Guide
An introduction to plan benefits and how to manage your account
33
Retiree 2022 Annual Enrollment Subsidy Letter
Annual Enrollment information for retirees who receive a post-retirement health subsidy
4
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
Retired Lay Employee Health Plan Information - 2022
Title
What is this for?
Pages
Plan Guide 2022
A guide to the 2022 UnitedHealthcare® Group Medicare Advantage (PPO) plan
100
UnitedHealthcare Group Medicare Advantage - 2022 Quick Start Guide
An introduction to plan benefits and how to manage your account
33
Retiree 2022 Annual Enrollment Non-Subsidy Letter
Annual Enrollment information for retirees who do not receive a post-retirement health subsidy
4
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
Seminarian Health Plan Information - 2023
Title
What is this for?
Pages
Mail It
Anthem BCBS BlueCard PPO 70 - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 80 - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP20 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP40 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 70 - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 80 - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP20 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP40 HSA - 2023
Summary of Benefits and Coverage (SBC)
6
2022-2023 CDHP/HSA Fact Sheet for Members
Information for members on Consumer Directed Health Plans (CDHP) and Health Savings Account (HSA)
6
Seminarians Health Plan Information - 2022
Title
What is this for?
Pages
Mail It
Anthem BCBS BlueCard PPO 80 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS BlueCard PPO 70 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP40 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS CDHP20 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Anthem BCBS Handbook 2022
Handbook of plan details
115
Cigna PPO 80 Summary 2022
Summary of Benefits and Coverage (SBC)
6
Cigna PPO 70 Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP40 HSA Summary 2022
Summary of Benefits and Coverage (SBC)
6
Cigna CDHP20 HSA Summary - 2022
Summary of Benefits and Coverage (SBC)
6
Cigna Handbook 2022
Handbook of plan details
110
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
Medicare Secondary Payer (SEE) Publications
Title
What is this for?
Pages
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
2
Dental Plan Information - 2023
Title
What is this for?
Pages
Mail It
Cigna Preventive Dental - 2023
Summary of Benefits and Coverage (SBC)
3
Cigna Basic Dental - 2023
Summary of Benefits and Coverage (SBC)
2
Cigna Dental & Orthodontia - 2023
Summary of Benefits and Coverage (SBC)
3
Dental Plan Information - 2022
Title
What is this for?
Pages
Mail It
Cigna Preventive Dental - 2022
Summary of Benefits and Coverage (SBC)
3
N/A
Cigna Basic Dental - 2022
Summary of Benefits and Coverage (SBC)
3
N/A
Cigna Dental & Orthodontia - 2022
Summary of Benefits and Coverage (SBC)
3
N/A
Cigna Dental Handbook - 2022
Handbook of plan details
70
Denominational Health Plan
Title
What is this for?
Pages
Mail It
DHP Annual Report 2021 - English
2021 Annual Report on the Denominational Health Plan
6
N/A
DHP Annual Report 2021 - Espanol
2021 Annual Report on the Denominational Health Plan
6
N/A
DHP Annual Report 2020 - English
2020 Annual Report on the Denominational Health Plan
3
N/A
DHP Annual Report 2020 - Español
2020 Annual Report on the Denominational Health Plan
3
N/A
DHP Annual Report 2020 - French
2020 Annual Report on the Denominational Health Plan
3
N/A
DHP Annual Report 2020 - Chinese
2020 Annual Report on the Denominational Health Plan
3
N/A
DHP Annual Report 2019 - English
2019 Annual Report on the Denominational Health Plan
3
N/A
DHP Annual Report 2019 - Español
2019 Annual Report on the Denominational Health Plan
3
N/A
DHP Annual Report 2018 - English
2018 Annual Report on the Denominational Health Plan
3
N/A
DHP Annual Report 2018 - Español
2018 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
3
N/A
DHP Annual Report 2016-Español
2016 Annual Report on the Denominational Health Plan (Español)
3
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
N/A
DHP Canon, Resolutions A177 and B026 and Model
Denominational Health Plan
6
Additional Benefits
Title
What is this for?
Pages
Mail It
100 Reasons to Call the Employee Assistance Program
100 Reasons to call EAP
3
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
N/A
United Healthcare Global Assistance Brochure
Emergency assistance available when traveling
6
Health Advocate Brochure
A personal health advocate service to help you with healthcare and insurance issues
2
N/A
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
6
Regulatory Notices
Title
What is this for?
Pages
Mail It
Your Rights and Protections Against Surprise Medical Bills
No Surprises Act Notice
2
N/A
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
5
Women’s Health and Cancer Rights Act (WHCRA) Notice
Women’s Health and Cancer Rights Act Notice
1
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