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Common Questions

Top Questions

What is a Medicare Supplement Health Plan?

In general, Medicare Supplement Health Plans are designed to help you pay the costs of healthcare received through Medicare. Choosing a Medicare Supplement Health Plan is a very important decision. You may wish to compare the supplement plans offered by the Medical Trust with plans offered by a local insurance company — often referred to as Medigap insurance policies.

Whether you choose to enroll in one of these plans is a decision only you can make. Depending on your healthcare needs and financial situation, you may choose to purchase a Medigap policy or join a Medicare managed care plan.

Which plan is right for me?

You can use our Medicare Supplement Comparison Chart to determine which the Medical Trust Medicare Supplement Health Plan may be right for you. Regardless of which plan you choose, you will be responsible for some out-of-pocket costs.

 

How much will my medication cost?

The cost of your medication depends on which supplement plan you choose and whether your medication is generic, formulary or non-formulary. Please see Pharmacy Benefits for details.

How do I file a health claim?

In most situations, your doctor, pharmacy, hospital, or other medical provider is responsible for submitting claims. Claims are first submitted to Medicare, then forwarded by Medicare to UnitedHealthcare (UHC) for secondary coverage. Don’t be concerned if your doctors are not in the UHC network — however, they must accept Medicare. Contact UnitedHealthcare at (800) 708-3052 with any questions regarding claims.

How do I replace my lost ID card?

Contact the company that issued your ID card for a replacement:

  • Medicare Supplement: Call UnitedHealthcare, (866) 204-8533
  • Pharmacy: Call Express Scripts, (800) 841-3361
  • Vision: Call EyeMed Vision Care,  (866) 723-0513
  • Dental: Call Cigna Dental, (800) 244-6224

You may also contact Client Services at the Medical Trust at (800) 480-9967.

Medicare

What is Medicare? 

Medicare is the health insurance program sponsored by the federal government.

Who qualifies for Medicare coverage? 

  • Most people over age 65
  • Some disabled people under age 65
  • People with End-Stage Renal Disease (ESRD)

What is Medicare Part A? 

Medicare Part A provides coverage for hospital inpatient care, skilled nursing facility care, hospice care and some home health care. Most people do not have to apply for Part A, since enrollment is automatic at age 65.

What is Medicare Part B? 

Medicare Part B provides coverage for medical expenses, including physician services; some other medical services that Part A does not cover, such as physical and occupational therapy; and some home health care. Most people pay monthly for Part B through a deduction from their Social Security payments.

Where can I find more information on Medicare? 

You can find more information in the downloadable 2015 Medicare & You handbook. Call (800) 633-4227 to request a printed copy be mailed to you.

Medicare Supplement

What are my coverage options?

The Episcopal Church Medical Trust offers three Medicare Supplement  Health Plans available with and without prescription drug benefits for retirees enrolled in Medicare Part D:

  • The Comprehensive Plan
  • The Plus Plan
  • The Premium Plan

What benefits are included in the Medicare Supplement Health Plans?

Our Medicare Supplement Health Plans include pharmacy, vision, and hearing benefits, in addition to Tivity Health SilverSneakers®, Cigna’s Employee Assistance Program (EAP), Health Advocate, and UnitedHealthcare Global Assistance for emergency medical assistance when you are traveling.

What is a premium? 

A premium is a payment for coverage made to Medicare, an insurance company or a health care plan. At the Medical Trust we generally refer to contributions, not premiums. The payment is generally made monthly. If authorized, payments to The Episcopal Church Medical Trust for health benefits may be automatically deducted from a retiree's pension checks.

What is a deductible?

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

What is a copayment?

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

What is coinsurance?

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.

What is included under home health care?

  • Part-time skilled nursing facility care
  • Physical, occupational and speech therapy
  • Services of a home health aide
  • Durable medical equipment and medical supplies

What is my primary coverage when I am enrolled in one of the Medicare Supplement Health Plans? 

Medicare is your primary coverage, and the Medicare Supplement Health Plan is your secondary coverage.

Are there networks of physicians or hospitals in the Medicare Supplement Health Plans? 

No, you may use a doctor or hospital that participates in Medicare. However, you will save money if your doctors accept Medicare assignment. If a doctor or hospital does not accept assignment, you may be required to pay more, or all, of your expenses.

Are there pharmacy networks in the Medicare Supplement Health Plans? 

Yes. For prescription drugs, you must use a network pharmacy. Visit Express Scripts' website to locate participating pharmacies or call Express Scripts at (866) 544-6963.

If I move to another state or travel within the 50 states for an extended period of time, will I still be eligible to remain in a Medicare Supplement Health Plan? 

Your coverage remains intact if you move to another state. You are covered when you travel within the 50 states and most United States territories.

Where can I find a provider for my vision needs? 

EyeMed has providers at more than 14,000 locations nationwide. To find one near you, visit EyeMed online or call EyeMed at (866) 723-0513.

What kind of coverage will I have in a foreign country? 

Under most circumstances, Medicare does not cover healthcare services performed outside the United States. The Episcopal Church Medical Trust travel plan rider covers health care costs associated with medically necessary treatment for an accidental injury or acute illness you may incur while you, or a covered dependent, are traveling outside the United States.

What is a formulary? 

A formulary is a list of commonly prescribed medications. The prescription drugs on the list are selected based on clinical effectiveness and opportunities to help contain your plan's costs. Formulary lists are subject to periodic review and modification by the health plan.

What is a brand-name drug? 

The brand name is the product name under which a drug is advertised and sold. The brand name is protected by trademark.

What is a generic drug? 

A generic drug is one that, by law, must have the same active ingredients as the brand-name drug it replaces. Generic drugs typically cost less than brand-name drugs. According to the FDA, generic drugs are just as safe and effective as brand-name drugs. The FDA regulates generic drugs to ensure that they meet rigid standards of quality.

Spouse & Dependents

Enrollment

What is open enrollment?

Open enrollment is a designated period each year when members may enroll in, or make changes to, healthcare coverage for themselves and/or their dependents. Selected plans become effective on the first day of the following plan year. Annual open enrollment for the Medicare Supplement Health Plans coincides with Medicare's open enrollment period, usually in the fall, for the benefit year effective the following January 1.

Are there any circumstances under which I can change plans other than during the open enrollment period?

Yes, you may change your coverage if you experience a significant life event, such as the death of a spouse, marriage, divorce, retirement, or the return to active compensated ministry. 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.

Do I need to wait for the open enrollment period if I am newly Medicare-eligible? 

No, you should contact us three months before you become eligible for Medicare.

I am Medicare-eligible, but still actively working and employed with the Church. May I join a Medicare Supplement Health Plan?

It depends. Please contact Client Services at (800) 480-9967, Monday - Friday, 8:30AM - 8:00PM ET (excluding holidays) for more information.

 

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

Unless otherwise noted, websites referenced herein that are outside the www.cpg.org domain are not associated with The Church Pension Fund and its affiliates (collectively, the Church Pension Group) and the Church Pension Group is not responsible for the content of any such websites.

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