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).
Yes, if your seminary participates in the Medical Trust Plans. To enroll in a medical plan offered by the Medical Trust, you must be a full-time student, as defined by the seminary, at a participating seminary of the Association of Episcopal Seminaries. Contact your seminary to confirm your eligibility.
You can enroll the following dependents on your medical plan:
Your domestic partner, if eligible based on the guidelines set by elected by the participating group
A child age 30 or younger on December 31st of the current year
A disabled child, 30 years of age or older on December 31st of the current year, 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.
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 the mail or at a pharmacy.
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 mail order after three pharmacy fills (once for the original prescription and two refills). Express Scripts' home delivery system permits up to a 90-day supply of medication at once, typically at a cost savings.
All of the Medical Trust health plans include:
Behavioral Health/Substance Use Disorder
Employee Assistance Program
Choosing generic (Tier 1) and then formulary (Tier 2) drugs will keep costs down, along with using the mail order prescription service. Discuss these options with your physician when you receive prescriptions.
EyeMed has providers at more than 14,000 locations nationwide. To find one near you, visit EyeMed, 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 pre-paid 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.
The Medical Trust offers three levels of dental coverage:
Preventive Dental PPO
Basic Dental PPO
Dental & Orthodontia PPO
Each seminary decides whether to offer dental benefits. Contact your seminary’s administrator to determine whether dental benefits are available to you.
To join a Medical Trust plan, you must enroll within 30 days of your seminary's registration deadline for the semester in which you wish to begin coverage. If you miss the enrollment period, you may enroll for the following semester. As a plan member, you remain enrolled year-round for as long as you remain in seminary. You can make changes to your coverage if you experience a significant life event during the plan year, such as the birth or adoption of a child, marriage, or divorce.
The effective date of coverage for a seminarian is the first day of the first semester or term in which he or she enrolls as a full-time student.
A deductible is the amount you must pay for healthcare before a plan begins to pay.
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 a percentage of the cost of services after deductibles have been paid that you may be required to pay as your share of the cost of services until you meet the out-of-pocket maximum.
The out-of-pocket maximum is the maximum out-of-pocket expense you will be responsible for during the plan year.
Your first step is to file an appeal with the healthcare plan. If you feel that the appeal is not successful, the Health Advocate, included in your health benefits, can help you resolve the claim. Call (866) 695-8622 or visit the Health Advocate website.
The Denominational Health Plan (DHP)
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.
Plans, Products & Vendors
No. Only medical benefits are required under the DHP. The Medical Trust does offer three dental plans using the Delta 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 77th General Convention.
Examples of canons/resolutions or policies that other dioceses have developed are available upon request from your Benefits Relationship 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.
The Medical Trust requires a declaration of the individual waiver through MyCPG Accounts. The employee affirms the election to waive coverage during their first enrollment period and at any subsequent point when they review or update their coverage information in MyCPG Accounts.