Medical Insurance
Plan Documents (pdfs)
Anthem Consumer Directed (High Deductible) Plan Documents
Dental and Behavioral Plan Documents
See Mental Health/Substance Abuse tab below for additional information on coverage.
Other Information
Pharmacy/Prescriptions
PHARMACY/PRESCRIPTIONS benefit is included along with Anthem BlueCard PPO 100, Anthem BlueCard PPO 80 and CIGNA medical plans
The provider is Express Scripts
PRESCRIPTIONS PLAN through Express Scripts
All plans continue to provide prescriptions through Express Scripts, therefore members may continue using their current Express Scripts card for Pharmacy/Prescriptions.
Policy numbers
RxBIN 610014
RxGroup EPISCPL
Issuer 9151014609
Customer Service number 800-841-3361
Drug Tier |
Retail |
Home Delivery |
Deductible |
None |
None |
Generic |
Up to $10 copay |
Up to $25 copay |
Preferred Brand-Name |
Up to $40 copay |
Up to $100 copay |
Non-Preferred Brand-Name |
Up to $80 copay |
Up to $200 copay |
Dispensing Limits |
Up to 30-day supply |
Up to 90-day supply |
- Express Scripts for members enrolled in Anthem Consumer-Directed Health Plan- CDHP–20/H.S.A.
Drug Tier |
Retail and Home Delivery |
Deductible (combined with medical deductible) |
$2,700 individual / $5,450 family |
Generic |
15% coinsurance after deductible |
Preferred Brand-Name |
25% coinsurance after deductible |
Non-Preferred Brand-Name |
50% coinsurance after deductible |
Dispensing Limits |
Up to 30-day supply (retail) or 90-day supply (home delivery |
Employee Assistance Program
Employee Assistance Program
The Employee Assistance Program (EAP), offered through Cigna Behavioral Health, is a free, confidential 24-hour a day service that assists members and their covered dependents with information, educational materials, resources, referrals, and ongoing support. The plan covers unlimited telephone consultations and up to 10 face-to-face counseling sessions per issue at no member cost.
We encourage you to promote this valuable service to your employees. You may also contact this program for advice on how to handle a workplace situation, or to find resources for helping people cope with a variety of disasters and challenging situations, such as floods and hurricanes.
The trained professional EAP staff can provide:
- 24/7 phone access for behavioral health issues
- Referrals for in-person counseling (including up to 10 sessions, per topic or issue, with no copay)
- Legal consultations
- Tips for balancing work and family
- Resources for more help in your community.
There are also online resources on such issues as:
- Emotional well-being and life events
- Family and care-giving
- Health and wellness
- Daily living
- Disaster Resource Center
To access EAP services, call (866) 395-7794, 24 hours a day, 7 days a week, or sign in to the website Cigna Behavioral Health (password: episcopal).
Behavioral Health Benefits (Mental Health/Substance Abuse)
Lifetime Maximum Benefit
The Annual and Lifetime Benefit Maximum has been eliminated.
Dependent Children Coverage
Children remain eligible for coverage to age 30.
Now they do NOT have to:
- Live at home
- Be full time students
- Be unmarried
- Have no dependents of their own
Value-Added Benefits
The healthcare plans offered by the Medical Trust offer value –added benefits for participants, they include:
Health Advocate
A member needs help resolving an insurance claim, understanding a complex medical condition, or finding services for an elderly parent. How can you help?
Direct him or her to Health Advocate, where professional advocates, typically registered nurses backed by a team of experts, help members navigate the health care system.
This free, confidential service can help members:
- Find the best hospitals, doctors, and other health care providers
- Obtain second opinions
- Schedule appointments with hard-to-reach specialists
- Resolve benefits claims and issues
- Correct billing mistakes
- Better understand their condition
Call (866) 695-8622, 24 hours a day, 7 days a week. Normal business hours are Monday through Friday, 8 a.m. to 9 p.m. ET.or sign in to the website Health Advocate (password: episcopal).
Vision
EyeMed Vision Care
In 2018 vision benefits will be provided through EyeMed Vision Care’s Insight Network.
Insight Network offers:
- More generous frames and contact lenses allowance
- Enhanced benefits for progressive lenses
- Fewer providers than in EyeMed’s Access Network
Is your provider in the Insight Network? Call (866) 723-0513, or visit www.eyemedvisioncare.com/ecmt.
Your EyeMed Benefits
$0 copays for annual eye exams with in-network providers*
- Annual allowance for contacts or frames, plus discounts if you go over your allowance when using network providers
- Additional eyewear purchases at 40% off
- Non-prescription sunglasses at 20% off
- 20% off remaining balances beyond plan coverage limits Savings on prescription eyeglasses or contact lenses
- Discounted LASIK or PRK surgical procedures
In-Network
There are two ways to find in-network providers and schedule exams
- Call (866) 723-0513
- Visit: www.eyemedvisioncare.com/ecmt
Out-of-Network
- Consult Summary of Benefits for information on reimbursement for covered services
- Mail an itemized bill from your provider with the claim form to EyeMed Claim form on: www.cpg.org
•Claims processing may take 3–4 weeks
Hearing
Medical Trust health plans include a hearing discount plan, which provides discounts on hearing exams and supplies.
Hearing Discounts
Hearing discounts are offered through HearPO for Medical Trust plans.
The HearPO network offers discounts for hearing aids and supplies through more than 1,400 HearPO affiliates across the U.S. These discounts are also available to extended family members. To access these discounts, family members simply mention that they are related to the member and identify themselves as a member of an Episcopal Church Medical Trust health plan.
HearPO provides:
- Testing performed by licensed hearing-care professionals
- Comprehensive follow-up services at no cost for one year
- Savings on all styles of hearing instruments and all levels of technology
- Discounts on hearing aid repairs
- 60-day trial period with a money-back guarantee
- Free demonstrations of the latest available technologies
Travel Medical Assistance
FrontierMEDEX provides emergency medical and travel assistance for Medical Trust plan members traveling at least 100 miles from home, either in the U.S. or abroad, 24 hours a day, 7 days a week. With FrontierMEDEX’s assistance, members have access to worldwide medical and dental referrals, emergency medical treatment, replacement of travel documents and other services.
The program includes:
- Assistance in obtaining medical treatment. FrontierMEDEX’s staff will help make the arrangements for local referrals for treatment or evacuation due to a medical emergency.
- Assistance with providing insurance information and medical records for treatment
- Replacement of prescriptions, medical devices and corrective lenses
- Emergency travel arrangements and replacement of lost or stolen travel documents
- Emergency fund transfers
FrontierMEDEX is not responsible for the member’s medical costs.
Diocesan Benefits Coordinator
Ms. Sara Saavedra
Convention Officer, Assistant Secretary of Convention, Diocesan Benefits Coordinator, Secretary to the Standing Committee
Office: 212-316-7423
Fax: 212-316-7420
ssaavedra@dioceseny.org
Group Policy Number Quick Reference
Anthem medical plans
For both Anthem Plans (BlueCard PPO 100 and BlueCard PPO 80) Group Policy Number is:
003330125
Plan Code 834/332
Customer Service number 1-844-812-9207
Anthem
3000 Goffs Falls Road, Manchester, NH 03111-0001.
www.anthem.com
CIGNA Open Access Plus
Group Policy # 3328261
CIGNA
P O Box 182223
Chattanooga, TN 37422-7223
Phone: 1-800-244-6224
www.cigna.com
PRESCRIPTIONS PLAN through Express Scripts
All plans continue to provide prescriptions through Express Scripts, therefore members may continue using their current Express Scripts card for Pharmacy/Prescriptions.
Policy numbers
RxBIN 610014
RxGroup EPISCPL
Issuer 9151014609
Customer Service number 800-841-3361
Vision Care for Eyeglasses is provided by EyeMed Vision Care’s Insight Network
Group Policy Number 9682527
1-866-723-0513
www.eyemedvisioncare.com
Mental Behavioral through CIGNA
No cards provided
Employer ID: Episcopal
www.cignabehavioral.com
(866) 395-7794