Employee Medical Dental

Churches: Please complete the online Church Benefit Survey to HELP US HELP YOU!

In Synod of the Pacific’s continuous quest to find the best overall medical coverage for our churches’ employees at the best possible prices, our insurance broker will be marketing our organization this year to new insurance carriers as well as current insurance carriers. To better serve you, please help us by completing our Church Benefits Survey by clicking on the above link. Once you have completed the survey, click “submit”. Enter fields as needed. If you have any issues submitting this survey online, please contact: Melinda Durham, Benefits Coordinator, at (800) 754-0669.

Synod of the Pacific

Benefits Services

The Synod of the Pacific offers comprehensive medical, dental and vision insurance coverage along with many voluntary benefits such as a 125 Flexible Spending Account, and several AFLAC plans, to all of its lay employees who work twenty hours or more per week. There are no physical examinations and no exclusions for pre-existing conditions.

The Synod has several medical plans it offers: Anthem HMO, Anthem Classic PPO, and Anthem Solutions PPO and Kaiser plans in California; residents outside California are offered the Anthem Classic PPO, Anthem Solutions PPO plan and Kaiser (depending on the State). Each plan includes complete head to toe coverage, a prescription plan and vision benefits; all this, plus competitive pricing too.

Our Self Insured Dental Plan thru Delta Dental allows you to choose your own dentist. In addition, there is a dentist Network available, if your provider is part of this network, you can enjoy less out of pocket expenses. All claims billing is done for you by your dentist’s office.

Eligibility l

You must be an employee of a church or affiliated organization of the Synod of the Pacific, working twenty hours or more per week.
Lay Employees (and their dependents) are eligible to participate in these programs after a sixty day waiting period, (from “date of hire”).
Ordained Clergy* may enroll immediately in elective dental and vision, coverage will begin the first day of the month following their date of hire. However, if the date of hire is the first day of the month, coverage would begin immediately.
Coverage must be provided by the employing organization, as part of its standard employee benefits package.
Employing organizations must provide all employees with fair and equal coverage within each basic employment classification. Basic Employment Classifications are:

1. Ordained Clergy*

2. Non-Ordained Exempt Staff

Christian Education Directors

Business Managers, etc.

3. Non-Exempt Staff

Clerical Staff

Custodians, etc.

Employing organizations must agree to pay at least the member portion of premiums.
Dependent coverage may be paid by plan members through pretax payroll deduction.

All terminations must be sent in writing to the Synod office no less than thirty days prior to employees last day. Coverage will end on the last day of the month; there are no pro-rated terminations.

Should you have any questions, please feel free to contact Melinda Durham at (800) 754-0669 or by email at melinda@synodpacific.org.

* The Synod of the Pacific’s Health Benefits are available to Ordained Clergy on a voluntary basis. Our medical plans do not compete or replace the Board of Pension’s medical plan.

2011 Medical Plan Summaries

EFFECTIVE NOVEMBER 1, 2010

Anthem Blue Cross & Kaiser HMO & Blue Cross PPO PLANS

*Description*	*Anthem BC HMO*	Kaiser HMO	*Anthem Blue Cross* *Classic PPO*		*Anthem Blue Cross* Solutions PPO
*Lifetime Maximum*	Unlimited		Unlimited		Unlimited
*Annual Deductible*	None		$500/Individual; $1,00 Family $750/Individual/Out-of-Network $2,250/Family/Out-of-Network		$2,500/Individual; $5,000/Family In or Out-of-Network
*Annual Out of Pocket Maximum* Individual Family	$1,500 $3,000	$1,500 $3,000	$3,000 – member/In-Network $6,000 – member/Out-of-Network		$2,5000/ Member/In Network $10,000/Member/Out-of-Network
			In Network	Out-Of-Network	In Network	Out-of-Network
*Professional*
Physician Visit	$30 Copay	$20 Copay	$30 Copay	40%	$10 Copay	40%
Specialist	$30 Copay	$20 Copay	$30 Copay	40%	$10 Copay	40%
Physical Therapy	$30 Copay	$20 Copay	20%	40%/$25 limit	20%/24 visits	40%/24 visits
Home Health Care	100%	100%	20% 100 visits/yr	40% 100 visits/yr	20% 100 visit/yr	40% 100 visits/yr
*Hospital Services*
Inpatient	$250 Copay		20%	40%/$500 deduct	20%	40%/$500 deduct
Outpatient	100%	$20 Copay	20%	40%/$500 deduct	10%	40%/$500 deduct
Emergency Room	$100 Copay, waived if admitted		$100 Deductible, waived if admitted, 20% coinsurance		$100 Deductible, waived if admitted, 20% coinsurance
*Lab & X-Ray*	100%		20%	40%	20%	40%
*Durable Medical Equipment*	20% Coinsurance		20%	40%	20%	40%
*Preventive Care*
Adult	No Copay	$20 Copay	No Copay	40%, no deduct	No Copay	40%/No deduct
Children	No Copay	$20 Copay	No Copay	40%, no deduct	No Copay, up to age 6	40%/No deduct, up to age 6
*Maternity*
Office Visits	$30 Copay	$5 Copay	$30 Copay	40%	$10 Copay	40%
Hospitalization			20%	40%	20%	40%/$500 Deduct
*Mental Health*
Inpatient	$250 per day	$250 per admission	20%	40%	20%	40%
Outpatient	$30 Copay, max 20 visits	$20 Copay max 20 visits	$30 Copay 20% Facility	40%	$10 Copay, no deductible, 20% Facility Care	40%
*Chemical Dependency*
Inpatient	$250 Copay per day		20%	40%	20%	40%
Outpatient	$30 Copay	$20 Copay	$30 Copay 20% Facility	40%	$10 Copay, no deductible, 20% Facility Care	40%
*Chiropractic Benefit*	$30 Copay	$15 Copay 30 visits	20% 24 visits	40%/$25 limit 24 visits	20% 24 visits	40%/$25 limit 24 Visits
*Vision Benefit*	Covered thru VSP Plan		Covered thru VSP Plan		Covered thru VSP Plan
*Prescription Drug*
Generic	$10 Copay	$10 Copay	$10 Copay	$10.00 Copay plus 50% max amt	$10 Copay	$10 Copay plus 50% max amt
Brand	$25 Copay	$20 Copay	$25 Copay	$25.00 Copay plus 50% max amt	$25 Copay	$25 Copay plus 50% max amt
Non-Formulary	$50 Copay $250 Brand Deductible	Must be Formulary	$40 Copay	$40.00 Copay plus 50% max amt	$50 Copay $250 Brand Deductible	$50 Copay plus 50% max amt
Days Supply	30 days		30 days		30 days

2011 Delta Dental and Vision Benefits Summaries

EFFECTIVE November 1, 2010

Dental Benefits	In Network	Out of Network	Vision Benefits	In Network	Out of Network
Calendar Year Deductible Per Person Family Unit	$50 $50	$150 $150	Copayment Exam Materials	$10.00 $25.00
Annual Benefit Maximum Per Covered Person	$1,500	$1,500	Eye Exams	$100%	$45.00 max
Preventive Service (deductible waived) Emergency Palliative Treatment Oral Examination - every 6 months X-rays - four bitewings every 12 months, full mouth series every 5 years Teeth Cleaning - every 6 months Fluoride Treatment for Children Space Maintainers for Children Topical Sealants (up to age 16)	100%	100%	Lenses Frequency: Every 12 months Single Vision Bifocal Trifocal Lenticular Note: Percentages and dollar amounts are after copayment.	100% 100% 100% 100%	$45.00 max $65.00 max $85.00 max $125.00 max
Basic Service Laboratory Test Diagnostic Consultation - one per year Fillings: Amalgam, Silicate, Acrylic Crowns: Stainless Steel Repairs of dentures, bridgework, crowns Endodontic Services/Root canal Periodontal Services Oral Surgery - Uncomplicated extractns General Anesthesia - Surgical procedures only Injectable Antiobiotics	90%	80%	Contact Lenses Fequency: Every 12 Months Medically Necessary Elective (maximum) *Copay does not apply (If you choose contact lenses, you will not be eligible to receive lenses for 12 onths and frames for 24 months following the date contacts were obtained.)	$120.00	$105.00 max
Major Services Bridges Installation fixed or removable Dentures - Full or Partial Crowns: Acrylic Metal, Porcelain Inlays Onlays Posts	60%	50%	Frames Frequency: Every 24 Months	$120.00 max 20% off amt over max	$47.00 max
Orthodontics (Under age 19) $1,500 Lifetime Maximum Deductible does not apply	50%	50%

Synod of the Pacific

2011 Medical and Dental Monthly Insurance Rates

EFFECTIVE NOVEMBER 1, 2010

DENTAL INSURANCE OPTIONAL VISION INSURANCE DENTAL/VISION PACKAGE


Delta Dental Insurance		Vision Plan (VSP)		Dental/Vision Package
Employee	$68.00	Employee	$20.00	Employee	$83.60
EE + Dependent	$120.00	EE + Dependent	$38.00	EE + Dependent	$150.10
EE + Family	$175.00	EE + Family	$60.00	EE + Family	$223.25

MEDICAL INSURANCE (Includes Vision Benefit)


California Plans		Outside California Plans
Anthem HMO
Employee	$725.10
EE + Spouse	$1,583.18	HMO NOT AVAILABLE
EE + Child(ren)	$1,298.21
Family	$2,225.88

Anthem Classic PPO		Anthem Classic PPO
Employee	$713.93	Employee	$772.32
EE + Spouse	$1,558.60	EE + Spouse	$1,687.10
EE + Child(ren)	$1,278.11	EE + Child(ren)	$1,383.25
Family	$2,191.28	Family	$2,372.30

Anthem Solutions PPO		AnthemSolutions PPO
Employee	$630.08	Employee	$682.98
EE + Spouse	$1,374.18	EE + Spouse	$1,490.54
EE + Child(ren)	$1,127.21	EE + Child(ren)	$1,222.42
Family	$1,931.38	Family	$2,095.35

Kaiser Permanente HMO		Kaiser Northwest HMO
Employee	$683.35	Employee	$534.12
EE + Spouse	$1,477.00	EE + Spouse	$1,056.75
EE + Child(ren)	$1,221.35	EE + Child(ren)
Family	$2,075.11	Family	$1,580.33

Note: The Synod’s general participation guidelines state that the employer will pay the employee cost for HMO coverage.

These rates are guaranteed based on the Synod’s current participation. We do not anticipate any enrollment challenges; however,

it is our duty to inform our participants there is always the possibility of being re-rated should we not meet the carrier’s participation

requirements.

Please call or email Melinda Durham (melinda@synodpacific.org), Benefits Coordinator, with your questions (800) 754-0669.

Downloads

Enrollment Froms	Benefit Summaries
Universal Enrollment Form	Medical
Medical/Dental/Vision	*California Plans*
	Anthem HMO
Voluntary Benefits	Anthem Classic PPO
Life Insurance	Anthem Solutions PPO
Reliance Life	Kaiser Permanente HMO

Section 125 FSA	*Out of State Plans*
Primark Benefits Section 125 Packet	Anthem Classic PPO
	Anthem Solutions PPO
	Kaiser Northwest

	Anthem HMO & Solutions Rx Plan
	Anthem Classic PPO Rx Plan
	Anthem Life Insurance

	*Dental*
	Deltal Dental Benefits Highlights

	Vision (VSP)
	Vision Service Plan