WNCC Healthcare Information for 2015

1. Healthcare Information Session
Uwharrie District
September 15, 2014
Jennifer Burton, Benefits Officer
& Dale Bryant, Benefits Administrator

2. What’s included…..
Medical benefits, including wellness program
Dental benefits
Vision benefits
Pharmacy benefits

3. What’s changing? What’s not?
Dental benefits: Stays the same with services and cost to
participant
Vision benefits: Stays the same with services; copays for
annual visit/exam will match to changes with medical
benefits plan

4. What’s changing? What’s not?
Medical benefits: Covered services remain the same;
Choice of two plan options with changes in either medical
costs or premium costs
Pharmacy benefits: Slight changes in formulary with new
Pharmacy Benefit Manager; no changes in copays for
types of medications (generics, formulary, or non-formulary)

5. Pharmacy Benefit Manager (PBM)
 Currently using ExpressScripts, formerly known as Medco, with
a traditional model of retail pricing with incentives given to
persons involved from pharmacies to manufacturers to PBMs
 New PBM is PharmAvail…. Working with a fiduciary model
where pricing to the consumer isn’t padded with costs of the
incentives; PBM profits only through administrative fee.
Company created with persons who are clinicians.

6. Pharmacy Benefit Manager (PBM)
 Plan design based on clinical research and discussion.
Recommendations to doctors based on this.
 Service center calls answered by real people in US
Committed to least disruption for participants, expecting the
change will be an upgrade.
Change will be seamless to participant in the plan. Present
your insurance card to your pharmacy of choice as always.

7. Pharmacy Benefit Manager (PBM)
Mail order prescriptions will continue to be available (more
information by end of year) with transfer of prescriptions
 For pharmacy locations, review all those working with
PharmAvail from their website
www.pharmavail.com/about/network
 Addition of injectable immunizations at pharmacy at no cost

8. Medical Health Plan Options
 Each participant will have the choice between two plans:
Basic plan: Same covered services; participant bears more
of the medical costs
Basic plus plan: Same covered services; participant
pays a higher premium
 As participant selects a plan option, any dependents must
also be included in the same plan.

9. Medical Health Plan Option: Basic
Same covered services as currently have
 Participant will bear additional medical costs through
increased co-pays, deductibles, coinsurance, and out-of-pocket
limits.
 Annual premium cost will total $10,200 with an affordable
portion to be contributed by pastor based on your total base
compensation.

10. Medical Health Plan Option: Basic
 Medical costs (in network) will be based on:
Co-pays for primary physician $30
Co-pays for specialty/urgent care visit $40
Individual deductible $1,500
Family deductible $4,500
Coinsurance percentage 70%
Out-of-pocket limitations (individual) $6,000
Out-of-pocket limitations (family) $13,200

11. Medical Health Plan Option: Basic Plus
Same covered services as currently have
 Participant will bear additional costs through increased
premiums, although the total premium is still reduced from the
prior year health insurance premium.
 Annual premium cost will total $12,300 with the pastor
contributing both a portion of the base premium relative to
your total base compensation PLUS the differential between
the premium for the basic plan and the basic plus plan
(differential equals $2,100)

12. Medical Health Plan Option: Basic Plus
 Medical costs (in network) will be based on:
Co-pays for primary physician $15
Co-pays for specialty/urgent care visit $25
Individual deductible $1,000
Family deductible $3,000
Coinsurance percentage 80%
Out-of-pocket limitations (individual) $4,000
Out-of-pocket limitations (family) $12,000

13. Pastor’s/Church’s Contribution under Plans
 Pastor’s contribution under the Basic Plan will be only the
percentage of the premium based on your salary range under
our sliding scale currently in place.
 Pastor’s contribution under the Basic Plus Plan will be the
percentage of the premium based on your salary range under
our sliding scale currently in place PLUS the difference
between the annual cost of the basic plan and the annual cost
of the basic plus plan (difference equals $2,100).
Church contribution equals the remainder of the premium less
the pastor’s contribution.

14. Example for Plan Determination
Consider the following:
Participant visits primary physician once per year for annual
physical.
Participant visits specialists (ophthalmologist,
gastroenterologist, cardiologist, hematologist, etc.) a total of
15 times per year.
Participant has certain tests performed (colonoscopy, sleep
study, etc.) totaling $3,000 before insurance or participant
payments.

15. Example for Plan Determination
 Medical costs for the participant under basic and basic plus:
 Primary care physician for annual physical Basic: $ 0 Basic Plus: $ 0
Specialist visits ($40/$25 x 15) $ 600 $ 375
 Tests performed at (coinsured) 30%/20% x $3,000 $ 900 $ 600
 Total medical costs $1,500 $ 975
Premium costs $ 204 $2,304
 Total health insurance costs for the year $1,704 $3,279
 Participant would have less out-of-pocket costs under Basic plan. Choice would also have
to include risk assessment of overall health for potential medically major events.

16. Added Wellness Program & Incentives
 Current plan does include some wellness items with no charges:
Annual physical for participants
Mammograms for women
Vaccines (flu, pneumonia, shingles, TDAP) for adults
Children’s vaccines
 Clergy Health Initiative (Spirited Life) had asked us to hold any
changes to our plan to add additional wellness items or incentives
because of their research study over the last three years. We have
been released from this restriction now that all cohorts have
completed their first year!

17. Added Wellness Program & Incentives
 Introduction of Wellness Incentives to go along with our Healthcare
Plans
 Incentives to include rewards for activity, rewards for assessment
completion, rewards for biometric screenings, rewards for healthy
ranges or improvement in certain biometrics…..
 These incentives will also include challenges periodically during a
year as additional activity within the five dimensions of health:
physical, emotional, spiritual, social, and financial.
 Reimbursements for certain items will also be included within the
wellness incentives.

18. Approved Incentive Plans - Activity
 Activity tracking through Virgin Pulse Physical Activity Program
 Incorporates Virgin HealthMiles walking program (including pedometers)
 Other activities will also be able to be tracked for additional “steps” or miles
 Various challenges throughout the year for which you can earn additional
reward points or “badges”
 Challenges between other UMC geographic groups within the US or districts of
our own conference
 Challenges between participants within the conference
 Reward point goals will be adjusted throughout your progress based on Virgin
Pulse algorithm

19. Pedometer from Virgin Pulse….
Meet… MAX

20. Approved Incentive Plan - Biometrics
Metabolic Syndrome:
Blood pressure
Blood sugar (glucose)
Cholesterol (HDL/LDL)
Triglycerides
Body Mass Index (BMI)
Waist circumference

21. Approved Incentive Plans - Biometrics
 Rewards for biometric items:
Health Risk Assessment completion through Healthgram
Biometric screening
Reward points for healthy ranges or improvement in certain
specific biometric items
 Reimbursements for certain items
Fitness center fees based on number of visits per year
Participation in Pfeiffer University Clergy Health Institute

22. Reward Points to Cash
 Each quarter, based on reward points earned, cash rewards will be
distributed.
 At the end of the year, especially for activity rewards, bonus awards
may be earned for meeting quarterly reward point goals.
 Total incentives available will be a substantial portion (up to 2/3) of
the total premium costs of the participant.

23. More information about wellness program
 In adding the Virgin Pulse program, more communication will be
forthcoming from both the conference office as well as from Virgin
Pulse before the end of the year.
 A “landing page” designed specifically for the WNC participants
will be created on the Virgin Pulse website. Registration for the
page will be required to begin earning the activity reward points.
 All this and full incentive awards and programs will be within the
communications later this year…. a communication blitz between
VirginHealthMiles and us.

24. How do we enroll?
 Pre-populated forms have been provided to us from Healthgram for re-enrollment
of ALL participants. Key information to be provided on these
forms:
Check your name, address, and phone number. If these are correct or
complete, please change on the form itself.
 Select the plan in which you want to enroll with the boxes on the right.
Complete the middle section for spouse and all dependents, including
birth dates and social security numbers, who will be enrolled.
 Note “qualifying events” which can cause a time at which plan
choices can be altered.

25. When do we complete the forms?
Where do we send?
 All forms need to be completed prior to November 1.
 Please write legibly!!
 After completion of your forms, please submit the forms with original
signatures to Dale Bryant, Benefit Administrator, at the Conference
office for us to receive no later than November 1!
Western NC Conference
PO Box 18005
Charlotte, NC 28218

26. Other enrollment thoughts…
 If your form is not received by November 1, you will be enrolled
in the basic plus plan if eligible for health benefits. In order to
have the plan that you request, please submit as quickly as
possible. Delays in receipt will also mean delays in receiving
new health cards!
 Enrollment for all portions of the health plan (medical, wellness,
pharmacy, dental, and vision) will be through this one form. The
only other step that participants will need to perform will be the
Virgin Pulse registration after December 31.
 New health cards are anticipated to be released so that
participants will have them prior to year end, December 31.

27. Changes to Clergy Compensation Form
 Due to these plan changes, there will be small changes you will
notice on your clergy compensation form. This will include
check boxes within the health insurance section of the form
where you will also show your selection of plans. Remember
these selections are your choice and not those of the church!!
 Also to note, as of January 1, 2014, employers are no longer
allowed to reimburse medical premiums for its employers as
non-taxable compensation. Therefore, for 2014 and forward,
these amounts MUST be included in your total compensation as
shown in Line 1 of the form (and on your Form W-2 at the end of
the year).

28. Church Cost for Pastor Benefits in 2014
 Churches fund the pension and health benefits of the pastor
each year. For 2014, these items and their cost were as follows:
Pension costs within three parts:
Defined benefit at set cost per pastor of $5,118
Defined contribution at 3% of pastor’s plan compensation
Comprehensive Protection Plan premium at 2.87% of plan
compensation (partially subsidized as GBOPHB invoices 3%)
Health care premiums at their share of $13,788

29. Church Cost for Pastor Benefits - 2015
 In funding the pension and health benefits of the pastor, in 2015,
these items and their cost will be as follows:
Pension costs within three parts:
Defined benefit at set cost per pastor of $4,092 (partially
subsidized as GBOPHB will invoice $5,356)
Defined contribution at 3% of pastor’s plan compensation
Comprehensive Protection Plan premium at 2.78% of plan
compensation (partially subsidized as GBOPHB invoices 3%)
Health care premiums at their share of $10,200 (either plan)

30. Comparison between years….
 In comparing these, the following savings are noted for each
church, per pastor:
Pension benefits (defined benefit): $5,118 - $4,092 = $1,026
(20% savings)
Pension benefits (comprehensive protection plan): 2.87% -
2.78% = .09% of plan compensation (3.1% savings)
Health benefits: $13,788 - $10,200 = $3,588 (26% savings)
 Total potential savings at minimum salary: $1,026 + ($40,000 x
.09%) + $3,588 = $4,650

31. How could these savings be used??
 Ministry needs of the church and community
Apportionment payments if not currently at 100%
 Savings or reserves for future needs
 OR……if the pastor has not had a salary increase or, for the
needs of health, will enroll in the basic plus plan, utilize these
savings to provide additional compensation to the pastor.

32. Are the pastors ready to approach PPRC?
 Requesting an increase in salary can be an awkward event for
even the most self-confident of us. Here’s some facts to
provide, especially if the pastor has not had an increase or if,
medically, the pastor will be selecting the basic plus plan:
Inflation (which equates to cost of living) has averaged 1.5%
over each of the last three years.
At minimum salary, additional cost of basic plus plan will be
approximately 6% of salary.

33. Are the pastors ready to approach PPRC?
You may be asked to “justify” your health plan choice.
While this is not appropriate for you to have to do, a basic
response could be that you have selected this plan based
on your current health needs. By being attuned to these
needs and utilizing the medical profession to assist in you
becoming healthier, you are able to provide stronger
pastoral care to them and your congregation that would not
be possible if this was not available.
From the conference office, we are also available to
provide average pastor salary based on size of church by
membership or worship attendance for comparison.

34. Items to remember….
 Health plan choice is yours and yours alone. Church does not
have the ability to make this choice for you.
 Church can provide a “reimbursement” for healthcare
premiums for our conference plan. However, it must be
included in your total compensation (Line 1) as taxable
income.
 If the church does not report in this manner, they will be
subject to penalties totaling $100 per day, annually $36,500,
and possible penalties for the misreporting of income on your
Form W-2 at the end of the year.

35. Items to remember….
 Pastor’s contribution to their health care premiums, along with
those of spouses and children if all are enrolled on the
conference plan, can be shown on Line 2b of the clergy
compensation form and reduce your taxable income for year
end reporting.
 Enrollment forms are due back to the Conference office no
later than November 1!!

36. It’s a lot of information…..
Any and all questions……?