After completing a two-year review of the Presbyterian Church (U.S.A.)’s Medical Plan for church workers, the denominations Board of Pensions (BOP) has approved numerous “modifications” designed to make the plan simpler and more understandable.

And at a time when many health insurers are scaling back benefits, the net effect of the BOP’s changes is $6 million in enhanced benefits, most of it through a new program to cover habilitative services for children with congenital developmental disabilities such as Down’s syndrome, autism, cerebral palsy, intellectual disability and spina bifida.

And it’s being done without a dues increase. Medical Plan dues will remain at 19.5 percent of “effective salary” in 2010 — the third consecutive year at that rate.

“The recommended modifications will make the Medical Plan more integrated, understandable, and equitable,” said Pat Haines, senior vice president of Benefits for the Board of Pensions, in a message to plan members after the June 27 board meeting here. “It’s important for churches, employing organizations, and Plan members to know that there’s a lot of good news to be found in these changes.”

Other major components of the changes are the establishment of parity between mental health benefits and other medical benefits and a brand-new provision that allows plan members to waive coverage for spouses and dependent children who have other comparable employer-based or military coverage.

All of the changes go into effect Jan. 1, 2010, except the dependent coverage waiver, which takes effect Oct. 1 of this year. Granting of a waiver will not affect dues paid by the employing organization.

The vote to extend coverage to habilitative services for children — sparked by an overture to last year’s 218th General Assembly on behalf of a former plan member who has a child with Down’s syndrome —  was praised by the Presbyterian Health, Education and Welfare Association, which has frequently clashed with the BOP on various health and mental health related issues.

In a letter to Haines, the social welfare coalition wrote that “coverage of habilitative therapies embodies both the Board of Pensions’ biblically-based commitment to caring for plan members and their families as well as the PC(USA)’s commitment to empower individuals with disabilities to realize their full potential and to serve as a leader in manifesting a just world …”

Establishing parity between mental health and medical benefits came in part as a response to federal legislation mandating such parity. The law now provides that the benefits for mental health and substance abuse services cannot be subject to financial or benefit limits that are more restrictive than those imposed for medical services.

“We have also been seeking plan simplification to address complex deductibles and varying limits and, lack of integration,” said Stew Beltz of the board’s Benefits Team. “We want to improve members’ experience with the benefit so they really value it.”

Parity-related changes encourage the use of in-network providers and generic drugs. They include:

  • Elimination of the medical deductible for out-of-network medical office visits and a straight 50 percent payment of the Plan’s allowance for out-of-network medical and mental health office visits;
  • Elimination of separate deductible for inpatient and higher level behavioral health services — now there will be one annual in-network deductible and one annual out-of-network deductible for both medical and mental health services combined, excluding office visits;
  • An increase in the out-of-network deductible for other medical services  from 1.5 to  2 percent of salary, excluding office visits;
  • Elimination of  the separate annual in-network copayment maximums of  4 percent of salary for medical and $1,500 for mental health services — now there will be a single 4 percent maximum on all in-network medical and mental health services combined, excluding office visits;
  • Elimination of the separate annual out-of-network copayment maximums of  8% of salary for medical and $2,500 for mental health services — now there will be a single annual out-of-network copayment maximum of  12 percent of salary for all out-of-network medical and mental health services combined, excluding office visits; and
  • Elimination of the $2,000 annual reimbursement limit for outpatient mental health and substance abuse treatment for Medicare Supplement subscribers.

The board also approved numerous changes in the prescription drug program, including:

  • Elimination of the $100 prescription drug deductible for members and families in both the Active and Medicare Supplement plans;
  • Elimination of the 20% copay  and minimum and maximum payments for generic drugs — now there will be a fixed $8 retail co-pay (one-month supply) and $20 mail-order co-pay (three-month supply);
  • Increase in the annual prescription drug co-payment family maximum from $2,000 to $2,500, the first increase since 2002;
  • Increase in the brand-name non-formulary co-pay from 40 percent to 50 percent and an increase in the minimum/maximum co-pays from  $40/$100 to $50/$100 (retail) and from $100/$300 to $125/$450 (mail order).

As a result of the changes, Beltz said, Result: “In 2010 I think we can have a one-page Medical Plan summary.” Plan members will see all benefits summarized in three sections, he said: basic medical services, the prescription drug program, and higher-level medical services.

In other business, the board:

  • Raised dues for the Affiliated Benefits Program — which offers medical coverage only or medical with death and disability coverage to employees in non-installed positions scheduled to work 20 hours a week or more — by 2.5 percent for 2010;
  • Authorized staff to apply for the federal government’s Medicare Part D (prescription drug) subsidy for 2010, estimated to be a little more than $6 million;
  • Raised the Medical Plan maximum benefit from $3 million to $3.5 million;
  • Approved a three-year contract with ActiveHealth Management to provide health and care management services;
  • Received a report from Thomas Park Jennings of Washington, DC — chair of the board’s Investment Committee — that the BOP’s balanced investment portfolio had a market value of $5.6 billion on May 31, 2009, with a return of 6.4% for the year to that date;
  • Received a report from its Assistance Committee that six eight-day CREDO conferences will be held in 2010. The CREDO program promotes the holistic health and welfare of pastors serving congregations. Participants work on personal and professional renewal, concentrating on four major components of well-being: spiritual, vocational, financial, and health. “The CREDO experience can change lives,” said the Rev. Mary Serovy, director of Presbyterian CREDO; and
  • Invited applications for Middle Governing Body Grants [link] for the year 2010. Ten matching grants of up to $15,000 are available to synods or groups of presbyteries that want to develop new programs to improve practical skills in their pastors. Proposed programs may provide training in congregational and staff leadership, budgeting and financial management, strategic planning, or conflict resolution. Deadline for application is Aug. 15, 2009.

Some information for this story furnished by Karen J. Babik, director of the BOP’s Communications, Public Relations, Marketing and Education department, and her staff.