 |
The
Synod of the Pacific |
-
A Synod of the Presbyterian Church USA - |
Announcement: Blue Cross of California to become - Anthem Blue Cross
Beginning April 1, 2008, Blue Cross of California will do business as Anthem Blue Cross, taking on a trusted brand name that symbolizes quality for millions of members across the country.
This means Blue Cross of California products and services will be offered under the Anthem Blue Cross brand. The change to Anthem is effective for our complete product portfolio including medical, dental, vision, life, employee assistance programs and behavioral health services.
The new brand name in California will continue to embody the consistency, strength, security and stability of the Blue Cross name. While the name and logo will be different, you can expect us to be the same trusted source for quality, affordable health care coverage.
|
Synod of the Pacific
Group Health 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, 403(b) retirement accounts, 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: Blue Cross HMO, Blue Cross PPO, and BlueCard HSA PPO plans in California; residents outside California are offered the BlueCard PPO and BlueCard HSA PPO plan. 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 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, 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.
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 Kendra Fraser at (800) 754-0669 or by email at Kendra@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. |
2008 Medical Plan Summaries
EFFECTIVE NOVEMBER 1, 2007
Blue Cross HMO & PPO PLANS
Description |
|
Blue Cross HMO (H17) |
|
Blue Cross PPO |
|
Blue Cross HSA PPO (LHSA16) |
Lifetime Maximum |
|
Unlimited |
|
$5,000,000/member |
|
$5,000,000/member |
Annual Deductible |
|
None |
|
$250.00 – Individual
$750.00 - Family |
|
$1,500 – Individual
$3,000 – Family |
Annual Out of Pocket Maximum |
|
$1,000 – Individual
$1,500 - Family |
|
$2,000 – member/In-Network
$6,000 – member/Non PPO Provider |
|
$3,000 – mem/$6,000 – Family/ In-Network
$6,000 – Mem/$12,000 – Fam/Out-of-Network |
|
|
|
|
In Network |
Out-Of-Network |
|
In Network |
Out-of-Network |
Professional |
|
|
|
|
|
|
|
|
$20 Copay |
|
$20 Copay |
40% |
|
10% |
30% |
|
|
$20 Copay |
|
$20 Copay |
40% |
|
10% |
30% |
|
|
$20 Copay |
|
20% |
40% |
|
10% |
30% |
|
|
$20 Copay |
|
20% |
40% |
|
10% |
30% |
Hospital Services |
|
|
|
|
|
|
|
|
$250 Copay |
|
20% |
40% |
|
10% |
30% |
|
|
100% |
|
20% |
40% |
|
10% |
30% |
|
|
$100 Copay, waived if admitted |
|
$100 Deductible, waived if admitted |
|
10% |
Lab & X-Ray |
|
100% |
|
20% |
40% |
|
10% |
30% |
Durable Medical Equipment |
|
100%, $5,000 max per year |
|
20% |
40% |
|
10% |
30% |
Preventive Care |
|
|
|
|
|
|
|
|
$20 Copay |
|
$20 Copay |
40% |
|
No Copay |
30% |
|
|
$20 Copay |
|
$20 Copay |
40% |
|
No Copay |
30% |
Maternity |
|
|
|
|
|
|
|
|
$20 Copay |
|
$20 Copay |
40% |
|
10% |
30% |
|
|
$250 per admission |
|
20% |
40% |
|
10% |
30% |
Mental Health |
|
|
|
|
|
|
|
|
Non severe not covered |
|
20% |
40% |
|
10% |
30% |
|
|
$35 Copay, max 20 visits per year |
|
20% |
40% |
|
10% |
30% |
Chemical Dependency |
|
|
|
|
|
|
|
|
Non severe not covered |
|
20% |
40% |
|
10% |
30% |
|
|
$35 Copay, nax 20 visits per year |
|
20% |
40% |
|
10% |
30% |
Chiropractic Benefit |
|
PCP referred |
|
20% |
40% |
|
10% |
30% |
Vision Benefit |
|
Covered thru VSP Plan |
|
Covered thru VSP Plan |
|
Covered thru VSP Plan |
Prescription Drug |
|
|
|
|
|
|
|
|
$10 Copay |
|
$10 Copay |
50% |
|
10% |
30% |
|
|
$20 Copay |
|
$20 Copay |
50% |
|
10% |
30% |
|
|
$40 Copay |
|
$40 Copay |
50% |
|
10% |
30% |
|
|
30 days |
|
30 days |
|
30 days |
This information is meant to be a summary of benefits only. Please refer to the plan document for detailed information. If there is a conflict between this information and the plan document, the plan document will prevail.
|
2008 Guardian Dental and Vision Benefits Summaries |
EFFECTIVE November 1, 2007 – October 31, 2008
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% |
$46.00 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% |
$47.00 max
$66.00 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.) |
100%
$120.00
|
$210.00 max
$120.00 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 |
|
Orthodontics (Under age 19)
$1,500 Lifetime Maximum
Deductible does not apply |
50% |
50%
|
|
|
|
|
|
Synod of the Pacific
2008 Medical and Dental Monthly Insurance Rates |
EFFECTIVE NOVEMBER 1, 2007
DENTAL INSURANCE
|
EMPLOYER |
EMPLOYEE |
TOTAL |
Guardian Life Insurance |
|
|
|
Employee |
$ 46.00 |
$ 0.00 |
$ 46.00 |
EE + Dependent |
$ 46.00 |
$ 44.00 |
$ 90.00 |
EE + Family |
$ 46.00 |
$ 104.00 |
$ 150.00 |
|
|
|
|
|
|
|
|
MEDICAL & VISION INSURANCE |
|
|
|
EMPLOYER |
EMPLOYEE |
TOTAL |
California Plans |
Blue Cross HMO |
|
|
|
Employee |
$ 479.49 |
$ 0.00 |
$ 479.49 |
EE + Spouse |
$ 479.49 |
$ 512.66 |
$ 992.15 |
EE + Child(ren) |
$ 479.49 |
$ 361.73 |
$ 841.21 |
Family |
$ 479.49 |
$ 928.31 |
$ 1,407.80 |
|
|
|
|
Blue Cross PPO |
|
|
|
Employee |
$ 586.28 |
$ 0.00 |
$ 586.28 |
EE + Spouse |
$ 586.28 |
$ 715.66 |
$ 1,301.94 |
EE + Child(ren) |
$ 586.28 |
$ 451.65 |
$ 1,037.93 |
Family |
$ 586.28 |
$ 1,228.57 |
$ 1,814.85 |
|
|
|
|
BlueCard Lumenos HSA PPO (High Deductible) |
|
|
Employee |
$ 458.07 |
$ 0.00 |
$ 458.07 |
EE + Spouse |
$ 458.07 |
$ 543.20 |
$ 1,001.27 |
EE + Child(ren) |
$ 458.07 |
$ 363.35 |
$ 821.43 |
Family |
$ 458.07 |
$ 952.24 |
$ 1,410.31 |
|
|
|
|
Outside California Plans |
|
|
|
BlueCard PPO |
|
|
|
Employee |
$ 632.63 |
$ 0.00 |
$ 632.63 |
EE + Spouse |
$ 632.63 |
$ 808.89 |
$ 1,441.52 |
EE + Child(ren) |
$ 632.63 |
$ 521.73 |
$ 1,154.36 |
Family |
$ 632.63 |
$ 1,387.67 |
$ 2,020.30 |
|
|
|
|
BlueCard Lumenos HSA PPO (High Deductible) |
|
|
|
Employee |
$ 536.47 |
$ 0.00 |
$ 536.47 |
EE + Spouse |
$ 536.47 |
$ 637.24 |
$1,173.71 |
EE + Child(ren) |
$ 536.47 |
$ 426.03 |
$ 962.49 |
Family |
$ 536.47 |
$1,116.81 |
$1,653.27 |
When changing carriers our programs are subject to the new carrier participation requirements. We do not anticipate any enrollment challenges, however, it is our duty to let our participants know that when changing carriers there is always the possibility of being re-rated should we not meet the new carrier’s participation requirements. |
Downloads
|
©
2003-2006 The Synod of the Pacific |
|
|
|
