Freqently Asked Questions - Insurance
Q. Are our premiums high because CoreSource is making a profit off of us?
A. No, CoreSource is a 3rd party claim administrator. They charge an amount per covered employee per month to process our claims, provide us with reports and contract a ppo network, drug network, medicare subsidy and handle our COBRA. The fee is currently $12.73 per employee per month.
Q. Why isn’t Methodist Healthcare in Memphis not in our Amco network since our Conference is one of the owners?
A. At our request, Amco has contracted with Methodist as well as some physicians. Because they are located out of Arkansas they are not shown on the www.amcoppo.com website. We are working to get this info out to you.
Q. Why has our deductible more than tripled this year?
A. That is not an easily answered question. The last 2 years we have spent more money for claims than we have collected in premiums. We have been blessed to have had a healthy reserve at the Foundation to cover these excesses. In those same years the market income on our investment has been lower than normal. The Plan has not made benefit cost saving changes since 2002 when our co-insurance decreased 10%. We cannot continue to increase premiums without changing the amount going out for claim benefits. We hope that by investing in your own health care costs you will appreciate the great benefits provided by our Conference via our Church members.
Q. Do I have to meet my deductible before any claims are paid?
A. There are many benefits available to you that do not require your annual deductible to be met such as; Wellness, Immunizations, PCP co-pays, mail-order drugs, routine vision, preventative dental and out-patient surgery.
Q. Have we considered contracting with an Insurance company such as Blue Cross Blue Shield?
A. Yes, we have. We are considered a “high risk group”. If the Plan was spending BCBS’s money rather than our own we would be guaranteed premium increases in the range of 11%- 20% and very likely would be cancelled. It would be very difficult indeed to find an Insurance Company willing to insure our older population (second career clergy, older seminary graduates, and retirees under age 65) by placing their money at risk.
Q. Do we still have vision? And if so how do I file a claim?
A. Our health plan does have routine vision: Office visit $40 paid 100%, up to $200 for glasses or contacts per person per year. On the back of your ARMET I.D. card you will find vision has been added to your coverage card CoreSource. If your physician does not file insurance mail your receipt to CoreSource for reimbursement.
Q. If we are able to contain our spending will benefits ever be added or increased?
A. Our seasoned committee strives to stay current on the health care scene today and to provide the best benefit that Conference Insurance money can buy. As our history has proven when funds are available we pass those funds on to you with benefits.
Q. I have 5 family members, do all of us have a $2000 deductible?
A. The maximum family deductible will be $6000. We used a dollar maximum rather than 3 per family which could result in the family paying more than $6000.
Q. My wife and I are retired, ages 69 and 71 respectively will we have these same changes to our Medicare supplement plan?
A. Yes and No,
B. No- Medicare is primary on your medical claims so those benefits have not changed.
C. Yes- We are primary payer on drugs. You have the same drug local pharmacy deductible, local and mail-order co-pay increases. And the 10% premium increase is across the board, Active and Retired. If the Board of Pensions provides your premium in full that increase is absorbed by our Board. You will be receiving a hard mail letter will outline retiree changes.
Claim scenarios - To assist with understanding some common insurance situations, the following scenarios have been provided.
- In January 2009 Ima Preacher, who is a full-time pastor participating in the Conference health insurance plan, went to her family practice physician because she felt she may have a sinus infection. While there she had an office visit for $150.00 and received a prescription for a z-pak. The office should collect a $30 co-pay from Ima. Since this doctor is in our Amco PPO Network they will discount the $150.00 office to $130, the $30 co-pay is credited and the $100 will be paid by Coresource with monies in our Health Trust account that consists of premium dollars we have collected. Nothing was applied to the $2000 deductible. Ima then goes to a CVS/Caremark pharmacy, presents her ARMET I.D. drug card to the pharmacist. The druggist looks on line and sees that the $100 drug annual deductible has not been satisfied. The Caremark discounted price for a z-pak generic is $25, until the $100 is met the price should be the discounted amount of $25. After the Rx deductible is met $10 would be her cost. The Conference pays the balance of $15 direct to Caremark.
- In January 2009 John Wesley wanted to start his year off right and to get his annual physical out of the way. He contacted his doctor who is in the Amco PPO Network by telephone and explained that he has a Wellness Benefit thru his employee health plan and scheduled a visit and a battery of tests. The consultation was $250.00. They checked his blood pressure, did a urinalysis and a prostate exam then ordered blood work to check his sugar levels, thyroid, and cholesterol the total was $450. The office visit was discounted to $200.00 and the lab and related care was discounted to $375.00. John would pay -0-. The Conference would pay the clinic $575.00 and John still has $625 remaining in 2009 for additional routine health checks later in the year.
- Emily and Daniel, a Clergy couple had twins born in March 2009. They chose a pediatrician not in the PPO Network. The visit for the children consisted of immunizations that cost a total of $219 each and visits that were $75 each. The Plan would pay the total cost by applying the Child Immunization benefit which has no dollar limit (other than customary physician limits). The visits would be paid under their $1200 annual Wellness benefit.
- Bobi Discipline, an Elder, was advised by his Internal Medicine Specialist that she would like to schedule an MRI for her during the month of June 2009. Bobi had only incurred mail-order pharmacy maintenance drugs that and the recent visit with his Internist and the discounted amount of $275 had been processed and applied to his annual deductible. The MRI fees included charges by the facility and the test which totaled $5969. All providers were in the network and the reduced amount was $3595. $1725 was applied to satisfy the deductible and a payment of $1496 was paid to the providers. Bobi’s responsibility will be $2374. Bobi’s church sponsors a 125 cafeteria plan and Bobi has estimated that her out of pocket in 2009 will be $8000. She submits his proof of payment to the cafeteria plan and receives reimbursement of $2374.
- Deacon Jones has her first Clergy appointment and has never used her health insurance. She also recently married. They plan to wait on starting their family for at least 3 years. Her Gyn has prescribed Seasonal as a birth control method. A generic for Seasonal, Ocella has just come on the market. Deacon Jones had her physician fax Caremark her prescription for a 90 day supply with 3 refills. Her monthly cost will be $20.
- Sally Member, spouse of an active clergy, who had not met her deductible had a seizure. Her husband called the ambulance who took her to the nearest hospital which was in our network. She was seen in ER and immediately admitted. The staff took benefit information off the back of her ARMET I.D. card and called the pre-cert number for the family. Sally stayed 3 days for observation and tests. The hospital bill totaled $98,000 for the 3 day stay. The PPO allowable was $59,000. Our Plan would deduct $2000 and $500 then pay calculate 80% of the balance $45,200. On this claim the participant total out of pocket would exceed $4000 and an additional $7,300 would be paid to the hospital. The participant responsibility would be $4,000 which they arranged to pay the hospital at $50 a month.
