Married members who are both enrolled in the Medical Plan PPO option are considered a member couple and may receive enhanced medical benefits. Out-of-pocket obligations are lower; neither member has a copay requirement for network and non-network office visits, and children do not have to meet a deductible.
Members may have any combination of Pastor’s Participation and/or menu options to have member couple status as long as they are both enrolled in the PPO option.
Following are scenarios that meet member couple status:
- Both members are in Pastor’s Participation.
- One member is in Pastor’s Participation, and one member is in menu options; the member in menu options elects, at minimum, Member-only coverage.
- Both members are in menu options, with no eligible children; one member elects Member + Spouse; the other, at minimum, Member-only.
- Both members are in menu options, with eligible children; one member elects Member + Family; the other, at minimum, Member-only.
Member couple status continues if
- one member is eligible for and enrolls in the PPO option through transitional participation;
- one member becomes disabled, member couple status may be maintained for up to three years or until the disabled member turns 65, whichever occurs first; or
- one member dies, the surviving member retains member couple status for one year.
If both members are eligible for menu options, and one spouse waives medical coverage, opting to receive medical coverage under the other’s Member + Spouse or Member + Family coverage, they will not qualify for member couple status.
Note: If two clergy members are part-time and share one position at the same church, they are considered a 14-09 couple. Only one spouse in a 14-09 couple is enrolled as the member for medical benefits; the other is enrolled as the spouse. Each spouse is enrolled for pension and death and disability coverage. 14-09 couples are not eligible for member couple status.