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Active Member

A member, other than a retired or disabled member, who is currently enrolled for benefits coverage in the Benefits Plan and whose dues are not delinquent. Active members include members who have been approved for enrollment on a transitional participation basis during a period of unemployment or other approved leave.

Administrative Rules

Policies and rules approved by the Board of Directors of the Board of Pensions. Available on Pensions.org or by calling the Board of Pensions, administrative rules guide the practical application of the Benefits Plan and its provisions.

Affiliated Benefits Program (ABP)

The Affiliated Benefits Program is designed to meet the benefit needs of organizations for their employees who do not participate in the Traditional Program. Through this program, employing organizations can offer enrollment in Medical coverage, or Medical, Death, and Disability coverage, to lay employees and ministers not mandated by the Book of Order to be enrolled in the Benefits Plan. An employer may impose an employee contribution towards the cost of medical benefits of up to 50 percent of the dues. Employing organizations may also offer optional programs available through the Board of Pensions.

Beneficiary

The receiver of benefits. For certain benefits under the Benefits Plan, a member may designate an individual to receive the benefit after the member's death. The Board must have a signed beneficiary designation form on file for benefits to be paid to a beneficiary.

Benefits Plan of the Presbyterian Church (U.S.A.)

The integrated benefits program of the Presbyterian Church (U.S.A.). The Traditional Program under the Benefits Plan consists of four core coverages — pension, medical, death, and disability — as well as four optional benefits: the Optional Dental Program, Retirement Savings Plan, Supplemental Death Benefits Program, and Optional Supplemental Disability Program. The Affiliated Benefits Program, which may be offered to those who are not covered through the Traditional Program, consists of medical coverage only or medical, death, and disability coverage.

BoardLink

An online payment system that helps churches, employing organizations, and individuals pay Board of Pensions invoices quickly and easily.

Book of Confessions

A volume of historic confessions of the Christian Church, selected for inclusion by the General Assembly to reflect the historic traditions of the Church and the Reformed Tradition. This volume is Part I of the Constitution of the Presbyterian Church (U.S.A.); the Book of Order is Part II.

Book of Order

Part II of the Constitution of the Presbyterian Church (U.S.A.), which includes Form of Government, Directory for Worship, and Rules of Discipline. Part I is the Book of Confessions.

Call

Under Presbyterian polity, a "call" is the terms of the formal relationship between a pastor or a Certified Christian Educator and his or her church, as approved and recorded in the presbytery minutes. 

Called and Installed Pastors

Under Presbyterian polity, there are two types of pastoral relations that may exist between a particular church and a minister of the Word and Sacrament: installed (permanent or designated) (pastor or associate pastor) or temporary relations (stated supply, temporary supply, organizing pastor, interim pastor and others).  Installed pastors are mandated by the Book of Order (G-14.0534) for full participation (pension, death and disability, and medical) in the Benefits Plan. 

Certificate of Creditable Coverage

A certificate that an employer or health plan is required to provide to any employee whose medical coverage is terminated for any reason. It indicates the dates of coverage of the employee and his or her dependents under that employer's coverage. The certificate is presented to an employee's subsequent employer or health plan to prove continuous medical plan coverage and avoid the exclusion of coverage for pre-existing conditions.

Christmas Joy Offering

One of the four special offerings designated by the General Assembly of the Presbyterian Church (U.S.A.) to provide congregations with direct ways of helping those in need. Fifty percent of the receipts of the Christmas Joy Offering are distributed to the Board of Pensions for the Assistance Program, which provides support to active and retired church workers and their spouses and families. The other fifty percent supports Presbyterian-related racial/ethnic education through the National Ministries Division of the General Assembly Council.

Churchwide Median Salaries

Based on salary information reported to the Board of Pensions, the Board annually determines the median salaries for each employment classification. The appropriate median salary is used to calculate pension credits and minimum death and disability benefits for all members paid below the median in each classification.

Commissioned Lay Pastor

A commissioned lay pastor is an elder of the Church who is granted a local commission by the presbytery to lead worship and preach the gospel, and watch over the people and provide for their nurture and service. A presbytery may authorize a commissioned lay pastor to perform certain functions including the administration of the Lord's Supper (Communion) or the Sacrament of Baptism, moderation of the session, and performance of a service of Christian marriage (when allowed by the state).

Community Nature of the Plan

Traditional coverage under the Benefits Plan is based on the Christian premise that we are a community of faith. The system for funding the Plan is designed to share the burden equitably among all employing organizations and members by basing dues and benefits on the effective salary for each participating position.

Coordination of Benefits

Refers to a second plan paying part of a medical claim. Under a traditional "coordination of benefits" standard, the second plan pays up to 100 percent of the remaining unpaid eligible charges; under a "maintenance of benefits" standard, the second plan pays only the amount necessary to make the reimbursement equivalent to what would have been paid had the second plan been the sole coverage available to the participant. The Benefits Plan applies a maintenance of benefits standard to the claims of members (other than member couples) and their eligible family members and a coordination of benefits standard to member couples and their eligible family members. (See also Maintenance of Benefits).

Copay

The fixed amount that Plan members pay for each office visit related to medical or surgical care: $25 for primary care physicians and $35 for specialists. Copays do not count towards the fulfillment of individual or family deductibles, or towards the copayment limit. 

Copayment

Portion of the covered medical expenses that the member must pay after meeting the Plan deductible. Generally, copayments are 20 percent of the UCR allowance, up to the copayment limit.

Copayment Maximum

The maximum amount a Plan member must pay in copayments in any year toward the cost of medical expenses cover under the Plan. Except for deductibles and the fixed copay a member pays for an office visit, the portion of eligible medical expenses the member pays accumulates until the copayment maximum is reached. There are separate copayment maximums for healthcare services (including medical/surgical services and mental health/substance abuse treatment) and prescription drug expenses.

Death Benefit Basis

The greater of the member's annual effective salary (up to the maximum compensation allowed by the IRS for qualified plans--$245,000 in 2010) or the annual churchwide median salary for his/her employment classification. 

Deductible

The amount an employee has to pay in any year before the Benefits Plan starts to pay for healthcare services. There is a separate deductible for the Plan member and a second deductible that applies to all eligible family members for covered healthcare services, including medical, surgical, mental health, and substance abuse services.

Defined Benefit Plan

A type of retirement plan which provides a pension benefit monthly to a participant for life, based on a definite formula. The Pension Plan is a defined benefit plan that pays benefits for the life of the member and his or her eligible survivors (an eligible spouse and/or minor children). In a defined benefit plan, the plan assumes the investment and longevity risks and makes up any shortfall from its reserves.

Defined Contribution Plan

A retirement plan that provides an individual account for each participant. Benefits are based solely on the amount contributed to the participant's account plus any investment earnings, expense, gains and losses that may be allocated to the participant's account. At retirement, the account balance is available for distribution. In a defined contribution plan, the participant assumes the investment and longevity risks; the value of the benefit fluctuates with economic conditions. The optional Retirement Savings Plan, a 403(b)(9) plan administered by the Board of Pensions, is an example of a defined contribution plan.

Dental Maintenance Organization (DMO)

An alternative delivery system where the purchaser pays a predetermined, fixed monthly fee to an organization that provides or arranges for a wide variety of dental services, usually with limited copayment or deductible costs required of the member (patient).

Disability (Disabled)

A Plan member is considered disabled for purposes of disability benefits if he or she is certified by the Board's medical counsel as being unable to perform his or her regular work duties (or any other work providing a reasonably comparable income) due to sickness or bodily injury. After 24 consecutive months of such disability, the member is still considered disabled if, due to sickness or bodily injury, he or she cannot perform any type of work for which he or she is fit by education, training, or experience. The Board's medical experts must certify all member disabilities and continuing disabilities.

Disease Management

An integrated wellness and disease prevention approach targeting individuals who are or may become at risk for certain chronic conditions. The disease management programs offered by the Board of Pensions use educational and prevention initiatives, careful monitoring techniques, patient self-care, and evidence-based clinical practice guidelines to improve outcomes and reduce costs for patients with chronic diseases.

Dues

Each employing organization's representative share of the total cost of the Benefits Plan. Dues are not related to the benefits paid to individual members; rather, they represent an equitable distribution of the total cost of the Plan among the various participating organizations. The dues for members with Traditional coverage are determined on the basis of effective salary (see also Effective Salary).

Effective Salary

Effective salary is any compensation paid during a Plan year to a Plan member by an employing organization; it is used to determine pension credits earned by the member, death and disability benefits, medical deductible and cost-sharing requirements, and dues paid by the employing organization. Effective salary includes sums paid for housing (including utilities and furnishings) allowance and deferred compensation (funded or unfunded) provided to a member by an employing organization during a Plan year. Other employer-provided group benefits and employer matching contributions to the Retirement Savings Plan are not included in effective salary.

Employee Assistance Program (EAP)

A service, program, or set of benefits designed to help members and their families with personal or family problems, including mental health, substance abuse, gambling addiction, marital problems, parenting problems, emotional problems, or financial pressures, so that they may continue to be effective on the job. Through CIGNA Behavioral Health, the Board offers an Employee Assistance Program to all active Plan members.

Employing Organization

Any organization within or related to the Church that employs personnel to carry out its ministry. Employing organizations of the PC(USA) include agencies, governing bodies, churches, seminaries, the Board of Pensions, etc.

Employment Classification

Employment classifications for the Benefits Plan are ordained, lay exempt, lay non-exempt. Exempt and non-exempt classifications are based on the wage and hour terms as defined by the Department of Labor. For additional information, visit the U.S. Department of Labor Web site.

Experience Apportionment

A discretionary amendment to the Pension Plan granting an increase in the accrued Pension Plan benefits of each member, whether active or retired, for as long as the member lives. When granted, it permanently increases active members' accrued pension credits and thus future retirement income, and provides retired members and survivors with a permanent percentage increase in their payments. When deciding to grant experience apportionments, the directors of the Board of Pensions consider any increase in the cost of living, investment and actuarial experience, level of reserves, and questions of fundamental fairness to all participants in the Plan. There is no guarantee that an experience apportionment will be made every year.

Flexible Spending Account (FSA)

A plan that provides employees a choice between taxable cash and non-taxable benefits for unreimbursed healthcare expenses or dependent care expenses. Flexible Spending Accounts can be funded through salary reduction, employer contributions, or a combination of the two. Such a plan qualifies under Section 125 of the IRS Code. (See also Medical Spending Account.)

Formulary

A list of prescription drugs that are preferred by the Plan because of favorable pricing and are dispensed by participating retail and mail order pharmacies. This list is subject to periodic review and may be changed by the Plan. Issued each year by Express Scripts, the Plan's pharmaceutical benefits plan manager, the formulary includes therapies for all conditions, all generics, and has an appeal process for approval of non-formulary medications when clinically established to be medically necessary.

Full Participation

Enrollment in all core components of Traditional coverage in the Benefits Plan: pension, medical, death, and disability coverage.

403(b)(9) Plan

A retirement income account that provides a defined contribution retirement income benefit for ministers and church employees. The Retirement Savings Plan of the Presbyterian Church (U.S.A.) is a 403(b)(9) plan. The "(9)" means it is a church retirement income account.

14-09 Clergy Couple

A 14-09 Clergy Couple consists of two part-time ministers married to each other and serving the same church in a pastoral relationship. ("14-09" refers to the General Assembly referral that resulted in the Board's adoption of the rule.) 14-09 Clergy Couples are eligible for special enrollment rules under which only one of the clergy couple members is enrolled in the Medical Plan; the other member is covered as a spouse under the family coverage provisions. (See Administrative Rule 123.)

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The 1996 federal statute that, among other things, limits the ability of a health plan to exclude coverage for pre-existing conditions. Title II of HIPAA mandates the use of uniform electronic transaction standards and sets standards for the privacy and security of individually identifiable health information maintained by healthcare providers and health plans.

Health Maintenance Organization (HMO)

A medical plan (generally prepaid) that provides a comprehensive and predetermined medical care benefit package, usually with limited copay or deductible costs required of the member (patient).

Housing Supplement

A type of financial assistance paid in monthly installments by the Assistance Program to eligible retirees or their surviving spouses to help with their housing-related expenses. Retirees or surviving spouses who have served the church for a certain number of years, whose total retirement income from all sources is below a level determined annually by the Board of Pensions, and whose total assets are below specified levels related to their living situation (independent, congregate, or assisted living) are eligible.  

Inactive Member

Refers to a member who is not currently enrolled for coverage in the Benefits Plan (or who is enrolled but whose dues are delinquent) and who has not started his or her pension. An inactive member with vested pension credits in the Pension Plan is sometimes also referred to as a "terminated vested member."

Income Supplement

A type of financial assistance paid in monthly installments by the Assistance Program to eligible retirees or their surviving spouses whose total retirement income from all sources falls below a target level determined each year by the Board of Pensions.

Joint and Survivor Options

By electing one of these pension payment options at retirement, a married member may provide a larger benefit for the surviving spouse after the member's death; pension payments to the member are reduced to pay for the enhanced survivor protection.

Limited Participation

A form of enrollment under the Traditional Program of the Benefits Plan in which the member is enrolled in the Medical, Death, and Disability plans, but not in the Pension Plan. Such limited participation is only allowed for the first three years of coverage.

Living Needs Benefit

A Benefits Plan provision that allows members of the Plan with death and disability coverage who are terminally ill to apply for advanced payment of part of their death benefits under the Plan.

Maintenance of Benefits (MOB)

A form of the coordination of benefits provision (when medical coverage is available from more than one source) under which the combined reimbursement from both plans is limited to the total amount the more generous plan would have paid, if no other coverage were available. It is also referred to as "integrated coverage." The Benefits Plan coordinates benefits on an MOB basis, except for member couples.

Maximum Medical Participation Basis

Maximum Medical Participation Basis is established each year for the purpose of determining dues, deductibles, and copayment amounts for medical coverage. The present Maximum Medical Participation Basis is equal to 200 percent of the pastors' median, the annual churchwide median effective salary of pastors serving churches.

Medically Necessary

The Medical Plan covers medical services and supplies that the Board determines are medically necessary, of demonstrated medical value, not experimental or investigational in nature, the most appropriate standard or level of care in accordance with sound medical practice, and appropriate for the symptom or medical condition of the patient.

Medicare

Administered by the Social Security Administration, Medicare is the U.S. federal government plan that pays for certain hospital and medical expenses for those who qualify, primarily persons age 65 and over. Medicare Part A is a basic plan covering hospital and related care. Medicare Part B is a voluntary supplementary plan covering the doctor's bills and other costs of medical and health services. Medicare Part C – Medicare Advantage – offers full replacement for Parts A, B, and D, generally through an HMO. Medicare Part D is an optional prescription drug plan.

Member Couple

Any two active members of the Benefits Plan who have Traditional coverage and are legally married to each other. Member couples may consist of two ministers, two lay members, or a lay member married to a minister of the Word and Sacrament.

Minimum Medical Participation Basis

Minimum Medical Participation Basis is established each year for the purpose of determining dues, deductibles, and copayment amounts for medical coverage. The present Minimum Medical Participation Basis is equal to 65 percent of the pastors' median, the annual churchwide median effective salary of pastors serving churches.

Minimum Pension Participation Basis

Established each year for the purpose of determining dues for pension and death and disability coverage. The Minimum Pension Participation Basis is 25 percent of the pastors' median.

Network Area

A geographic area where the Medical Plan, or its designated claims administrator, has agreements with a PPO or other managed-care organization relating to the fees charged by network providers for services to members and their eligible family members. Members may choose to use network or out-of-network providers. 

Network Provider

A hospital, physician, or other healthcare provider that has an agreement with a PPO or other managed-care organization with which the Medical Plan, or its designated claims administrator, has contracted to provide services to members and their eligible family members at negotiated rates.

Non-Network Area

A geographic area where access to network providers through the PPO or other managed care organization with which the Medical Plan, or its designated claims administrator, has contracted does not meet the access criteria. 

Non-Network Provider

A provider who does not participate in a network offered by the Medical Plan and who provides services or supplies in a non-network area to a member or an eligible family member. (See also Non-Network Area.)

Out-of-Network Provider

A provider in a network area that does not participate in the networks offered by the Medical Plan, or its designated claims administrator. (See also Network Area.)

Post-Retirement Service

Board-approved service that does not cause a temporary suspension of retirement benefits after a member retires. The member does not accrue pension credits during such service. Post-retirement service dues of 12 percent are assessed to the employing organization on temporary pastoral positions of 20 hours or more filled by retired ministers.

Pre-existing Condition

Under the Medical Plan, a pre-existing condition is a physical or mental condition for which a member or eligible family member received a diagnosis, medical advice, treatment, or medication, within six months immediately preceding enrollment in the Plan ("the look back period"). The Plan will not cover medical costs relating to a pre-existing condition for the first 12 months of Plan enrollment ("the coverage limitation"). In accordance with the provisions of HIPAA, as of October 1, 1997, the length of the coverage limitation is reduced by the number of months the patient had continuous coverage prior to enrollment, as long as any gap in coverage is no more than 63 days.

The Disability Plan also has a pre-existing condition exclusion. No disability benefit will be paid to a member for any disability arising during the first 12 months of a member's coverage under the Disability Plan from a condition (physical or mental) for which a member received a diagnosis, medical advice, treatment, or medication within the 12-month period immediately preceding the date of the member's enrollment for Disability Plan coverage.

Preferred Provider Organization (PPO)

Groups of physicians, hospitals, and other provider groups who contract to offer fixed discounted prices in return for patient volume and rapid payment. Highmark Blue Cross Blue Shield participates in nationwide networks of physicians and hospitals available to members of the Benefits Plan. Aetna offers networks of dental care providers to members enrolled in the Optional Dental Program.

Qualified Life Change Event

A Qualified Life Change Event is an event that gives a member the opportunity to make a change to their benefit enrollments and the dependent coverages related to the event. Examples of Qualified Life Change Events are a change in marital status (e.g., marriage or divorce), change in dependent status (e.g., birth, adoption, or legal guardianship), change in spouse's benefits, change in dependent eligibility (e.g., change in full-time student status, removal of legal custody of a dependent, the death of a spouse or dependent, among others), change in service (new service).

Note: The Board must receive notification of the change through Benefits Connect or in writing within 31 days from the date of the Qualified Life Change Event.

Retirement Ages

Normal Retirement: age 65.
Early Retirement: after attaining age 55; the benefit is reduced for all pensions beginning before age 65.
Post-Normal Retirement: after attaining age 65; the benefit is increased for all pensions beginning after age 65.

Shared Grants

An assistance program designed to help active and retired church workers and their spouses with special financial needs or in emergency situations. A shared grant must be recommended by a governing body or an employing organization of the Church that is willing to financially share in the grant with the Board. Application is made through the governing body or employing organization.

Social Security Leveling Option

Members who retire between the ages of 55 and 62 may choose this option, which allows them to receive adjusted pension benefits so that their total income is consistent before and after receiving Social Security benefits at age 62. Under this option, the member's pension benefit is temporarily increased from retirement until age 62, when the Plan benefit permanently decreases by the amount of the estimated Social Security benefit.

Summary Plan Document (SPD)

A booklet that explains the provisions of a benefits plan, such as the Medical Plan. Intended as a reference tool, an SPD provides full descriptions of coverage terms and details of a specific plan. To obtain an SPD, click on "Forms and Publications" at Pensions.org or call the Board of Pensions.

Survivor's Pension Benefit

If a member who has vested pension credits dies, the Benefits Plan pays a lifetime survivor's pension to the spouse or other eligible dependent(s). The normal survivor's pension equals one-half of the pension credits earned up to the date of death.

Traditional Program

The Traditional Program (or coverage) of the Benefits Plan consists of four core coverages: Pension, Medical, Death, and Disability. Employing organizations are required to enroll mandated members and may enroll other active members for full or limited participation in the Traditional Program. (See Full Participation; see also Limited Participation.) Employing organizations may also enroll members in any of four optional benefits: the Optional Dental Program, optional Retirement Savings Plan, Supplemental Death Benefits Program, and Optional Supplemental Disability Program.

Transitional Participation Basis

A coverage status provided at the sole discretion of the Board to a Traditional Program member if he or she is certified by his or her former employer or presbytery as:

• currently unemployed but actively seeking church employment
• enrolled for full-time church-related studies, or
• subject to a disciplinary process that lead to a temporary leave or unemployment.

On this status, a member may, by paying the required dues, continue the same Benefits Plan Traditional Program coverage (except for Optional Dental Benefits) for a period of time determined by the Board.

UCR (Usual, Customary, and Reasonable) Allowance

The usual, customary, and reasonable charge (UCR) for particular medical procedures, services, or supplies based on the rates that comparable medical care providers in the same or neighboring communities are willing to accept for the same services. The UCR rates are set by the Board, in its sole discretion, as the reasonable charge to be reimbursed for services provided by healthcare physicians and providers who have not contracted with the network administrator for a fixed fee schedule. 

Utilization Review (UR)

Process of comparing the appropriateness and quality of recommended care with evidence-based best practices. Includes inpatient care, including pre-admission screening (pre-certification), continued stay review, discharge planning, and retrospective review; and, second surgical opinions, case management, bill auditing, and pre-certification for certain diagnostic tests.

Vacancy Dues

During the first 12 months of a vacancy in an installed position at a church, dues shall be paid by the church at the rate of 12 percent of the Pension Participation Basis of the most recent minister who occupied the ministerial position that has become vacant. Vacancy dues are used by the Board to subsidize the cost of the Medicare Supplement for its participants, retired Plan members, and their spouses.

Vesting

Refers to a nonforfeitable right to a pension benefit. Once a Pension Plan member completes three years of eligible service, the member has a non-forfeitable (vested) right to the pension benefit earned to date even if the member leaves the service of the Church before retiring. Thus, even if a vested member leaves eligible service before retirement, that member is still eligible to receive a monthly retirement pension from the Benefits Plan when he or she satisfies the requirements to retire and applies for the benefit. Full-time attendance at seminary also counts towards vesting for ordained ministers.