Medical Plan

The Medical Plan offers employers the choice of three coverage options — all of which deliver outstanding value to you and your employees and include high-value features that promote wholeness and well-being.

The Medical Plan offers flexibility and affordability to employers with the choice of three coverage options:

Each option delivers high-quality coverage and outstanding value, with features not readily found on the commercial market.

The Board of Pensions partners with Highmark for network and claims administration. Employees enrolled in the Medical Plan have access to the Blue Cross Blue Shield network of physicians, hospitals, and other healthcare providers.

Commitment to wholeness and well-being

All three medical coverage options include high-value features at no additional cost to you or your employees, demonstrating our commitment to our members’ wholeness and well-being. These features include the following:

 

Generous preventive care benefits exceed Highmark’s standards and Affordable Care Act requirements, and include an annual wellness exam, well-baby visits, specified screenings, immunizations, blood tests, and more.

 
Pharmacy benefits, offered through our partnership with OptumRx, include a robust preventive drug list and reduced copays for select prescription drugs. Additionally, certain medications are offered in multiple tiers; members can lower out-of-pocket costs when using a lower tier.
 
Call to Health, our online well-being program, focuses on four overall aspects of wholeness: spiritual, health, financial, and vocational. Participating members can significantly lower their annual deductibles in the following plan year and may be eligible to receive gift cards for completing challenges.
 
Teladoc is a telemedicine feature that allows members 24-hour access to consultations with licensed physicians via voice or video call for a reduced cost. Physicians may also prescribe medications over the phone for added convenience. 

Employee Assistance Program, managed by Cigna, supports members’ emotional and financial health through a range of confidential services, including counseling sessions, legal and financial consultations, immediate assistance with critical emotional needs, and more. 

Centers of Excellence are providers that meet both quality and cost-efficiency standards. Patients receive reduced-cost access to medical facilities proven to deliver superior results for complicated, costly surgical procedures, including bariatric surgery, transplants, knee and hip replacements, and spinal surgery. 

Livongo for Diabetes Program combines the latest technology with coaching to help members living with diabetes manage their condition. Participants receive an advanced glucose meter, unlimited test strips, and access to a Certified Diabetes Educator.

Return on value and pricing stability

As a nonprofit organization, the Board of Pensions is able to pass along greater value per dollar to our participating employers than can be found commercially. An example of this is the Medical Plan's 87 percent gross revenue-to-claims ratio. Backed by strong operating reserves, we have demonstrated significant year-over-year pricing stability for employers. Additionally, our high-cost claims fund insulates employers from risk.

The Board of Pensions is a leader in the Church Benefits Association and contracts for all medical coverage as part of the association's purchasing coalition, which includes dozens of other denominations. Having such power in numbers — nearly 200,000 faith communities — results in the ability to negotiate lower administrative costs and highly favorable contract terms. We pass along any savings we receive to our employers.

Community nature

As a reflection of the community nature that underlies our Benefits Plan, the Medical Plan is designed to promote shared responsibility for healthcare costs — gains and losses are shared across the total population of employers participating in the Medical Plan in the form of standard rates, adjusted for age and regional cost factors. In the PPO coverage option, deductibles are income-sensitive, so members with higher salaries pay more to help support those who earn less.

A culture and tradition of service

Our in-house customer service team is staffed by highly trained representatives who provide caring, thoughtful guidance to employers and plan members. Read more about the administrative resources and personalized service support we provide.

Cost of coverage

Employers may offer either the PPO, the EPO, or the HDHP; any two options; or all three.

Employees elect coverage in levels:

  • Member-only
  • Member + Spouse
  • Member + Child(ren)
  • Member + Family

As the employer, you must contribute at least 50 percent of the cost of Member-only coverage in the lowest-cost option offered — regardless of which option or coverage level the employee elects.

Employees may be required to pay

  • the balance of the cost for Member-only coverage; and/or
  • up to 100 percent of the incremental cost of coverage for their eligible family members.

Read more details about medical coverage costs for employers.

Interested in offering medical coverage?
Here's what to do next.

For current employers

If you currently offer benefits through the Benefits Plan of the Presbyterian Church (U.S.A.), you may elect this benefit when you update your Employer Agreement on Benefits Connect for the following year. Employer Agreements are usually available for updating July through October.

For new employers

If you do not currently offer benefits through the Benefits Plan and would like to learn more about its features and how the Board of Pensions serves employers, call our Employer Services team at 800-773-7752 (800-PRESPLAN) to discuss how we can best meet your and your employees' needs.

About Highmark

Highmark Inc. is a national, diversified healthcare partner that serves members across the United States. Highmark, and its affiliates, operate health insurance plans that serve more than 21 million members. The company is among the top 10 largest health insurers in the United States.