Medical continuation

Medical continuation coverage gives you and your eligible family members the option to continue medical coverage when it would otherwise end; for example, your employment ends or you retire before age 65.

How it works

If your medical coverage through the Board of Pensions is ending, enrolling in medical continuation coverage enables you to keep the same coverage you have now — PPO,* EPO, or HDHP — but on a self-paid basis and for a limited time.

You may be eligible to enroll in medical continuation coverage if you are

  • a member who is terminating employment or whose hours are reduced resulting in a loss of eligibility for coverage;
  • a seminary student or an individual on transitional participation status who is terminating from the Benefits Plan;
  • a disabled member whose disability status is ending;
  • a member who is retiring before age 65;
  • a covered child who is reaching age 26; or
  • a surviving or former spouse.

*If enrolled in medical continuation coverage under the PPO, your deductible and medical copayment maximum are based on the congregational ministers median ($60,800 in 2020).

Early retirement

If you retire before age 65, you may be eligible to enroll in the Medicare Supplement Plan once you are eligible for Medicare if you meet the Rule of 70 and maintain continuous coverage under a qualified health plan. Medical continuation coverage may satisfy the continuous coverage requirement for future enrollment in the Medicare Supplement Plan

You may have other options, including any plan on the federal Health Insurance Marketplace or a state’s health insurance exchange, that will satisfy the continuous coverage requirement to enroll in the Medicare Supplement Plan at age 65 (assuming you are eligible). For more information, call the Board at 800-773-7752 (800-PRESPLAN).

Duration of coverage

How long you may continue coverage depends on why your current medical coverage is ending and whether you meet the Rule of 70, as shown on the Medical continuation eligibility and duration chart. Typically, medical continuation coverage for terminated members lasts up to 18 months. Children who lose their eligibility at age 26 (or later, if disabled) may elect medical continuation coverage for up to 36 months.

If you are a pastor or graduated seminary student on transitional participation status, you may continue medical benefits for an additional 18 months after you reach your maximum eligibility for transitional participation coverage by enrolling in medical continuation coverage. If you enroll in medical continuation coverage first, you will not be eligible for transitional participation coverage.

Cost

The cost for medical continuation coverage starts on the day the coverage becomes effective. Monthly rates for 2020 for medical continuation coverage are as follows*:

​Coverage level​PPO​EPOHDHP
​Member-only​$955​$812​$750
​Member + Child(ren)​$1,481​$1,259$1,163
​Member + Spouse​$1,941​$1,650$1,524
​Member + Family​$2,644​$2,247$2,076

*Rates shown are for medical continuation coverage through Highmark. For continuation coverage through Aetna, contact the Board for costs.

How to enroll

You must enroll for medical continuation coverage within 60 days of the event that caused your coverage to end. If you do not enroll when you are first eligible, you will not be able to enroll later. You must enroll in the same option (PPO, EPO, or HDHP) and coverage level (Member-only, Member + Spouse, Member + Child(ren), or Member + Family) for medical continuation coverage that you had while working for the Presbyterian Church (U.S.A.) or an affiliated employer.

To enroll, return the completed personal information, subscription, and authorization sections of the Medical Continuation Enrollment or Waiver form to the Board, with the initial payment, within 60 days of the event that resulted in termination of your coverage under the Medical Plan. Your continuation coverage begins immediately following any applicable coverage period in which coverage is provided at no cost to you.

Your covered spouse and children may enroll in medical continuation coverage, even if you do not.

Continuous coverage waiver

If you retire before age 65 and you and/or your spouse choose other qualified health coverage instead of medical continuation coverage but you wish to preserve the right to enroll in Medicare Supplement when the other coverage ends, you must officially waive medical continuation coverage.

Canceling coverage

You may cancel your medical continuation coverage by sending a written cancellation request in advance of the date your coverage would end to

The Board of Pensions of the Presbyterian Church (U.S.A.)
Attn: Plan Operations
2000 Market St.
Philadelphia, PA 19103-3298

The Board must receive your request at least one month in advance of the date you want the coverage to end.

Important: If you cancel your medical continuation coverage, you cannot reinstate it.