Care navigation is available to members enrolled in the PPO, EPO, and HDHP as part of their medical benefits. When these employees have a question about medical or prescription drug benefits, Quantum Health's Care Coordinators are just a call, click, or tap away.
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.
All three medical coverage options include unique features that deliver outstanding value in promoting wholeness and well-being, at no addition cost to employers. 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.
Care navigation, provided in partnership with Quantum Health, helps make it easier for members to navigate today’s complicated healthcare system. When a member calls Quantum Health, a highly trained Care Coordinator serves as their personal healthcare guide, identifying healthcare needs, resolving issues, and providing personalized support.
Pharmacy benefits, offered through our partnership with Express Scripts, include a robust preventive drug list and reduced out-of-pocket costs when using drugs on this list. 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 Plan, managed by Cigna, supports members' emotional and financial health and work/life balance 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.
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. 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.
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.
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.
Employers may offer either the PPO, the EPO, or the HDHP; any two options; or all three.
Employees elect coverage in levels:
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
Medical coverage costs are based on claims experience adjusted for regional and demographic factors.
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.
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.
Highmark Blue Cross Blue Shield 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.