1. Healthcare

2014-2015
The Seminary
Student Option
of the Concordia Health Plan
Broad Coverage and Great Value for Students and their Families
The preferred health plan of
most LCMS employers ...
This is your overview
The Concordia Health Plan provides peace of mind
of the Seminary
We are pleased to offer the comprehensive benefits of the Concordia Health Plan (CHP)
to our students. Although the cost is comparable with other insurance plans, the CHP
covers so much more:
Student Option of
the Concordia Health
Plan—Option CSS.
Good health is a blessing we
want everyone in our church
to enjoy — including those
preparing for a life of service in
The Lutheran Church — Missouri
Synod (LCMS).
Students at Concordia
Seminary and Concordia
Theological Seminary have the
same comprehensive health
coverage enjoyed by workers
throughout the LCMS.
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• Medical care, including preventive services,
well-child care, and routine exams
• Dental care
• Prescription drug coverage
• Mental health and substance abuse care
• An employee (student) assistance
program
• Health and wellness programs
• Vision care
• Discounts on hearing care
We offer you these benefits not only to protect you against the financial burden of
illness and serious injury, but also to help you and your loved ones enjoy the best
of health.
The Concordia Health Plan enrollment guidelines
All students in residential programs taking seven credit hours or more are required to
have health coverage while attending school. Coverage is also required during vicarage,
internship, foreign study, and for residential S.T.M. and Ph.D. students carrying six or
more credit hours, full-time residential students working on a dissertation or preparing
for exams, and international students. Students’ spouses and dependent children are
also eligible for coverage.
Students may opt out of the CHP only if covered under another health plan, as
described below:
• A spouse’s group health plan (coverage by virtue of employment, including military
service)
• A parent’s group health plan (coverage by virtue of employment, including military
service)
• A former employer’s group health plan
• A current, non-LCMS employer’s group health plan
• A military retiree health plan
• A Medicare supplemental plan
• A governmental medical assistance program for low-income persons (e.g., Medicaid)
• A foreign country plan while studying outside the United States
• A group health plan of an LCMS employer located in the state of Hawaii
• Healthcare coverage through a Health Insurance Marketplace made available by the
Affordable Care Act.
...is also your health plan.
Transition of care for new members and dependents
If you or your family members are currently receiving medical treatment
under a different health plan, we will work with you to ensure that care
continues once you are enrolled in the CHP.
If your current care provider is a member of the Blue Cross Blue Shield network, you can receive network benefits. Once your CHP coverage is effective, be sure to tell your doctor that your plan has changed and present your
new ID card. Also, provide the Blue Cross Blue Shield phone number (800793-6922) so that your doctor can verify your benefits.
If you are currently receiving care from a provider not in the Blue Cross
Blue Shield network, call Blue Cross customer service at 800-793-6922 for
assistance in creating a transition plan.
Exceptional coverage now and in the future
The CHP brings together companies known for providing high levels of customer service: Blue Cross Blue Shield for medical benefits; Cigna for mental
health and substance abuse care, dental benefits, and wellness programs;
Express Scripts for prescription drug benefits; and Vision Service Plan for vision care.
By joining the CHP now, you and your family can take advantage of the
many benefits these programs offer—and maintain those benefits after
graduation.
You may continue your CHP coverage for up to 15 months after you or your
eligible family members no longer qualify for the seminary student option of
the CHP.
If you accept a call or take a job with an employer that offers the CHP and
there is no lapse in coverage, your coverage will continue without interruption, and any amounts you’ve paid toward your deductible or coinsurance
maximum during the current calendar year will be carried over.
Coverage starts the first day of
the month that classes begin.
Students and their eligible family members
who are already enrolled in the CHP do not
need to re-enroll for the 2014-2015 plan
year. New and existing students who are
enrolling themselves for the first time will
need to complete the enclosed Seminary
Student Enrollment Form. Those enrolling new dependents or making changes to
their existing coverage will need to submit
a Seminary Student Open Enrollment
Form, Seminary Student Special Enrollment Form, or Seminary Student
Request for Membership Change Form
depending on your situation. You will find
these forms at www.ConcordiaPlans.org
under Who Am I? > Student > Seminary
Students.
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Concordia Health Plan Advantages
for Seminary The Concordia Health Plan
delivers benefits and value for
today’s seminary students and
their families.
The Concordia Health Plan is:
Comprehensive.
Under the CHP, students and their families have access to a broad range of benefits, including 100%
coverage for preventive care services. The plan also
covers prescription drugs, as well as dental, vision,
hearing, mental health, and substance abuse services.
It provides a variety of health and wellness programs,
too.
Portable with an LCMS employer.
Following seminary, if you accept a call or take a job
with an employer that offers the CHP, your coverage may continue without interruption. Any amount
you’ve paid toward your deductible in that calendar
year will carry over as well, provided there is no break
in coverage.
Available post-seminary.
Coverage for students and eligible family members
may be extended up to 15 months following graduation in the event employment with an LCMS employer does not begin right away.
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Students
Guaranteed.
All eligible seminary students and eligible family members, regardless of age, gender, or health
status, are guaranteed coverage through the CHP.
Family-friendly.
Enrolled dependent children can remain enrolled
until age 26. Also, should the need arise, surviving
dependent spouses and children would be eligible to
purchase extended coverage through the CHP.
Fair for all.
The CHP costs are based on “community rating,” so
your contribution rates do not fluctuate on the basis
of age, gender, or health status.
Responsive.
You’ll find a wealth of information and helpful
resources online at www.ConcordiaPlans.org.
If you have questions about your plan, select
“Contact Us” on the website to send us an e-mail.
Or you can call us toll-free at 888-927-7526,
Monday–Friday, 7 a.m.–5 p.m., Central Time. We’re
here to help you!
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Option CSS
NETWORK
Medical Benefits Administered
by Blue Cross Blue Shield of
Minnesota 800-793-6922
NON-NETWORK
Plan Year Deductible
$500 per person; $1,000 per family
$1,000 per person; $2,000 per family
Coinsurance
80%
60%
Plan Year Coinsurance Maximum
$3,000 per person; $6,000 per family
$7,000 per person; $14,000 per family
Preventive Care
100%
Not covered
Primary Care Physician Office Visit Copay
$25
$50
Specialty Physician Office Visit Copay
$25
$50
Inpatient Hospital Coinsurance
80% after deductible
60% after deductible
Outpatient Hospital Coinsurance
80% after deductible
60% after deductible
Emergency Room Copay
$100 (no copay if admitted into hospital)
Retail Pharmacy Short-term Drugs
(up to 30-day supply)
Home Delivery for Maintenance/
Long-term Drugs*
(90-day supply)
*See details on pg. 6
Generic Drugs
$10
$20
Formulary Brand Drugs
$25
$50
Non-formulary Brand Drugs
$50
$100
Prescription Drug Benefits
Administered by Express Scripts
800-789-7488
NETWORK
Dental Benefits Administered by
Cigna Dental 800-CIGNA24 (244-6224)
NON-NETWORK
Plan Year Maximum Benefit
$1,500
Plan Year Deductible
$50 per person
Preventive Care
100% (no deductible, not subject to
plan maximum benefit)
90% (no deductible, not subject to
plan maximum benefit)
Diagnostic Care
100% (no deductible)
90% (no deductible)
Basic Restorative Services
80% after deductible
70% after deductible
Major Restorative Services
50% after deductible
50% up to a lifetime maximum of $1,250
Orthodontia for Dependent Children
Mental Health/Substance Abuse
and Employee (Student) Assistance
Programs Administered by Cigna
Behavioral Health 866-726-5267
Includes inpatient and outpatient care for mental health/substance abuse issues, as well as assistance with behavioral health and everyday life concerns
(e.g., stress, family matters, legal issues)
Be Well … Serve Well Health &
Wellness Programs Administered
by CareAllies 800-605-6621
Includes Disease Management, Lifestyle Management, 24-Hour Nurse Line,
Health Advisor Program, Health Assessment, Healthy Pregnancies/Healthy
Babies Program, and Cancer Support Program. See enclosed flyer for more
information.
Vision Benefits Administered by
Vision Service Plan 800-877-7195
Includes coverage for eye exams and corrective eyewear/contact lenses
Hearing Discount Program Administered Includes discounts for testing, hearing aids, and hearing aid maintenance/
by HearUSA 800-442-8231
repair
Lifetime Maximum for Concordia
Health Plan Benefits
Unlimited
For more details about your coverage, visit www.ConcordiaPlans.org.
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Getting the most from your health plan
Save on your prescription drugs
To maximize your CHP benefits and enjoy the greatest savings,
you’ll want to select network providers for your care.
If you or your dependents take medication on a
regular basis, you can save money — and trips to
the pharmacy — with home delivery through Express
Scripts. This mail-order service delivers a 90-day supply of medication to your home for the same cost
as a 60-day supply from the retail pharmacy. It’s like
getting one free refill every three months!
To find a network doctor, hospital, or facility, go to www.
bluecrossmn.com/concordia, select “Find a Doctor,” and search
the National BlueCard PPO network. (Enter Alpha prefix: CND.) Or
call Blue Cross at 800-793-6922.
For network dentists, vision care specialists, and mental health
professionals, visit www.ConcordiaPlans.org and click on
“Providers.” You’ll find a directory of benefits administrators, with
phone numbers and links you can use to access network provider
information.
Express Scripts maintains an extensive network of retail pharmacies, including large chain pharmacies, grocers, and discount
retailers. Once you are enrolled in the CHP, you can visit www.
Express-Scripts.com to find a complete listing of network pharmacies in your area. Or you can call Express Scripts at 800-7897488 for more information.
For additional savings, ask your doctor to order medications listed on
the Express Scripts drug formulary. To view an abbreviated formulary
containing the most commonly prescribed medications, visit the “Resources” section of www.ConcordiaPlans.org and select “Forms.”
*After four (4) consecutive fills within one hundred
twenty (120) days of the same prescription at your
local pharmacy, starting with the fifth (5th) fill at the
local pharmacy, you will pay 50% of the cost or the
appropriate mail order copay, whichever is greater.
Some exceptions may apply if the drug (A) is not
available for purchase through the Express Scripts’
mail order program, (B) cannot be provided through
the mail due to state law, or (C) is considered a
controlled substance by Express Scripts.
Special Note: Specialty drugs are covered by the
Plan only if purchased from the specialty-drug mail
order pharmacy specified by Express Scripts, and
are limited to a 30-day supply. Specialty drugs are
high-cost oral or injectable medications used to treat
certain complex conditions.
Broad coverage, great value
2014-2015 Rate
With the CHP, you and your family are protected by coverage that includes medical (with preventive care), prescription drugs, dental, vision,
hearing, mental health, and substance abuse care, as well as employee
(student) assistance and wellness programs — all for about the same cost as
more limited health plans.
This chart reflects your cost for the CHP coverage.
Self Only
Self & Spouse
Self & Children
Family
$227 per month
$535 per month
$512 per month
$818 per month
For payment information, refer to the cover
letter provided by the Seminary.
Next Steps
1. Already enrolled, making no changes to your coverage? No further action is necessary.
2. Enrolling in or making changes to your CHP coverage?
• Review the directions and deadlines for enrollment outlined in the cover letter from
the seminary, which accompanied this brochure.
• Complete the enclosed enrollment form.
• Return it to the designated representative at the seminary as directed in the cover letter.
• If you are or your dependent is enrolling in the CHP, a welcome kit from Concordia Plan
Services and ID cards from Blue Cross Blue Shield of Minnesota and Express Scripts will be
mailed to the address indicated on the enrollment form.
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Grandfathered Status Notice
Concordia Plan Services believes the Concordia Health Plan (CHP) is a
“grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable
Concordia Plan Services
The Lutheran Church — Missouri Synod
1333 South Kirkwood Road
St. Louis, MO 63122-7295
888-927-7526
www.ConcordiaPlans.org
[email protected]
Care Act, a grandfathered health plan can preserve certain basic health
coverage that was already in effect when that law was enacted. Being a
grandfathered health plan means that the CHP may not include certain
consumer protections of the Affordable Care Act that apply to other
plans, for example, the requirement to provide an internal and external
appeal review process. However, grandfathered health plans must comply
with certain other consumer protections in the Affordable Care Act, for
example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do
not apply to a grandfathered health plan and what might cause a plan
to change from grandfathered health plan status can be directed to
Concordia Plan Services at 888-927-7526. You may also contact the U.S.
Department of Health and Human Services at www.HealthCare.gov.
The information included in this booklet is a brief summary of the Concordia Health Plan for seminary students. It does
not include every detail. In the event of a conflict between the information included here and the terms of the plan as
stated in the official plan document, the plan document will govern.
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