The Roman Catholic Diocese of Las Cruces 2019‐2020 Benefit ... · Health Insurance Marketplace or...
Transcript of The Roman Catholic Diocese of Las Cruces 2019‐2020 Benefit ... · Health Insurance Marketplace or...
The Roman Catholic Diocese of Las Cruces
2019‐2020 Benefit Summary
Effective July 1, 2019 – June 30, 2020
Benefits Overview
The Roman Catholic Diocese of Las Cruces is proud to offer a comprehensive benefits package to eligible
employees. The complete benefit package is briefly summarized in this booklet. You share the costs of some
benefits (medical and dental), pay 100% of vision (optional) and the Diocese of Las Cruces provides other
benefits at no costs to you (life, accidental death & dismemberment, and long‐term disability).
*Notice*
NOTICE FOR ALL EMPLOYEES – Exhibit A is a notice to all employees called the “New Health Insurance
Marketplace Coverage Options and Your Health Coverage” as required by the Affordable Care Act (ACA). The
notice contains information about the new Insurance Marketplace, open enrollment for the Marketplace, and
that you may qualify to save money in the Marketplace. The new Health Insurance Marketplace is commonly
referred to as “The Exchange” and can be accessed at www.bewellnm.com.
If you are already covered under the Diocesan Health Insurance Plan then you can to shop for insurance in the
Health Insurance Marketplace or remain on your current plan.
The benefit plans offered are:
Medical (includes RX)
Dental
Vision
Life Insurance
Accidental Death & Dismemberment
(AD&D) Insurance
Long‐Term Disability
This booklet gives you an overview of the main features of your benefits plan. The plans are administered according to legal plan
documents and insurance contracts. Although we’ve tried to summarize the provisions of these legal documents clearly and
accurately, if any information presented here conflicts with legal documents, the legal documents will govern.
For more detailed information on the plans and your legal rights under the plans, be sure to read the summary plan descriptions or
request a copy of the plan documents.
All benefit plans are subject to change from time to time and the Roman Catholic Diocese of Las Cruces reserves the right to amend
or cancel any benefits described in this booklet, with or without notice. This document does not guarantee any benefits.
Eligibility
Priests of the Diocese of Las Cruces who are incardinated and hold an official assignment from the
Bishop or who are on official assignment from the Bishop
Full‐Time lay employees who are regularly scheduled to work 30‐hours or more per week. Part‐Time,
Seasonal, and Temporary employees are not eligible.
Legal spouse and/or child(ren) of the employee
Effective Date of Coverage
Coverage begins on 1st of the month following date of assignment/hire rounded to the current month if
eligibility falls on the 1st. A dependent’s coverage becomes effective on the same date as the Plan participants’,
provided the dependent enrolled at that time.
Coverage Reminders
All of the Reta Trust prescription drug plans meet Medicare Part D guidelines for credible coverage.
The Reta PPO Plan has a pre‐existing condition clause. The pre‐existing period may be reduced or
eliminated with proof of prior coverage. Please submit your HIPAA Certificate with your enrollment
form or first claim to Anthem Blue Cross.
Deductions are on a pre‐tax basis.
Changes in coverage during Open Enrollment become effective the following July 1.
Changing Your Benefits
You must notify the Insurance Office and complete a new enrollment/change form within 31 days of any Life
Event or you will not able to make an enrollment change until the next open enrollment period. Documentation
is required to provide proof. In general, the following is a list of qualifying life events:
Change in legal marital status
Change in number of dependents
Change in employment status
Change in work schedule
Change in place of residence or worksite
Change in your health coverage or your spouse’s coverage
Change in an individual’s eligibility for Medicare or Medicaid
A court order
An event that is a special enrollment event under HIPAA
Notify the Insurance Office immediately when:
1. Change of address to ensure you receive information concerning your benefit plans.
2. A dependent is no longer eligible for coverage from a Diocesan plan.
Any changes you make must be consistent with the change in status.
Medical Plans Administered by Anthem BCBS
The Anthem BCBS PPO and EPO are sponsored by the Reta Trust, which offers affordable, quality healthcare
consistent with the moral and ethical teachings of the Catholic Church. A snapshot comparison and brief
overview of the medical plans follow, along with the current monthly premiums.
For additional benefit information, please refer to your summary plan booklet or contact Anthem BCBS at
1.888.722.1077.
Snapshot Comparison
PPO Plans
EPO Plans
Dental Plan
Vision Plan
Life Insurance and Accidental Death and Dismemberment (AD&D) Income Administered by ING/ReliaStar
Life Insurance
Life Insurance provides basic protection for your loved ones if something happens to you. While many U.S.
households have life insurance, the average amount of coverage is often inadequate to meet family needs or
pay off debt. Taking advantage of life insurance coverage provided by the Diocese of Las Cruces can be an
important part of your financial security.
Program Basics
Your Basic Life and AD&D (if applicable) coverage is employer provided at no cost to you.
Basic Life and AD&D Insurance is underwritten by ReliaStar Life Insurance Company.
Your Coverage
For all active Full‐Time employees living in the U.S. and all eligible vowed employees not on assignment
Basic Life amount: $25,000.
Conversion: If your Basic Life insurance terminates, the plan’s Conversion option allows you to convert
all or a portion of your group coverage to an individual policy. You must request conversion and pay the
required premium within 31 days of the date your Basic Life insurance terminates. No proof of good
health will be required. Conversion does not apply to Basic AD&D.
Benefits reduce to 65% of original coverage at age 65 and 50% of original coverage at age 70.
Basic AD&D
For all active Full‐Time employees living in the U.S.
Basic AD&D benefit amount: $25,000.
You suffer an accident or injury that results in a covered loss within 180 days of the accident and the loss
results directly from the injury independent of other causes, benefits are payable as follows:
100% Benefit for loss of Life
100% Benefit for loss of Both Hands, Both Feet, o Sight of Both Eyes
100% Benefit for loss of One Hand and One Foot
100% Benefit for loss of Speech and Hearing in Both Ears
100% Benefit for loss of One Hand or One Foot or Sight of One Eye
50% Benefit for loss of One Hand or One Foot or Sight of One Eye
25% Benefit for loss of Speech
25% Benefit for loss of Hearing in Both Ears
25% Benefit for loss of Thumb and Index Finger of Same Hand
ReliaStar Life pays only one 100% benefit while the Group Policy is in effect. If you have a loss for which
ReliaStar Life pays no more than 50% Benefit for the next loss.
Benefits reduce to 65% ($16,250) of original coverage at age 65 and to 50% ($12,500) of original
coverage at age 70.
Long‐Term Disability (LTD) Income Insurance
Disability Income coverage protects a percentage of your income if you have an illness or injury and are unable
to work for a prolonged period of time. Monthly Income Benefits help assure financial support that will fill the
gap between expenses and income for an extended period of disability.
Program Basics
Monthly Income Benefits: Your employer provides this coverage to all Full‐Time employees living in the
U.S.
Group Disability Income Insurance is underwritten by ReliaStar Life Insurance Company.
Your Coverage
Monthly Income Benefits
60% of your Basic Monthly Earnings
Maximum Monthly Income Benefit = $5,000
Minimum Monthly Income Benefit = $100 or 10% of Basic Monthly Earnings
Benefits Waiting period = 90 days
Definition of Disability = a change in your functional capacity resulting in your inability to work due to accidental
injury or sickness.
Priests, Religious and Seminarians residing in the U.S.
Your inability to perform the essential duties of your own occupation
All Other Eligible Employees
During the benefit waiting period and the following 24 months, your inability to perform the essential
duties of your own occupation.
After 24 months of benefits, your inability to perform the essential duties of any gainful occupation.
Maximum Benefit Period:
Age at Disability Maximum Benefit Period
Less than age 61 – to normal retirement age, but not less than 60 months
61 but less than 62 – to normal retirement age, but not less than 48 months
62 but less than 63 – to normal retirement age, but not less than 42 months
63 but less than 64 – to normal retirement age, but not less than 36 months
64 but less than 65 – to normal retirement age, but not less than 30 months
65 but less than 66 – 24 months
66 but less than 67 – 21 months
67 but less than 68 – 18 months
68 but less than 69 – 15 months
69 and over – 12 months
Contact Information
If you have a specific questions about the Diocese of Las Cruces’s benefit plan, please contact the administrator
listed below, or your local HR department.
Plan Type Provider Name Member Services Web Address Medical Plan Anthem BCBS 1.888.722.1077 www.anthem.com
Temp ID Cards First, contact Diocesan Insurance Office to verify mailing address then contact Anthem member services
Claims Address for Anthem First, download the Anthem Claim Form from Diocesan website then submit form and claims to: Anthem BCBS PO Box 60007 Los Angeles, CA 90060
Prescription EnvisionRX 1.844.852.7437 www.envisionrx.com
Dental Plan Delta Dental of NM 2500 Louisiana Blvd. NE Suite 600 Albuquerque, NM 87110
1.877.395.9420 www.deltadentalnm.com
Vision Plan VSP Vision 1.800.877.7195 www.vsp.com
Diocesan Office of Risk Management/Insurance
Mr. Brent Hatley 1280 Med Park Dr. Las Cruces, NM 88005
P: 1.575.523.7577 F: 1.575.524.3874
www.rcdlc.org