Benefit Eligibility

An employee is eligible to enroll in benefits if the employee is normally scheduled to work 1,000 or more compensated hours per plan year, regardless of whether they are an exempt or non-exempt employee.

2023 Benefit Updates:

  • The Standard Rx option will be coinsurance-based (vs copays) with maximum amounts to protect members from excessive costs and minimums to drive plan savings
  • All plan designs will add a new cost-sharing tier for Specialty drugs

Express Scripts (for Anthem & Cigna members)










Notes:

  • Anthem and Cigna Consumer-Directed Health Plan (CDHP) members will continue to have coinsurance-based prescription drug plan cost sharing with a combined medical and pharmacy deductible. Anthem and Cigna CDHPs will also introduce a Specialty Rx tier with 50% coinsurance after deductible.
  • The Express Scripts prescription drug program will continue to maintain a retail refill limit policy. The retail refill limit requires that you use home delivery if you are prescribed a maintenance medication, rather than refilling multiple prescriptions for the same drug at a retail pharmacy. See the Plan Document Handbook for more information.

Kaiser Permanente:
Members enrolled in the Kaiser Permanente EPO High and the Kaiser Permanente EPO 80 plans will have the following cost sharing for prescription drug benefits:














Note:
Kaiser CDHP members will continue to have coinsurance-based prescription drug plan cost sharing with a combined medical and pharmacy deductible. Kaiser CDHPs will also introduce a Specialty Rx tier of 50% coinsurance after deductible.

The Medical Trust will continue to waive all copays, deductibles, and coinsurance for its members for healthcare services relating to the evaluation and testing for COVID-19 through at least December 31, 2023. In addition, the Medical Trust also will waive all copays, deductibles, and in-network coinsurance for its active members for healthcare services relating to the treatment of COVID-19 through at least December 31, 2023.²

²This deductible waiver includes our HSA-qualified CDHPs as permitted by IRS Notice 2020-15.

Telehealth platforms for Active Members³ – You can access a medical professional through telehealth platforms offered by Anthem, Cigna, or Kaiser using your computer or mobile device. You will need high-speed internet access, a webcam or built-in camera, and audio capability. Please remember your personal healthcare provider may not participate on the vendor’s telehealth platform.

For Anthem and Cigna PPO members and Kaiser EPO members, all services received via vendor telehealth platforms are available to you with no deductible, copay, or coinsurance through December 31, 2023. For CDHP members, while temporary legislation currently permits the Medical Trust to provide you with first-dollar coverage of vendor telehealth platform services, there is no guarantee that this relief will be extended beyond December 31, 2022. If Congress does not extend this relief, during 2023, you will be required to meet your deductible before carrier telehealth services will be covered with no copay or coinsurance.

  • Anthem Blue Cross Blue Shield – Access LiveHealthOnline.com or download the LiveHealth Online mobile app in the App Store ® or Google Play™
  • Cigna – Access MDLiveforCigna.com on your computer or download the MDLIVE mobile app by searching in the App Store ® or Google Play™
  • Kaiser Permanente – Access Kaiser’s telehealth platform services by calling the number on the back of your member ID card

³Please note, telehealth can help with minor, non-life-threatening conditions. During a medical emergency, individuals should visit the nearest hospital or call 911 for assistance.

A virtual visit is an appointment with your personal healthcare provider carried out through an electronic medium of your provider’s choice (e g , Zoom, Skype, telephonic) but that is not offered through your health plan carrier’s telehealth platform (e g , Anthem LiveHealth Online, Cigna MDLive).

The Medical Trust will continue to allow claims for virtual visits with network and out-of-network providers that do not use a telehealth platform offered by Anthem or Cigna through December 31, 2023.

Virtual visits are covered at standard levels of benefits and member cost shares.

Note: Kaiser’s healthcare model requires its members to use the Kaiser telehealth platform for telehealth services.

Hinge Health is available at no cost to Anthem and Cigna members effective October 1, 2022. Through the Hinge Health Digital Musculoskeletal (MSK) Clinic, participants have access to personalized MSK care programs depending on their specific MSK needs.

  • Prevention – Program designed to increase education with regard to key strengthening and stretching activities around healthy habits. The Prevention program is software based and offered through the Hinge Health app.
  • Chronic – Program designed to address long-term back and joint pain It includes personalized app-guided exercise therapy sessions, one-on-one access to a personalized health coach, personalized education content, and behavioral health support. Participants in the chronic program may also be offered access to virtual sessions with a licensed physical therapist and/or the non-invasive ENSO High Frequency Impulse Therapy™ pain management device and service, as appropriate, for symptomatic relief.
  • Acute – Program designed to address recent injuries. It includes live virtual sessions with a dedicated licensed physical therapist along with software- guided rehabilitation and education.
  • Surgery – Program designed to address pre/post-surgery rehab for the most common MSK Surgeries. It includes personalized app-guided exercise therapy sessions, 1:1 access to a personalized health coach and physical therapist, personalized education content, and behavioral health support.
  • Expert Medical Opinion – Service offering second opinions for elective MSK procedures.

For applicable programs, a participant may obtain up to six virtual physical therapy sessions per episode (with no cost share to the member) prior to in- person healthcare provider or physical therapy care.

State laws may limit access without a physician’s referral.

To get started with Hinge Health, visit hingehealth.com/ecmt to enroll.

If you have any questions regarding Hinge Health, email help@hingehealth.com or call (855) 902-2777.

Vision benefits offered through EyeMed’s Insight Network provide coverage for an annual eye exam and cost savings on prescription glasses or contact lenses.

Effective January 1, 2023, the annual frames or contact lenses allowance will increase from $150 to $200.

The Medical Trust’s Episcopal Health Plan includes benefits for the diagnosis and treatment of infertility. Covered health services include diagnostic and exploratory procedures to determine whether a member suffers from infertility. Covered fertilization services include artificial insemination, in vitro fertilization, GIFT (gamete intra-fallopian transfer), and ZIFT (zygote intra-fallopian transfer) procedures.

Currently, there is a lifetime benefit maximum of $10,000 for services covered under the medical plan and $10,000 for services covered under the pharmacy plan.

Effective January 1, 2023, the lifetime benefit maximum will be a combined $50,000 for medical and pharmacy services.

In addition, the Medical Trust will provide standard fertility preservation services for individuals who must undergo medically necessary treatment that may cause iatrogenic infertility.

Note: Member cost shares (copays, coinsurance, and deductibles) apply; however, cost shares do not count against the lifetime benefit maximum.

The Medical Trust’s Episcopal Health Plan includes benefits for hearing aid devices.

Effective January 1, 2023, the benefit maximum for hearing aid devices will be a single $3,000 maximum every three years. The benefit maximum for hearing aid devices will no longer have a per ear maximum (currently $1,500 per ear).

Note: Member cost shares (copays, coinsurance, and deductibles) apply; however, cost shares do not count against the benefit maximums.

Currently, the Medical Trust’s Episcopal Health Plan excludes travel vaccines from coverage.

Effective January 1, 2023, the Medical Trust will cover travel vaccines for personal travel Member cost sharing will follow the benefit plan design for immunizations.

The Internal Revenue Service increased the minimum and maximum amounts that a high-deductible health plan (HDHP) may impose as a deductible.4

For 2023, the minimum amount that must be imposed as a deductible for self- only coverage under an HDHP is $1,500. The minimum amount that must be imposed as a deductible for family coverage under an HDHP is $3,000. The amounts for 2022 were $1,400 and $2,800, respectively.

Effective January 1, 2023, the Medical Trust’s Anthem and Cigna CDHP-15 network deductible for self-only coverage will be $1,500, and the network deductible for family coverage will be $3,000. The out-of-network deductible for self-only coverage will be $3,000, and the out-of-network deductible for family coverage will be $6,000.

4See IRS Notice 2022-24.