Know Your Insurance Plan
Learn the important things to know about the NC Conference Insurance plans and programs.
Use the categories below to browse our facts.
Active Ministry & Employment
About the Plan’s Coverage
Retirement & Medical Leave
Active Ministry or Employment
Eligibility for Conference Insurance Plans
Clergy eligibility for life insurance plans is based on meeting all three of the following criteria:
- Work a minimum of 30 hours per week
- Have an appointment percentage of 1/2 time or greater
- Line 7 of the Clergy Compensation Worksheet must indicate a Plan Compensation equal to or greater than one-half of minimum full-time salary (clergy only) [2023 Line 7 must be equal to or greater than $24,160]
Clergy eligibility for HealthFlex insurance plans is based on the following criteria:
- Have an appointment percentage of 1/2 time or greater
- Work a minimum of 30 hours per week
Lay eligibility for life and HealthFlex insurance plans is based on working at least 30 hours per week.
Clergy appointed to Medical Leave must:
- Have been enrolled in the plans on the date immediately preceding your appointment to Medical Leave
HealthFlex Plans and Provisions
The 2023 HealthFlex Plan Comparison highlights key differences and similarities between the various plans. The 2024 HealthFlex Plan Comparison is now available as well.
Current Participants in the HealthFlex insurance plans can visit BenefitsAccess.org to learn about their elections and benefits.
Those considering enrollment in HealthFlex can visit the Conference Insurance webpage to learn more. Additional information is available at Wespath’s Annual Election website.
HealthFlex Prescription Coverage
The HealthFlex Prescription coverage is designed with patient safety and cost containment in mind. Prescriptions for 30-days or less that are not maintenance (long-term) medications can be filled at any in-network pharmacy. After three 30-day fills at any in-network pharmacy for a daily medication (same dosage for all fills), then it is required to switch the medication to being filled by OptumRX Home Delivery or Walgreens. This requirement applies only to maintenance medications (90-day prescriptions). If these providers are not used, the member will pay the full discounted cost of the medication.
You’ve Got a Deadline to Make Changes to Your Coverage
You must notify the Benefits Team within 31 days of any change that would affect your eligibility or enrollment in the Conference insurance plans. Examples of such changes include the birth of children, marriage, divorce, death, or loss of spousal coverage.
Will Preparation Services for Participants in the Supplemental Life Insurance Option
Everyone needs a will. Having a will prevents unnecessary stress, ensures your final wishes are clear, and is an ultimate way to express your care to your loved ones. Enrollees in the Conference’s Supplemental Life Insurance plan through MetLife, can take advantage of Will Preparation services. These services provide access to a network of attorneys who prepare and update wills, living wills, and powers of attorney. You may also use a non-participating attorney and receive reimbursement for covered services according to a set fee schedule.
Annual Election Period
The Annual Election Period is the time for current and new enrollees to make their benefit option elections for the coming new year. This period for establishing 2024 benefits will be in November 2023.
For HealthFlex medical, dental, vision, and health account benefit enrollments, visit Wespath’s Annual Election website to learn more. Then visit BenefitsAccess.org during the Annual Election period to make your choices for next year. If you’ve never used Benefits Access, click New User Registration. Call 1-844-688-1375 Monday-Friday 8 am – 8 pm EST between November 2 – 17 for support.
For Basic and Supplemental Life insurance choices, complete the NC Conference’s Annual Election Form.
2023 Insurance Rates
Both church and personal costs for 2023 insurance plan coverages are posted on our Insurance Rates webpage.
Basic & Supplemental Life Insurance
Your salary-paying unit provides for the Basic Life Insurance benefits. Each participant in the Basic Life program may also elect to enroll in the voluntary Supplemental Life Insurance plan. Rates are withheld from the participant’s salary on an after-tax basis and remitted by the salary-paying unit.
Your Insurance Enrollment Impacts Your Medical Leave Benefits
Enrollment in the Conference insurance plan immediately preceding the effective date of a Medical Leave determines eligibility for Conference insurance benefits after the appointment to Medical Leave.
Your Insurance Enrollment Impacts Your Retirement Benefits
Post-retirement health plan funding will be determined using years of NC pension credit accrued through June 30, 2009 plus the number of months of active enrollment in the Conference insurance plan between July 1, 2009 and your retirement date. Retirees must have a minimum of 180 months of combined credit over the course of their career to receive the minimum funding in retirement. Refer to the Board of Pension report in the Conference Journal for more details.
Ways to Wellness
The NC Conference offers a wellness program to support conference members in making their personal wellness a priority. The programs described on our Wellness webpage are offered as resources on your journey towards healthy living.
IRS Limits for Health Accounts
The IRS 2023 limits for contributions are listed below for the following health accounts:
- Health Flexible Spending Account – $300 minimum – $3,050 maximum
- Dependent Care Flexible Spending Account – $2,500 for married filing separately and $5,000 for married filing jointly
- Health Savings Account (plan sponsor + your money):
- $3,850 (self-only)
- $7,750 (family)
- Individuals over 55 may contribute extra $1,000 annually
- HealthFlex Health Reimbursement Account – no limit
About the Plan’s Coverage
Your Health Plan Covers Women’s Health & Cancer Rights
This notice informs you of the federal regulation that requires all health plans that cover mastectomies to also cover the reconstruction of the removed breast. If you have a mastectomy and elect breast reconstruction in connection with the mastectomy, you are covered for the following:
- Reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
- Prostheses and treatment of physical complications of the mastectomy, including lymphedemas.
Your Health Information is Protected By HIPPA
This is to remind plan participants and beneficiaries of the NC United Methodist Conference Health Plan that the Plan has issued a Health Plan Privacy Notice that describes how the Plan uses and discloses protected health information (PHI). A copy of this notice is available online.
You May Need This Notice If You Are Joining a Medicare Drug Plan
If you or your spouse are Medicare eligible, keep this notice for your records. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with NCCUMC and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
- Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
- NCCUMC has determined that the prescription drug coverage offered by the NCCUMC Health Plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from November 15th through December 31st. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with NCCUMC and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to enroll in a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than the Medicare base beneficiary premium. You’ll have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join.
For More Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the Benefits Team for further information at the information below. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through the NCCUMC Plan changes you may also request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans:
- Visit medicare.gov
- Call your State Health Insurance Assistance Program (see your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at socialsecurity.gov, or you may call them at 1-800-772-1213 (TTY 1-800-325-0778).
Retirement & Medical Leave
Insurance Participants On Medical Leave Will Have a Benefits Change At Age 65
Insurance benefits for clergy on Medical Leave will be calculated as if you had retired on the first of the month in which you turn age 65. Your coverage under the NC Conference Blue Cross Blue Shield medical plan will end on the last day of the prior month. In the 90-day period prior to the month this change takes effect, you will need to coordinate with your Social Security office to set up your Medicare Parts A & B benefits effective the first of the month in which you turn age 65. You will also work with Via Benefits in this 90-day period to establish your Health Reimbursement Account (HRA) funding from the Conference which will help offset your continued out-of-pocket health care expenses. This change in primary insurance coverage will not impact your conference relationship nor your appointment to Medical Leave. You will receive correspondence from the Conference Benefits Team in advance of this change which will provide your specific details and next action steps.
Insurance Participants Who Retired Under Age 65 Will Have a Benefits Change At Age 65
Your post-retirement health plan funding has been determined using years of NC pension credit accrued through June 30, 2009 plus the number of months of active enrollment in the Conference insurance plan between July 1, 2009 and your retirement date. Retirees must have a minimum of 180 months of combined credit over the course of their career to receive the minimum funding in retirement. Refer to the Board of Pension report in the Conference Journal for more details.
Upon attaining age 65, Medicare will become your primary insurance carrier and the NC Conference will begin funding your Health Reimbursement Account (HRA) administered through Via Benefits. This account is used to aid in the purchase of individual plans or Medicare supplemental plans on the open market and to offset your out-of-pocket health care expenses. You may consult a Via Benefits advisor for assistance in choosing a plan. Within 90 days prior to the first of the month in which you turn age 65, you must contact Medicare to sign up for Parts A & B. Also during this time participants and their eligible spouses must both contact Via Benefits at 855-801-9759 to activate both of their HRAs in a timely manner.
Retirees Over Age 65, Learn More About Your Health Reimbursement Account (HRA)
The NC Board of Pension established a Health Reimbursement Account arrangement effective January 1, 2014, for eligible participants. Each plan year (which is January – December), funding is provided based on the retiree’s specific retirement criteria. This funding is to be used to reimburse participants for eligible medical expenses with no tax implication to the participant. Via Benefits is the vendor chosen by the Conference to administer your HRA. This is a reimbursement account. You must provide proof that you have paid the eligible expense in order to be reimbursed.
Visit the Retiree Health page for current funding amounts.
How Do I Get My Money?
- Premium reimbursements can be handled by:
- Completing and submitting a paper claim form each month, or
- Your insurance company may be willing to submit an electronic payment file on your behalf
- Out of Pocket Expenses may be filed using a paper claim form or through your online account at my.viabenefits.com/nccumc
- You can receive your HRA reimbursements by check or direct bank deposit
What Do I Need To File A Claim?
- If you are filing a claim for premium reimbursement, you must provide documentation (such as your monthly payment invoice) from your insurance carrier that provides:
- The covered participant’s name. The document must show each covered person’s name
- The name of the insurance carrier
- The date range of the coverage (effective date, end date)
- A description of the type of coverage
- The premium amount you paid for each person
- If you are filing a claim for out of pocket expenses, you must provide documentation that shows:
- The name of the patient
- The name of the doctor or medical facility
- The date of service
- The type of service
- The amount you paid
- Helpful documents to include with your out of pocket expense claim:
- The discharge document that is provided to you at the time you leave the doctor’s office. If you are not offered a copy at the time that you check out, simply ask for a copy.
- The Explanation of Benefits that Medicare or your insurance carrier provides showing the amount that was not covered by insurance
- Proof of payment such as a canceled check, credit card receipt, or receipt from the provider stating the amount that you paid for your service
- Documents that indicate that insurance is pending are not acceptable
What Other Helpful Tips Do You Recommend?
- Sign and date all claim forms.
- Keep a copy of everything you submit.
- Submit legible copies of your receipts (retain the originals for your records).
What Is An HRA Eligible Reimbursable Expense?
- Premiums paid for medical insurance plans such as:
- Medicare Supplement, Medigap, Medicare Advantage, Medicare D pharmacy plans
- Medicare Part B (this is withheld from your Social Security each month)
- Vision plans or Dental plans
- Out of Pocket expenses such as:
- Doctor’s office visit co-pays
- Eyeglasses or contacts
- IRS qualified expenses (see IRS Publication 502 for more details) such as, but not limited to:
- Abdominal supports • Acupuncture • Air conditioner (when necessary for relief from difficulty in breathing) • Alcoholism treatment • Ambulance • Anesthetist • Arch supports • Artificial limbs • Autoette (when used for relief of sickness/disability) • Birth Control Pills (by prescription) • Blood tests • Blood transfusions • Braces • Cardiographs • Chiropractor • Christian Science Practitioner • Contact Lenses • Contraceptive devices (by prescription) • Convalescent home (for medical treatment only) • Crutches • Dental Treatment • Dental X-rays • Dentures • Dermatologist • Diagnostic fees • Diathermy • Drug addiction therapy • Drugs (prescription) • Elastic hosiery (prescription) • Eyeglasses • Fees paid to health institute prescribed by a doctor • FICA and FUTA tax paid for medical care service • Fluoridation unit • Guide dog • Gum treatment • Gynecologist • Healing services • Hearing aids and batteries • Hospital bills • Hydrotherapy • Insulin treatment • Lab tests • Lead paint removal • Legal fees • Lodging (away from home for outpatient care) • Metabolism tests • Neurologist • Nursing (including board and meals) • Obstetrician • Operating room costs • Ophthalmologist • Optician • Optometrist • Oral surgery • Organ transplant (including donor’s expenses) • Orthopedic shoes • Orthopedist • Osteopath • Oxygen and oxygen equipment • Pediatrician • Physician • Physiotherapist • Podiatrist • Postnatal treatments • Practical nurse for medical services • Prenatal care • Prescription medicines • Psychiatrist • Psychoanalyst • Psychologist • Psychotherapy • Radium Therapy • Registered nurse • Special school costs for the handicapped • Spinal fluid test • Splints • Sterilization • Surgeon • Telephone or TV equipment to assist the hard-of-hearing • Therapy equipment • Transportation expenses (relative to health care) • Ultra-violet ray treatment • Vaccines • Vasectomy • Vitamins (if prescribed) • Wheelchair • X-rays
Who Can I Call For More Help?
- Via Benefits Customer Support: 855-801-9759 or my.viabenefits.com/nccumc
- NC Conference Benefits Team: 800-849-4433 or firstname.lastname@example.org
The Shepherd’s Fund
Learn more about The Shepherd’s Fund, a benevolent grant to assist retirees and their spouses as well as medical leave members and their spouses. There is a broad list of qualifiying expenses such as medical, dental, hearing aids, funeral expenses and more!
More resources are available on the Treasurer’s Office Downloads webpage.
Your Benefits Team is available to provide enrollment/change forms and answer all your insurance questions! Contact us at email@example.com.