Medical Group Insurance
The Diocesan Group offers several medical plans to eligible employees. The plans, their monthly rates, and area of availability are shown below.
The Diocesan Staff are here to serve you, please contact Theresa Stottlemire at (602) 254-0976 or theresa@azdiocese.org or Vicki Hohnbaum at (602) 254-0976 or vicki@azdiocese.org if you have any questions.
Click on the plan name to see a summary of the 2008 benefits:
| 2008 Medical Health Offerings for The Episcopal Diocese of Arizona | ||||||
|---|---|---|---|---|---|---|
Single | Plus | Family | ||||
| 2007 | 2008 | 2007 | 2008 | 2007 | 2008 | |
| HMO | ||||||
| 459 | 509 | 828 | 919 | 1,289 | 1,431 | |
EPO | ||||||
| 643 | 714 | 1,159 | 1,286 | 1,802 | 2,000 | |
| 643 | 714 | 1,159 | 1,286 | 1,802 | 2,000 | |
POS | ||||||
| 674 | 748 | 1,213 | 1,346 | 1,887 | 2,095 | |
| | ||||||
PPO | | |||||
| 813 | 902 | 1,464 | 1,625 | 2,276 | 2,526 | |
| United Healthcare Choice Plus | 700 | 789 | 1,281 | 1,422 | 1,992 | 2,211 |
HDHP/HAS | | |||||
| 396 | 426 | 713 | 766 | 1,109 | 1,192 | |
| Eyemed | included with medical insurance | |||||
| Prescription | included with medical insurance | |||||
HMO availability in the Diocese
HMO coverage is available in all counties expect for Coconino, Greenlee, and Navajo. (for reference; actual availability is by zip code)
Managed Care Plans
Aetna HMO, First Health EPO and Blue Cross/Blue Shield PPO are all managed care plans.
Aetna HMO:
You must choose a Primary Care Physician (PCP). You can change your PCP at any time. If you need the care of a specialist, for the service to be covered in-network, you must get a referral from you PCP to a specialist who participates in the network. Aetna will be in touch with you about designating the PCP after you enrollment is processed.
First Health EPO (Exclusive Provider Organization):
Benefits provided only within a network
First Health uses a national provider network. Members can receive care from any participating provider, even away from home.
For most outpatient care, out-of-pocket costs are reduced to a small co-payment, and the plan pays 100% of all covered inpatient care. The plans pay benefits only for services received in the network.
In an emergency situation, claims are paid regardless of where services are provided.
A network plan may not be the best option if the hospitals and providers a member uses most often do not participate in the plan's network.
Blue Cross/Blue Shield PPO (Preferred Provider Organization):
PPO plans offer access to doctors, hospitals, and other providers who have agreed to participate in the network and accept lower fees for their services.
This type of plan is a good choice for those who place a high value on being able to see any provider they choose, yet still want to keep out-of-pocket costs low.
Members receive the highest level of benefits and the lowest out-of-pocket costs by seeing participating providers. They don't need to select a PCP and can see any participating provider they choose, even a specialist, whenever they choose.
Seeing non-participating doctors
Members can also choose to see non-participating doctors for care, but benefits are reduced and out-of-pocket costs are higher.
They may also need to file their own claim forms when seeing non-participating providers. Participating providers file claims on members' behalf, and out-of-pocket expenses are limited to a co-payment or coinsurance.
Our PPO network is national, so members can obtain care from any participating provider, even away from home. In an emergency situation, it is not necessary to locate a network provider. Emergency claims are paid at the highest level of benefits.
Enrollment deadlines
You must enroll in one of these medical options within 30 days of your date of hire. If you miss the enrollment deadline, you will not be able to enroll in a medical option until the annual open enrollment period.
Effective Date of Coverage
Your coverage will be effective on the first day of the first full month of your employment. If you hire date is July 1 (or the first working day in July), your coverage will be effective July 1. If you hire date is July 10, your coverage will be effective on August 1. The effective date of coverage is not up to the employer or employee; it is based without exception on the employee’s date of hire.
Same-sex partner coverage
The diocese group plans include coverage for the same-sex partners of eligible employees. There are affidavits and supporting documentation that must be submitted to the Diocesan Finance office. If you would like this coverage please contact us for further information.
Significant life changes
If you experience a significant life change during the year (e.g., marriage, divorce, birth or adoption of a child, loss of spousal coverage) you may make changes outside of the open enrollment period as long as
- you file the necessary paperwork within 30 days of the event
- there is no break in coverage.
For additional information, including summary descriptions of the plans, enrollment kits, and change forms, contact Theresa Stottlemire at (602) 254-0976 or theresa@azdiocese.org or Vicki Hohnbaum at (602) 254-0976 or vicki@azdiocese.org.
