Changes to Health & Dental Benefits
In October, GSI announced some changes to the structure of the health and dental benefits that will take effect in 2021. These changes strive to ensure the long-term sustainability of the plan and add flexibility to the benefits.
Starting in January of 2021, the health and dental benefits will move to Core and Enhanced streams of coverage. Plan members will be enrolled in either the Core or Enhanced stream, based on eligibility criteria.
Eligibility for each stream will be determined solely by a member’s salary basis in relation to YMPE1. Members earning YMPE or greater will be enrolled in the Enhanced stream, and those earning less than YMPE, but meet the minimum eligibility of 25% YMPE, will be enrolled in the Core stream.
Health Care Spending Account
Something new to the plan will be a feature called a ‘Health Care Spending Account’ (HCSA). Both Enhanced and Core streams will include an HCSA that will allow the plan member flexibility in covering benefits costs and offset the reductions in the maximum coverages as described below. The HCSA can also be used to cover eligible expenses not currently in the ELCIC Group Benefits Plan.
Prescription Drugs, Vision Care & Paramedical Services
The covered amount for prescription drugs will be reduced from the current 80% to 70% for the Enhanced stream and reduced to 60% for the Core stream. Plan members in both streams will still have a drug card that they may use at their pharmacy. The out-of-pocket maximum will also be removed from the prescription drug benefit. The prescription drugs plan will become a mandatory generic plan where only the amount of the lowest cost of an available drug will be applied.
For vision care, the Enhanced stream will cover eye exams and prescription glasses and contact lenses, as in the past, while the Core stream will cover only eye exams. The covered amount for paramedical services will be reduced to 70% for Enhanced plan members and reduced to 60% for Core plan members. Also, those in the Core stream will see the paramedical maximums somewhat reduced.
The basic dental benefit will see the deductible removed and replaced with co-insurance. Both streams will have 70% coverage on basic dental expenses. The major dental benefit remains at 50% for both streams, but orthodontic coverage will be removed from the Core stream. Also, the overall maximum for the Core stream will be reduced from $2,000 to $1,000.
Health and dental benefits within the current plan, will remain the same until these changes take effect January 2021.
The move to Core and Enhanced streams reflects GSI’s desire to support a sustainable health and dental benefit plan that is manageable for all congregations/employers, while still providing excellent coverage for plan members. In the months to come, we will continue to share these details with you in our e-newsletters.
You may also check-out the ‘Health & Dental Redesign 2018’ Q&A section of our website with answers to questions you might have. If you have any additional questions about this upcoming change, please direct your inquiries to GSI.