wfn.org | Board of Pensions Approves HMO Options to New Sites in Seven States

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25-July-1996 
 
 
 
96271             Board of Pensions Approves HMO 
               Options to New Sites in Seven States 
 
                         by Julian Shipp 
 
PHILADELPHIA--Effective Jan. 1, 1997, HMO options are being extended to new 
sites in seven states following approval by the Board of  Pensions (BOP) 
during its July 18-20 meeting here. 
 
      HMOs, or health maintenance organizations, will be available in 
Connecticut, Hawaii, Indiana, Kansas, Missouri, Pennsylvania and Michigan, 
according to Beach B. Hall, BOP Healthcare Committee chair from Rogers 
City, Mich. 
 
     In making its recommendation to the Board, Hall said, the committee 
looked at HMO availability in geographical areas encompassing 61 
presbyteries. The cost effectiveness of offering those HMOs in these new 
areas was also examined. 
 
     "In some cases we found that the HMO costs far exceeded the dues 
income and would be, in effect, a money loser, and in those areas we did 
not offer HMOs," Hall said. "In other areas, we just didn't have good 
access to HMOs and didn't offer them in those cases either." 
 
     Hall said members in presbyteries affected by the HMO additions will 
be notified in August and September, then given the opportunity to join in 
October. Members who already have HMO options in their presbyteries, but 
are not now participating, will also be given the opportunity to join. 
Coverage through the HMO will become effective Jan. 1, 1997. 
 
     The Board's HMO options stem from action it first took in 1995. HMOs 
offer members many advantages, including avoiding co-insurance and 
deductible costs. Doctor's visits and other services through the HMO 
network are generally provided at minimal cost. 
 
                   Medicare Supplement Program 
 
     The Board also approved a proposal for a pilot program in which the 
Board will allow a Medicare-eligible member to withdraw from the Medicare 
supplement program to join an HMO while reserving the right to re-enter the 
plan once within the first 12-month period following HMO enrollment if 
he/she decides to return to regular Medicare Supplement coverage. 
 
     Hall said that under the current Medicare Supplement Program, in order 
to be enrolled the member has to be in Medicare A and B plus pay a monthly 
premium. Moreover, if a person leaves the Medicare Supplement Program of 
the church, they cannot return to it. 
 
     "In the last two years, there have been HMOs that will take Medicare 
enrollees for in some cases no cost except their Medicare payments, or in 
other cases a minimal amount per month," Hall explained.  "Some of our 
members have expressed an interest in joining those programs ... so that is 
why we are offering those people an opportunity to leave the church plan 
with a single guaranteed right of re-entry into the church plan during the 
first 12 months. After that, they can only re-enter the plan if they move 
out of the service area or if the Medicare HMO discontinues this program." 
 
     Hall said he expects fewer than 10 percent of Medicare Supplement 
recipients to take advantage of the pilot program. This program also 
becomes effective Jan. 1, 1997. 
 
 .                                             Board responds to 208th 
General Assembly actions 
 
     The Board  also responded to action taken by the 208th General 
Assembly (1996). The Board delayed for one year its March 1996 action 
regarding the 30-60-90-day coverage provision under the major medical 
provisions of the plan (changing coverage to the end of the month in which 
the termination occurrs) in order to allow further evaluation of the needs 
of certain affected members. 
 
     A parallel change that would have affected pension disability and 
death benefits was disapproved by the 208th General Assembly (1996). 
 
     This recommendation is in response to the further consideration 
requested by the 208th General Assembly (1996) in the following resolution: 
 
     "That the Assembly respond to Commissioner's Resolutions 96-32 and 
96-33 by requesting the Board of Pensions study the proposed amendments to 
Sections 4.6 and 11.3(b) of the Benefits Plan and the amendment reported to 
the General Assembly in Section 13.13 of the Medical Benefits Plan 
(paragraph 43.090) with respect to any inquiries there may entail for those 
affected, such as interim pastors, small-church pastors, retirees, 
survivors, etc." 

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