Elgin, IL - Tackling such diverse issues as web site capabilities, E-mail coordination, and medical insurance possibilities, district executives and associates gathered at Bethany Seminary on January 22 to Wrestle with issues of mutual concern. Jeff Garber, director, Brethren Insurance Plans, reported on the Brethren Medical Plan.

Requesting Proposals and Comparing National and Regional Carriers

For 1998 staff and consultants have developed a two-pronged approach for finding alternatives to the high costs of medical insurance. First we asked national insurance carriers to submit proposals for providing our insurance. Two national insurers, Aetna/U.S. Healthcare and CIGNA, have responded. By February 1, local and regional competitors will be asked to submit similar proposals by February 27 at which time we will compare them to those from the national carriers.

Studying the Way Our Plan Is Funded

At the same time we are reviewing proposals, we are studying the way the Brethren Medical Plan is funded. Historically, before 1982, medical insurance for pastors and other church employees was purchased from Equitable. It was what is called a fully insured plan. In 1982, the Pension Board (now BBT) felt that savings could be realized by providing the services and administration ourselves. This marked the beginning of the self-funded medical plan we know today. The self-funded plan worked well until managed care emerged. Now we again must look at taking advantage of new cost savings in the marketplace and possibly buying insurance from someone else.

HMOS in Pennsylvania

This process has started. Since January 1998 we have purchased HMO plans available to most of the pastors in Pennsylvania through an arrangement with Blue Cross Blue Shield. Currently about 70 members of the Pastors Group have signed up. We hope to offer similar choices between standard (fee-for-service) and managed care plans to pastors in all areas where it is possible to do so. Our goal is to provide choices for all our pastors, including our retirees.

HMOS in More Districts

At the end of February, when the regional and local proposals are returned, we plan to offer HMO opportunities to more districts. Our goal is to have some plans in place by as early as July 1 of this year and, if that target is too ambitious, by no later than next January. Districts will be phased in as soon as acceptable alternatives are negotiated. As we add each new option, policy manuals, insurance forms, and administrative manuals will also be updated.

Flexible Spending Accounts and Wellness

"Our first priority is to provide good coverage at reasonable cost and that's where we are devoting the majority of our time. Two other areas which may interest you are flexible spending accounts and wellness programming. Tax laws allow employees to set up accounts that fund out-of-pocket medical and dependent care expenses with pre-tax dollars. Flexible spending accounts may be offered as a Brethren Medical Plan service. These laws also allow the employee to use pre-tax money to pay for medical insurance premiums.

Our wellness program is directed at promoting good health among our members. A recent survey gave us excellent information on the key health issues that concern our pastors. Next steps will depend on the demands of HMO development and finding appropriate funding.

Questions and Answers

DE:Pastors are telling us that their churches can't afford salary increases because insurance costs are gobbling up their budgets, and they are angry when they discover that pastors in Pennsylvania can get their insurance at a lower cost.

JEFF: We intend to make these kinds of options available across the denomination as soon as possible. Also to stay mutually supportive, we are using a small portion of the HMO premiums to offset costs in the standard plan. When we finally accomplish our goal of providing lower cost insurance choices across the denomination, congregations should have more budget for their pastor's salary. It's our top priority.

DE:Are we moving away from one premium to many? Will premiums be based on age, gender and geographical area?

JEFF: It's true that when purchasing an individual policy, insurance for a younger person with a good medical history is less costly than the rate for an older person. However, most group plans do not determine premiums based on age, and we do not wish to set premium rates based on either age or gender. Our plan is to have consistent premiums for each available managed care option and one fee-for-service premium.

We may be able to blend rates for all pastors across the denomination thus making premiums equal. This would mean some would pay below local market rates for coverage and some would pay above. It may prove better to offer options at the local insurer's rate. Our concern with using the blended rate is that churches located in the regions where lower premiums are available may leave the Brethren Medical Plan and buy insurance on their own. We would appreciate input from CODE on this issue.

DE:What does the movement away from self funding (self insurance) mean?

JEFF: It means the insurer will take the risk rather than the Brethren Medical Plan. Members will submit claims to the insurance carrier, not BBT. The carrier will process the claims and handle customer service related to claims. BBT will coordinate enrollment, send out bills, collect premiums, and, if needed, act as an advocate for members.

DE:What if a pastor moves?

JEFF: The Brethren Medical Plan is very portable. If a pastor accepts another call, participation in the BMP can continue. There might be a need to change networks and the possibility that benefits might be slightly different (i.e., an HMO option might replace a PPO or a fee-for-service option might replace a POS option), but there is no loss of eligibility.