Pre-Conference Workbook - North Carolina Conference of The ...

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7. Participants applying at any time other than the initial enrollment period (30 days from the date first
eligible) would may be subject to the one year pre-existing conditions clause. Submission of a valid
Certificate of Insurance may eliminate or decrease this 12 month clause. The exception to this rule would
be possible by a change in life status causing loss of coverage: divorce, death of spouse, loss of spouse’s
employment, reduction of hours regarding spouse’s coverage. Effective January 1, 2014, participants will
no longer be subject to the pre-existing conditions clause under federal healthcare reform. Children
under the age of 19 are not subject to preexisting conditions.
8. Effective January 1, 2004, the Conference health insurance plan will be the primary carrier for
active participants who continue to work past the Medicare eligibility age, and are enrolled in the
Conference health plan.
9. Retired participants should sign up for Medicare parts A and B upon reaching the Medicare eligibility
age. The Medicare Companion Plan is the only plan offered to retirees past this age. Medicare
becomes the primary payer, with the Conference plan as secondary.
10. A participant must be covered in the Conference insurance for five consecutive and
uninterrupted years immediately prior to retirement to retain insurance benefits after
retirement.
All participants enrolled on January 1, 2001 will be prorated under this rule.
11. Pre-Certification of all in-patient admissions is required. Effective January 1, 2004, call Blue
Cross Blue Shield of NC at 800-214-4844. Mental Health benefits should be pre-certified through
Magellan Behavioral Health at 800-359-2422
12. Denial of claims or incorrect processing of claims should be appealed through Blue Cross Blue
Shield of NC. There are two levels of appeal.
13. Payment for the church’s portion of the insurance programs must be made by the
church/charge treasurer. Personal checks cannot be accepted due to IRS regulations
governing ....... Section 125 cafeteria plans. The personal portion of insurance premiums should be
withheld from ....... the participant’s salary by the salary-paying unit on a pre-tax basis.
14. Premiums for health and life insurance may be paid in ADVANCE on a monthly, quarterly,
semi-annual, or annual basis.
15. Lay persons or clergy on maternity/family medical leave may continue their insurance
coverage, as long as the premiums are paid.
16. The Insurance Committee may terminate the coverage for non-payment of premiums. Insurance
payments which are 60 days late (from the date of the bill) will result in termination of benefits. Termination
will take place on the last day of the month in which the 60th day has occurred. Benefits may be reinstated
without lapse in coverage if full payment is made within 30 days of the termination date. Thereafter,
insurance coverage may be reinstated upon full payment and coverage will be effective the first day of the
following month. The one-year waiting period for pre-existing conditions will may apply to all reinstatements
where a lapse in coverage occurs. Children under the age of 19 are not subject to preexisting conditions.
17. In case of termination of coverage, the church is responsible for the premium until the
Treasurer’s Office is notified in writing of such termination.
IV. Statement of Intent
The NC Annual Conference established a Group Health and Life Insurance Plan with the intent of providing
coverage for the active and retired clergy and a Group Health Plan with the intent of providing coverage
for active clergy. However, the Annual Conference reserves the right to terminate the health and life
contracts, in whole or in part, at any time. The Annual Conference, at any time or from time to time, may
amend any or all of the provisions of the health or life plan without the consent of individual participants.
V. Eligibility Policies of Non-Retired Participants
A. If you enroll in the Conference insurance plan, you are eligible for your coverage to begin on the first day of
the month following the date of hire, or appointment. Coverage is not automatic. Completion of an
enrollment form on a timely basis is required (within 30 days of original eligibility).
B. You must work a minimum of 30 hours per week to be eligible for the Conference insurance plans.
C. Health insurance and life insurance through the Conference groups will be available to the following:
1. Clergy who are members in full connection of the Conference, probationary and commissioned
probationary members, associate members, student local clergy, part-time local clergy, interim supplies
(covered as lay employees) serving full-time or part-time (half-time or greater making one-half of minimum
salary as determined by the Pension Worksheet line 7 and working at least 30 hours per week) under
appointment in:
a. One of the churches or charges of the NC Conference.
b. One of the institutions or agencies of this Conference receiving financial support from the
Conference.
c. An institution or agency established to provide a ministry or service provided that:
i. Clergy shall elect in writing within 30 days after the appointment to continue the
coverage. If the coverage is discontinued, a one year waiting period for pre-existing
conditions may apply.
ii. The institution shall be responsible for payment of all insurance premiums by the due
date.
2. Clergy on Leave of Absence, provided a written request to retain benefits is submitted to the Benefits
Manager within 30 days of the appointment of Leave of Absence. The participant is responsible for the
entire monthly rate (church portion and personal portion) by the due date.
D. Post Retirement Benefits
1. Eligibility for post retirement benefits may be viewed in detail in the Board of Pensions Report Section B.