1. How do I enroll in the Concordia Plans?
2. I have been placed by the Board of Assignments. Am I eligible for "early enrollment?"
3. Who are considered "eligible dependents"?
4. If I choose not to enroll my dependents in the CHP, must I report them to Concordia Plan Services?
5. Why should I submit a Beneficiary Designation?
6. What type of changes could affect my Plan membership?
7. How do I pay for emergency situations?
8. What is the definition of “full-time” or “part-time” for the different Plans?
9. Are Vicars eligible for health coverage?
10. What is the Rule of 85?
11. How soon should I contact Concordia Plan Services about my retirement?
12. If I terminate LCMS employment, when will my health coverage end?
13. Can Day-Care workers be enrolled in the Plans?
14. Who pays for coverage for the different Plans?
15. My spouse and I work for the same school, but we are enrolled in the Concordia Health Plan (CHP) separately. Can I be included as his dependent?
16. What is a “Cafeteria Plan”?
17. Am I covered while traveling abroad?
18. What can I count toward my housing allowance?
19. Does the Concordia Health Plan cover chiropractic care?
20. How long can my child be covered as a dependent?
21. What's the difference between copays, deductibles, and coinsurance?
22. What is a coinsurance maximum and how does it work?
23. With “Choice,” can an employer choose freely among the different CHP plan coverage options available each year, or do they get locked-in to certain options? In other words, if an employer elects the option with a $500 deductible one year, can they change back to an option with a $300 deductible, or no deductible, the following year?

Whether you are a new employee or transferring from another LCMS employer, enrollment in the Plans is not automatic. You and your employer must complete an Enrollment Form and Beneficiary Designation and submit these forms to the Concordia Plan Services office. Your employer may have a supply of forms on hand. If not, forms can be requested by contacting Concordia Plan Services or can be downloaded from the Concordia Plan Services Web site.

Once your enrollment has been processed, you will receive written confirmation of your coverage effective dates and Summary Plan Description books for each Plan in which you are enrolled. If you have elected to enroll in the Concordia Health Plan, your Identification Cards will be sent under separate cover once the network manager has been notified by Concordia Plan Services of your eligibility.

A graduate who has completed his/her academic requirements for graduation and is placed by the Synod's Board of Assignment for employment with an employer participating in the Concordia Plans may be enrolled in the Concordia Plans by his/her employer effective either:

• the first day of the month after beginning full-time employment with the employer where assigned, or
• the first day of the month following the date the worker was assigned and completed all academic requirements for graduation (even though the individual has not actually begun full-time employment), but no later than the first day of the month following the employment date.

Example: A person who is placed in April, completed his academic requirements and graduates in May, and is employed August 15, can be enrolled effective June 1, July 1, August 1, or September 1.

If no specific request is made regarding the enrollment date at the time application for the Concordia Plans is made, enrollment will become effective the first day of the month following full-time employment.

Upon enrollment in the Concordia Plans, the graduate also becomes eligible to participate in the All-Cause Accident Insurance Program.

For Concordia Plan Services purposes, the term "dependent" is defined as:

a) a spouse who is not legally separated from the worker
b) a worker's unmarried child under age 21, including a stepchild, legally adopted child and foster child
c) an unmarried child, including a stepchild, legally adopted child and foster child, who reaches age 21 may still be considered an eligible dependent if the worker provides more than 51% of support and such child is:

i) totally disabled before attaining age 21, or
ii) a full-time student in an educational institution (but not after attaining age 27 unless totally disabled while a student.)

Yes. Should your spouse and/or child(ren) die while you are an active worker, you would be entitled to a death benefit from the CDSP on their behalf. If we do not have accurate information in our files, benefit payments could be delayed or declined.

In the event of your death while you are an active worker, death benefits from the CDSP are paid only to named beneficiaries.

Please report the following changes to Concordia Plan Services as any one of these could affect your membership:

a) change in marital status–marriage, legal separation or divorce
b) addition of new dependent (spouse or child)
c) removal of a dependent
d) change in employment status–termination of employment, transferring to another LCMS employer, change in the number of hours worked, etc.
e) change of address

For any life-threatening emergency, members and their dependents enrolled in the Concordia Health Plan (CHP) should go to the nearest hospital, regardless if it is a network hospital or not. You will have an applicable copay for the emergency room (ER) visit. After the copay, the CHP pays 100% of the cost of covered network medical expenses for the ER visit. If you are admitted to the hospital, the copay is waived. Be sure that you or someone from your family informs your network manager of the emergency within 48 hours.

If you visit a hospital emergency room when the situation is not life-threatening, or if you fail to contact your health provider within 48 hours, you will receive non-network benefits for the ER charges. In other words, you will be responsible for a percentage of the ER charges after the single or family deductible has been met.

For the Concordia Retirement Plan (CRP) and Concordia Disability and Survivor Plan (CDSP) the definitions are as follows:

• Full-time - Any worker employed more than 20 hours per week and more than 5 months per year must be enrolled in these two Plans.
• Part-time - Any worker employed 20 hours or less per week is ineligible to participate.

For the Concordia Health Plan (CHP) the definitions are as follows:

• Full-time - Any worker employed more than 20, 25, or 30 hours per week, as designated by the employer, and more than 5 months per year, is eligible for CHP coverage.
• Part-time - Any worker employed 20, 25, or 30 hours or less per week, according to the employer’s designation.

If an employer has adopted the CHP, the employer designates – from the three options available – which hourly requirement will be applied to all workers. Once that declaration has been made with our office, all eligible workers regardless of age, sex, occupation, or faith must be offered the opportunity to enroll themselves and any eligible dependents in this health plan. A worker can always refuse participation, but must be given the opportunity to enroll.

Employers can change the “full-time” definition they have elected once a year by completing a Declaration of Hours form. If an employer has not made a specific election in the past, the 20-hour minimum requirement is applicable until the employer decides to change.

Employers can change the definition of “full-time” ONLY as it pertains to the Concordia Health Plan. By making a change to “more than 25 hours” or “more than 30 hours,” it’s possible to have a worker be considered full-time and eligible under the CRP and CDSP, yet part-time and ineligible under the CHP.

Vicars, intern teachers, and other student intern workers who are serving an employer and who will return to a college or seminary to complete their studies are not eligible to enroll in the Concordia Plans or the Accident Insurance Program.

However, those who have completed their formal course-work and will not return to a seminary or college are eligible, and at the option of the employer may be enrolled. The regular Enrollment Form allows for designating this early enrollment intention.

The "Rule of 85" is a formula to help you determine how much of your primary retirement benefit you will receive if you decide to retire before 65. It works like this:
If the sum of your age at retirement PLUS your years of Concordia Retirement Plan participation add up to the number 85 (or greater), you qualify for the "Rule of 85."

Normally, if you decide to retire before age 65 and receive your monthly benefit, your age 65 benefit is reduced because you are receiving your benefit over a longer period of time. For example, the age 62 benefit would be about 88% of the age 65 benefit (it’s reduced to make it payable for 3 extra years). However, by qualifying under the "Rule of 85," the benefit is NOT reduced and you will receive 100% of your age 62 benefit. Should you retire before age 62, and still meet the requirement of the "Rule of 85," you will have 100% of the benefit available at age 62, and can begin benefits immediately upon retirement with the reduction measured from age 62 instead of age 65.

If you retire early, and you meet the "Rule of 85," 100% of the earned benefit up to that point is payable, but not the potential actual benefit had you continued working until 65. That’s because the actual age 65 benefit is based on what a person’s Final Average Compensation is upon retirement. (In other words, were you to actually continue working, there is a good chance that your salary would increase in each of those years boosting your Final Average Compensation amount, plus you would also receive more creditable service.)

Please notify our office approximately 3 months prior to your retirement to start the paperwork.

Coverage by the Concordia Health Plan (CHP) terminates at the end of the calendar month in which you terminate employment with a participating employer. Coverage will end regardless of whether you are in the process of receiving treatment for an existing illness or injury, unless you are totally disabled. You may, however, continue coverage for a maximum of 15 months by giving prompt notice to the Board of Managers and paying the cost of coverage. Simply write a letter to Concordia Plan Services informing us that you are terminating with your employer, but would like an extension of your CHP coverage. The cost to continue coverage is based on your class of coverage before termination and the geographic area where you live.

Day-Care workers are to be enrolled, as all other full-time workers, in the Concordia Retirement Plan and the Concordia Disability and Survivor Plan and offered the option to enroll in the Concordia Health Plan and Accident Insurance Program.

The enrollment and participation provisions of the Concordia Plans apply to Day-Care workers. It enables these full-time workers to have the same opportunity for the protection and benefits of the Plans as do other full-time workers. The employer is then in compliance with the provisions of the Plans and avoids the problem of discrimination in benefits provided to workers. Therefore, the cost of providing benefits for these workers should be included in the total cost for the operation of the program.

The employer is responsible for paying the entire cost of the Concordia Retirement Plan (CRP) and Concordia Disability and Survivor Plan (CDSP) and at least 50% of the cost of the worker's coverage for the Concordia Health Plan (CHP). The worker is expected to pay the cost for dependent health coverage, unless the employer establishes a policy to pay for all or part of the cost for dependent coverage. The employer must be consistent and non-discriminatory for all workers when creating such a policy.

If the worker shares the cost for dependent CHP coverage with the employer, the worker's portion is to be obtained by payroll deduction since an invoice will only be sent to the employer for the total amount due. If the employer sets up a Cafeteria Plan, the cost of CHP dependent coverage can be withheld on a pre-tax basis.

NOTE: When a worker becomes disabled, the employer must continue paying the contributions for that worker’s coverage until the contribution waiver becomes effective the third month following commencement of disability benefits.

A husband and wife, who are both employed by the same or different employers participating in the CHP, must each be enrolled separately as workers if coverage for both is desired. A spouse cannot be enrolled as a dependent if eligible to be enrolled as a worker. This avoids the possible inequity of an employer paying for the coverage of a spouse who is also employed by another LCMS employer. Eligible dependent children may be enrolled by either spouse, but not both.

A Cafeteria Plan is a program that allows workers who pay for all or a part of dependent Concordia Health Plan (CHP) coverage to do so with pre-tax dollars. In other words, such an arrangement allows workers to reduce their salaries for tax purposes and have the reduction used for their share of the CHP cost, thus saving money by lowering their income taxes. Contact the Concordia Plan Services office for information on setting up a Cafeteria Plan.

While traveling outside the United States, members and their dependents enrolled in the Concordia Health Plan are covered for any emergency or urgent care not anticipated before leaving the U.S. Should you need medical care, simply go to the nearest hospital. Unfortunately, you will have to pay the full amount for any charges while there. However, upon returning back to the United States, send the bills to your network provider (Blue Cross Blue Shield) for proper reimbursement. All network copays and coinsurance will still apply as usual (those would simply be deducted from the reimbursement amount). For correct reimbursement, you should provide the foreign exchange rate applicable on the date the services were rendered.

For long-term prescription needs, you should get your prescription filled before you travel. If you require medication while abroad, you will have to purchase the medication and then submit an Express Scripts Out-of-Country Claim Submission form upon your return to the U.S.

You will need to include a detailed copy of the prescription receipt, any translation you can provide (if the original receipt is in a foreign language with foreign currency), and the currency exchange rate.

The law allows ordained and commissioned ministers to exclude from taxable income that part of his or her wages designated as housing allowance to the extent that it is used to provide a home and doesn't exceed the fair rental value of that home (furnished) plus the cost of utilities. If your house is paid for, you can subtract from your reportable annuity such expenses as:

• real estate taxes and insurance on your primary residence
• repair or improvement expenses
• utilities
• lawn care and landscaping
• furnishings or any similar housing expenses.

Your exclusion must be the least of either your actual eligible housing expenses or the annual fair rental value of your primary residence, furnished, including utilities. After these expenses have been subtracted, that balance, if any, should be reported as taxable on your Form 1040.

For any questions that go beyond the scope of this information, we recommend speaking with a tax consultant.

For active workers (non-Medicare members), the Concordia Health Plan (CHP) does provide benefits for chiropractic care. The Summary Plan Description for the CHP defines chiropractic treatment as the “manual manipulation of the spine and related body structures to correct misalignment of the spine and related body structures.” Coverage also includes X-rays to diagnose and determine the treatment along with accompanying therapy (hot or cold packs, mechanical traction, electrical stimulation, paraffin packs, diathermy, manual traction, and ultrasound).

For in-network benefits, no referral is required for a chiropractic visit, and you pay your applicable copay per office visit. There is an annual maximum benefit of $750 per person. For non-network benefits, you will have to satisfy your applicable deductible and coinsurance amounts. See your plan summary for specific amounts. For Medicare Members, Medicare does not cover most chiropractic services. The one chiropractic service they do cover is for manipulation of the spine to correct a “subluxation” (partial dislocation). Medicare does not pay for x-rays. Their Web site, however, states, “You don’t need an X-ray to prove you have a subluxation of the spine.” As always, the CHP will only cover those services that are covered by Medicare.

If you are a member of the Concordia Health Plan (CHP), and as long as your child is a full-time student at an educational institution and is dependent on you for at least half of his/her support, he/she can be covered under the CHP through age 26. Coverage will end should your child turn 27, get married, or enter the military anytime prior to turning age 27.

If your child is no longer eligible as your dependent in the CHP, you may continue his/her health coverage on an individual basis for up to six months (as long as he/she remains unmarried and does not enter military service). The cost of coverage will be the same contribution rate applicable for unmarried workers in the area where your child lives.
Please note: once a child turns 21, our office sends a letter to the parents asking them to let us know if the child is still a full-time student and fits the criteria listed above. The parents are asked to notify our office if health coverage is to continue. If the parents do not respond, the child's coverage will cease.

IT he differences can best be explained by the following example:

A worker, enrolled in Option B, goes to the physician because of a persistent sharp pain in his shoulder. His cost for the office visit is a $20 copay. None of that payment is applied toward his deductible or coinsurance maximum.

The physician recommends seeing a specialist, and so the member visits an orthopedic surgeon. The cost to the member for this orthopedic office visit is another $20 copay. Again, none of that amount is applied to the deductible or coinsurance maximum.

The orthopedic surgeon has the worker undergo an MRI to see what’s bothering the shoulder. The cost of the MRI is $500. The member is responsible for the first $300 of the MRI bill to satisfy the deductible. The remaining $200 is now divided according to coinsurance (a medical term for “sharing the cost”): the Concordia Health Plan (CHP) pays its share which is 85% ($170); the member pays his share which is 15% ($30).

Finally, the shoulder requires outpatient surgery to repair it. The cost for arthroscopic surgery is $2,500. The deductible has already been satisfied for the year, so the coinsurance once again applies: the CHP pays 85% ($2,125), and the member pays 15% ($375).

The cost to the CHP for this whole medical problem: $2,295. The cost to the member: $745

A coinsurance maximum comes into play after you have satisfied your calendar-year deductible and you begin paying your coinsurance amount for medical services. Each time you pay a coinsurance amount, you begin a coinsurance “tally” for the calendar year. Once you hit the coinsurance maximum amount for your particular Concordia Health Plan (CHP) coverage option, the CHP pays 100% for the remainder of the year and you pay no further coinsurance unless you reach your maximum lifetime amount of $2.5 million. The coinsurance maximum varies for each of the four options, so be sure to check your Summary of Benefits or “Choice” information for the exact amount. Just remember, copays do not apply toward your deductible or your coinsurance maximum.

Please Note: Copays still apply even if the coinsurance maximum has been reached

During the election process held each year in the fall, an employer can choose from ANY of the options available. In other words, employers are not "locked in" and can freely "opt down" or "opt up" each year with no penalties or restrictions. For example, if an employer elected Option C one year, that employer could elect to move back to Option A the following year.

Keep in mind, however, that once an option is selected, employers are committed to a full year under that option and will not be able to switch to another option during the year. They will be able to change their election each January 1 to whatever option they feel best fits their situation for that year.

Please note that the same philosophy holds true for those employers who are eligible to offer Worker Choice to their workers—those workers can move up or down among the options offered by their employer on January 1 each year.