Health Insurance 2025 – Higher Costs for Everyone Prepare for Open Enrollment

Out of pocket costs will be going up for everyone but there is a way you can avoid this and possibly save money by making an educated choice.

Many across the diocese are currently enrolled in the PPO 100 plan and likely haven’t explored other options. For 2025 the base plan that churches must provide without any premium cost to the individual will be the PPO 90. Last year churches were encouraged to continue paying the full premium for the PPO 100 if possible but changes in pricing structure have made that recommendation no longer feasible. However, the Benefits Committee has come up with a few creative ways to control costs for all involved.

In the past premium increases have been spread across the board with the same percentage applied to all plans. For 2025, however, in response to the report of the Task Force on the Denominational Health Plan and Resolution A 101 from General Convention, the top two plans (PPO 100 and PPO 90) are seeing drastically higher increases. While the PPO 80 and CDHP plans are seeing increases of only 3%, the PPO 90 is increasing 9% and the PPO 100 is increasing 12.5%. Even choosing to pay the difference in premium from the PPO 90 to the PPO 100 would cost more than the maximum out of pocket expense you would incur throughout the year on the PPO 90.

As an incentive to keep costs lower for everyone, the Benefits Committee is recommending that the PPO 90 be used as the base plan and requesting that churches provide individuals selecting this plan with an amount equal to the additional out of pocket maximum they might incur ($500/individual; $1,000/family). This would be taxable income to the individual but would offset the potential increase in healthcare costs through the year and would still keep the health insurance cost to the church lower than if the PPO 100 were chosen. Premiums for 2025 can be found here.

We are also proposing an acceptable alternative in the form of the CDHP 20 with a contribution to the Health Savings Account equal to the maximum out of pocket expense for the year. This is a learning opportunity for many of us in the diocese but one that can have great value. The combination of premium costs and full funding of the HSA reduces the health insurance cost to the church and also reduces the actual out of pocket healthcare expenses for the individual to $0. An added bonus is that the HSA belongs to the individual and will roll over to future years and eventually into retirement.

Unfortunately, due to Medicare rules, the CDHP/HSA option is only available for those who are not enrolled in Medicare (generally anyone over age 65 or about to turn 65 in 2025). However, the Medicare Secondary Payer Small Employer Exception (MSP) can provide an option for those over age 65, on Medicare Part A who work in churches that employ no more than 19 people. This option can result in reduced cost to both employer and employee. Contact Pat Hawkins (phawkins@dioceseofnj.org) for information.

A workshop on the benefits of choosing a CDHP/HSA plan was provided on Wednesday, October 9. 2024. View the recording of the workshop on the diocesan YouTube channel here: https://youtu.be/hZfYVFukHr4. Annual Enrollment opens on Wednesday, October 16, 2024. Information is being sent directly from CPG and is hoped to go out the week of October 14.

New Clergy/Lay Employee information

When calling a new cleric or hiring a new lay employee it is important to contact the Diocesan Benefits Administrator for guidance on requirements, necessary documents and proper enrollment in benefits programs. The Administrator should also be contacted any time there is a change in employment – new clergy or lay employee, change in compensation, change in hours, termination, retirement. Benefits enrollment or changes must be completed within 30 days of eligibility.

- Pensions

All clergy must be enrolled in the Clergy Pension Plan within 30 days of hire.
Lay employees who are scheduled to work at least 1000 hours per year (20 hours per week) must be enrolled in one of the lay pension plans offered through the Church Pension Group. Enrollment must be within 30 days of hire.
Forms should be submitted to the Diocesan Benefits Administrator for processing with CPG. Sending forms directly to CPG may delay processing and may result in errors in assessments and retirement benefits.
- Employment Change Form – use this form for new clergy and to submit compensation changes
- Employee Enrollment Form: Defined Contribution Plans – use this form for new lay employees or for clergy enrolling in the Retirement Savings Plan
- Employee Application Form: Defined Benefit Plan – use this form to enroll a new lay employee in the Lay DB plan

- Health Insurance

Health Insurance must be provided for all clergy and for all lay employees who are scheduled to work at least 1500 hours per year (28 hours per week). The premium for the base plan must be paid by the church without cost to the employee per the guidelines in Canon 36.
Lay employees who are scheduled to work between 1000 hours per year (20 hours per week) and 1500 hours per year (28 hours per week) must be offered the opportunity to enroll in a health insurance plan, however there is no premium payment requirement for the church.
Insurance Plans for 2024
Insurance Plans for 2025
Insurance Premiums for 2024
Insurance Premiums for 2025
- Insurance Enrollment Form for Open Enrollment (2025)
- Insurance Enrollment Form (2024) – Enrollment must be within 30 days of the date of hire, during Open Enrollment in the fall of each year or during a Special Enrollment Period (such as losing previous insurance).
- Medicare Secondary Payer Small Employer Exception Form – For active clergy and lay employees who are over age 65 and are enrolled in Medicare Part A (or if this applies to their spouse who will also be enrolled in the Medical Trust plan), and who are working for a church or organization that has no more than 19 employees, an exception to the Medicare rules can be requested. If approved, Medicare Part A will be the primary payer for hospitalization while all other benefits will continue to be covered under the chosen Medical Trust plan. This exception reduces the premium cost of the Medical Trust plan while providing the same benefits.

- Dental Insurance

Dental Insurance must be provided for all clergy and the premium for the base plan must be paid by the church with no cost to the cleric. If a more expensive plan is selected, the church may pay the full premium or may require the cleric to pay the difference between the premium for the base plan and that of the chosen plan.
Dental Insurance may be provided for lay employees who are scheduled to work at least 1000 hours per year (20 hours per week). If provided, it must be available to all lay employees and the premium for the base plan must be paid by the church with no cost to the employee. If a more expensive plan is selected, the church may pay the full premium or may require the employee to pay the difference between the premium for the base plan and that of the chosen plan. Parity in cost sharing applies.

- Group Life Insurance

Group Life Insurance must be provided for all clergy and the premium must be paid by the church with no cost to the cleric.
Group Life Insurance may be provided for lay employees who are scheduled to work at least 1000 hours per year (20 hours per week). If provided, it must be available to all lay employees and the premium must be paid by the church with no cost to the employee.

- Corporation for Relief of Widows, Widowers and Children of Clergy

The Corporation for the Relief of Widows, Widowers and Children of Clergy of the Protestant Episcopal Church in the State of New Jersey A joint corporation of the Dioceses of New Jersey and Newark to provide financial assistance to widows, widowers and surviving minor children of Episcopal clergy in NJ. Any clergy person under age 60 who has been canonically and actually resident in one of the two dioceses for at least a year can apply to be a contributor. A small annual contribution ($50) for up to 25 years can provide a surviving spouse or partner with an annual annuity for life. Check out the FAQ here. Please contact Pat Hawkins for more information.

Leave Taking and Retirement

- Continuation of Benefits

The Church Medical Trust will offer terminated employees an Extension of Benefits for health and dental insurance that will allow the employee to continue their insurance at the same premium cost currently being paid for a period of up to 36 months.
An offer to convert the group life insurance policy to an individual life insurance policy may be made by the Church Pension Group.

- Retirees and Retirement Planning

Planning Ahead for Retirement – It is advisable to contact Church Pension Group and the Diocesan Benefits Administrator as far in advance of a planned retirement as possible but no less than 3 months prior to retirement.
Group Medicare Advantage Plan– The Diocese of New Jersey provides a subsidy toward retiree health insurance for all clergy who are canonically resident and retire from a position within the diocese. This subsidy is based on years of service within the diocese and is in addition to the subsidy provided by Church Pension Group.
Diocesan Policy
Application – the application will be provided in the retirement package from CPG or can be obtained by contacting the Diocesan Benefits Administrator
Retired Clergy and Spouses