2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston

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2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
2022
PRIEST BENEFITS GUIDE
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022             Medical    Pharmacy     Dental     Vision    Life, AD&D   Additional
        Benefits             Benefits    Benefits   Benefits   Benefits   Disability    Benefits

       If you have Medicare or will become eligible for Medicare in the next 12 months, a
       federal law gives you more choices about your prescription drug coverage. Please
                   see the separate legal disclosure booklet for more details.

2022 Priest Benefits Guide                                                                          2
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022             Medical    Pharmacy         Dental           Vision        Life, AD&D       Additional
        Benefits             Benefits    Benefits       Benefits         Benefits       Disability        Benefits

    YOUR 2022
    BENEFITS
       The benefits described in this guide are effective January 1—December 31, 2022.

    Welcome!
    The Archdiocese of Galveston-Houston is proud to offer a comprehensive benefits package that has been
    customized to meet your needs. We are committed to promoting better health for our priests. This means you
    have access to annual physicals and more—all at no cost to you. Please review this guide carefully and
    consider your options so that you can make the best choices for your situation.
    This benefits guide has been prepared to summarize the many benefit programs and plans available to our
    priests. Please read this information carefully. This benefit guide is a summary and not intended to be
    comprehensive, so please refer to the plan documents pertaining to each plan for more information.

    Open Enrollment
    Open Enrollment will begin October 1st and end November 5th, 2021. Any changes you make to your benefit
    elections during Open Enrollment will become effective on January 1, 2022. To enroll or make changes to your
    benefit elections, you must log on to the ADP web portal. Detailed instructions on how to complete your
    enrollment in ADP are available on the Archdiocese of Galveston-Houston Human Resources website:
    www.archgh.org/hr. If you do not take action during open enrollment, your Priest Benefits will automatically roll
    over to the 2022 plan year.

    What’s New for 2022?
    New Provider: Life, Disability and FMLA
    Effective January 1, 2022, Voya will administer our Life and Disability plans. There are no changes to the
    benefits under these plans. However, if you need to make a claim or report a leave of absence on or after
    January 1, 2022, you must contact Voya. Please see page 3 for contact information and policy numbers.
    OptumRx Formulary Change
    The formulary (or “drug list”) for the Medical/Rx plans will change effective January 1, 2022. This means
    some drugs that are currently covered may be excluded from coverage beginning January 1st. If you are
    taking a drug that will be impacted by this change, you will receive notification in the mail from OptumRx,
    and we encourage you to review this information and discuss your treatment options with your doctor.

2022 Priest Benefits Guide                                                                                              1
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022       Medical        Pharmacy              Dental            Vision        Life, AD&D        Additional
        Benefits       Benefits        Benefits            Benefits          Benefits       Disability         Benefits

                                             Enrolling in Benefits
                                             You can complete your enrollment quickly and easily online by
                                             logging onto ADP. Follow these steps to get started:

                                                  1    Go to www.workforcenow.adp.com

                                                       Log into ADP using your username and password. For login help or
                                                  2
                                                       to reset your password, click on “Forgot Your User ID/Password?”

                                                       Detailed instructions are available on the Human Resources website:
                                                  3
                                                       www.archgh.org/hr

    Your Benefit Premiums
    Benefit                                                                 Who Pays the Cost?

    Medical & Prescription Drug Coverage              The Archdiocese of Galveston-Houston pays the entire cost

    Dental Coverage                                   The Archdiocese of Galveston-Houston pays the entire cost

    Vision Coverage                                                   You pay the full premium amount

    Basic Life/AD&D Insurance                         The Archdiocese of Galveston-Houston pays the entire cost

    Supplemental Life Insurance                                       You pay the full premium amount

    Employee Assistance Program                       The Archdiocese of Galveston-Houston pays the entire cost

    Important Reminders
    Free Preventive Care
    Your Archdiocese of Galveston-Houston Medical Plan covers in-network preventive care at 100%. This means
    you can receive your annual physical, prostate exams, immunizations, and other routine preventive services on
    an annual basis at no cost to you! Remember to ask your doctor if the services are classified as preventive—
    you may have to pay for services received during your visit if they are not classified as preventive.

    Virtual Visits with MDLive
    You have access to virtual visits through MDLive. Whether you’re at home or traveling, access to a board-
    certified doctor is available 24 hours a day, 7 days a week through the phone, online video, or the BCBSTX
    Mobile App. You can speak to a doctor immediately or schedule an appointment based on your availability.
    Please see page 8 for more details about this service.

    BCBSTX 24/7 Nurseline
    The BCBSTX 24/7 Nurseline gives you access to a team of registered nurses available to answer your health
    questions and help you decide whether you should go to the emergency room, urgent care center, or make an
    appointment with your doctor. Nurses are available 24 hours a day, 7 days a week. This valuable resource can
    help you learn about health conditions and enable you to make smart health care decisions.

2                                                                                             Archdiocese of Galveston-Houston
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022              Medical             Pharmacy           Dental             Vision         Life, AD&D         Additional
        Benefits              Benefits             Benefits         Benefits           Benefits        Disability          Benefits

    The Benefits Help Line
    The Archdiocese of Galveston-Houston Benefits Help Line is a
    valuable resource for your health, welfare, and insurance
    benefits. Talk to a personal benefits advocate about your
    eligibility, enrollment, benefit questions, finding a provider,
    billing or claim questions, and more!
    The Benefits Help Line is available Monday through Friday,
    7:00 AM to 6:00 PM Central Time.
          855-664-8164                          agh_benefits@ajg.com

    Important Contacts
                Benefit                         Vendor                         Phone                        Website/Email

                                            Archdiocese of
          Human Resources                                               713-652-8265                      www.archgh.org/hr
                                          Galveston-Houston

                Medical                  Blue Cross Blue Shield
                                                                        800-521-2227                       www.bcbstx.com
            (Group #274679)                of Texas (BCBSTX)

          Prescription Drugs                   OptumRx                 1-855-524-0381                     www.optumrx.com

             Virtual Visits                     MDLive                  888-680-8646                   www.mdlive.com/bcbstx

                                         Blue Cross Blue Shield
               Nurseline                                                800-581-0393                                N/A
                                           of Texas (BCBSTX)

       Diabetes & Hypertension
               Support                          Livongo                 800-945-4355                   join.livongo.com/ARCHGH
       (Registration Code: ARCHGH)

                Dental                   Blue Cross Blue Shield
                                                                        800-521-2227                       www.bcbstx.com
            (Group #274852)                of Texas (BCBSTX)

                 Vision
                                                 VSP                   1-800-877-7195                       www.vsp.com
           (Group #12001362)

            Life and AD&D
                                                 Voya                  1-888-238-4840                   www.voya.com/claims
            (Group #723517)

        Employee Assistance                                                                          www.guidanceresources.com
                                                Voya                    877-533-2363
             Program                                                                                       Web ID: MY5848i
                                             (ComPsych)               TTY: 800-697-0353
            (Group #723517)                                                                           Mobile App: GuidanceNow℠

                                                                                                         travelsecurity.garda.com
          Travel Assistance                      Voya              In the US: 800-859-2821
                                                                                                  Email: ops@europassistance-usa.com
            (Group #723517)               (Europ Assistance)      Worldwide: +1-202-296-8355
                                                                                                      Contract Number: 17372020

      Funeral Planning, Will Prep           Everest Funeral
                                                                       1-800-913-8318                  everestfuneral.com/voya
             & Concierge                      Concierge

2022 Priest Benefits Guide                                                                                                             3
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022                     Medical                     Pharmacy                       Dental                       Vision                    Life, AD&D                   Additional
          Benefits                     Benefits                     Benefits                     Benefits                     Benefits                   Disability                    Benefits

    MEDICAL
    BENEFITS
    The Archdiocese of Galveston-Houston offers two medical plans through Blue Cross Blue Shield of Texas
    (BCBSTX). With a PPO plan, you have the ability to see the doctor of your choice. However, you will pay less out
    -of-pocket if you choose doctors, hospitals, and other healthcare providers in the Blue Choice PPO Network. To
    find an in-network provider, go to www.bcbstx.com and click on “Find a Doctor or Hospital” or contact the
    Benefits Help Line by emailing agh_benefits@ajg.com or call 1-855-664-8164.

    Medical Services                                                                                                                Priest Plan
    BCBSTX Blue Choice Network                                                                        In-Network                                                  Out-of-Network

    Annual Deductible                                                                                    $400                                                            $800

    Coinsurance                                                                        You pay 10% after deductible                                   You pay 40% after deductible

    Out-of-Pocket Maximum                                                                               $1,500                                                         $3,000

    Preventive Care                                                                              Plan pays 100%                                              40% after deductible

    Primary Care Office Visit                                                                        $15 copay                                               40% after deductible

    Specialist Office Visit                                                                          $25 copay                                               40% after deductible

    MDLive Virtual Visit                                                                             $15 copay                                                     Not Covered

    Urgent Care Center                                                                               $25 copay                                               40% after deductible

    Emergency Room                                                                                  $100 copay                                                      $100 copay
                                                                                               (copay waived if admitted)                                     (copay waived if admitted)

    Diagnostic Tests                                                                             Plan pays 100%                                              40% after deductible
    X-ray, labs, blood work                                                                 (LabCorp or Quest Diagnostics)

    Imaging                                                                                  10% after deductible                                            40% after deductible
    MRI, CT/PET Scan

    Inpatient Services                                                                       10% after deductible                                            40% after deductible

    Outpatient Services                                                                      10% after deductible                                            40% after deductible

    The Archdiocese of Galveston-Houston believes its Medical and Pharmacy Plan as described in this guide is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (PPACA). As
    permitted by PPACA, a grandfathered health plan must preserve certain basic health coverage that was already in the Plan when that law was enacted. Being a grandfathered health plan means that your
    Plan may not include certain consumer protections (health and pharmaceutical coverages) of PPACA that apply to other (non-grandfathered) plans, for example, the requirement for the provision of
    preventive health services without any cost sharing. However, the grandfathered plans must comply with certain other consumer protections in PPACA, for example, the elimination of lifetime limits on
    benefits. As a grandfathered plan, this Plan, self-funded by the Archdiocese of Galveston-Houston, does not provide medical and pharmaceutical coverage that contravenes with Catholic teachings.
    Questions regarding which protections (Medical and Pharmaceutical coverages) apply and which protections (Medical and Pharmaceutical coverages) do not apply to our grandfathered health plan status
    can be directed to the plan administrator, Charlie Pavlovsky, at 713-652-8261.

4                                                                                                                                                           Archdiocese of Galveston-Houston
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022             Medical        Pharmacy             Dental             Vision       Life, AD&D     Additional
        Benefits             Benefits        Benefits           Benefits           Benefits      Disability      Benefits

    TELEHEALTH
    BENEFITS
    Get Care When and Where You Need It
    MDLive provides you with access to board-certified doctors anytime and anywhere it’s most convenient for
    you—at home, work, or on the go. MDLive has the nation’s largest telehealth network of doctors ready to
    provide convenient, quality care by phone or secure video. Doctors can diagnose a wide range of non-
    emergency medical issues and even send prescribed medications to your pharmacy of choice. MDLive
    physicians can treat the following:
               Flu                          Sore throat                     Headache                Rash
               Allergies                    Fever                           Nausea/vomiting         Ear problems
               Cough                        Sinus infection                 Pink eye                UTI

                                            ON YOUR PLAN:
                                            $15 COPAY
    How to Get Started                                                          www.mdlive.com/bcbstx
    To register, go to www.mdlive.com/bcbstx. Enter
    your first and last name, date of birth, and BCBSTX
    member ID number. Once you have an account, you                             888-680-8646
    can browse doctor profiles, view available
    appointment times, and schedule an appointment
    with the doctor of your choice.                                             www.mdlive.com/getapp

2022 Priest Benefits Guide                                                                                                   5
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022                          Medical                         Pharmacy                            Dental     Vision    Life, AD&D      Additional
           Benefits                          Benefits                         Benefits                          Benefits   Benefits   Disability       Benefits

                                                                                             24/7 Nurseline
                                                                                             Health happens—good or bad, 24 hours a day, 7 days a week. That
                                                                                             is why BCBSTX has registered nurses waiting to talk to you
                                                                                             whenever you call the 24/7 Nurseline. Registered nurses are
                                                                                             available to answer health questions and to help you decide
                                                                                             whether you should go to the emergency room, urgent care, or
                                                                                             make an appointment with your doctor. Plus when you call, you can
                                                                                             also access an audio library of more than 1,000 health topics—from
                                                                                             allergies to surgeries—with more than 500 topics available in
                                                                                             Spanish. Call the 24/7 Nurseline anytime at 800-581-0393.

    Blue Access For Members
    Get information about your health benefits anytime, anywhere. Use your computer, phone or tablet to access
    the Blue Cross Blue Shield of Texas (BCBSTX) secure member website, Blue Access for Members. With Blue
    Access for Members, you can:

     Provider Finder
      Locate a doctor, hospital or facility in the BCBSTX Blue Choice PPO Network

     ID Cards
      Request a new ID card, or print a temporary one

     Wellness Tools & Resources
      Access handy tools like Well onTarget, which has fitness trackers, food diaries,
      and more

     Claims
      View or print Explanation of Benefits statements, and check the status or
      history of a claim

     My Coverage
      See your benefits at a glance or in detail

     Customer Service
      Use secure messaging to get in touch with helpful customer service
      representatives

    It’s easy to get started! Visit www.bcbstx.com/member and click on “Register Now” under the blue Member
    Login button. You will need the information on your BCBSTX ID card to complete your registration. If you do
    not have this information, you can call the BCBSTX Help Desk at 888-706-0583 for assistance.

    BCBSTX Mobile App
    Many of the services and resources available through Blue Access for
    Members can also be found right in the palm of your hand! With the
                                                                                                                              IT’S EASY TO GET
    BCBSTX Mobile App, you can access your important health plan
    information wherever you are. Text* BCBSTXAPP to 33633 to get the
    app, or download it directly from the App Store or Google Play.
                                                                                                                              CONNECTED
    *Message and data rates may apply. Terms and conditions and privacy policy at bcbstx.com/mobile/text-messaging.

6                                                                                                                                      Archdiocese of Galveston-Houston
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022             Medical       Pharmacy          Dental          Vision       Life, AD&D      Additional
        Benefits             Benefits       Benefits        Benefits        Benefits      Disability       Benefits

    Blue365 Discounts
    Blue365 is just one more advantage you have by being a Blue Cross Blue Shield of Texas (BCBSTX) member!
    With this program, you may save money on health and wellness products and services from top retailers that
    are not covered by insurance. There are no claims to file and no referrals or preauthorizations.
    Once you sign up for Blue365 at blue365deals.com/bcbstx, weekly “Featured Deals” will be emailed to you.
    These deals offer special savings for a short period of time. Below are some of the ongoing deals you can
    access on the Blue365 website:

                               EyeMed | Davis Vision
                               You can save on eye exams, eyeglasses, contact lenses and accessories. You have
                               access to national and regional retail stores and local eye doctors. You may also get
                               possible savings on laser vision correction.

    TruHearing® | Beltone™ | American Hearing Benefits
    Receive exclusive access to low pricing on today’s latest hearing aid technology. You
    could get savings on hearing tests, evaluations and hearing aids.

                               Sun Basket | Nutrisystem® | Farmbox Direct
                               Help reach your weight loss goals with savings from leading programs. You may save
                               on healthy meals, membership fees (where applicable), and nutritional products and
                               services.

    Fitbit®
    You can customize your workout routine with Fitbit’s family of trackers and
    smartwatches that can be employed seamlessly with your lifestyle, your budget, and
    your goals. You’ll get a 20% discount on Fitbit devices plus free shipping.

                               Reebok | SKECHERS®
                               Reebok makes top athletic equipment for all people. Get 20% off select models.
                               SKECHERS, a leader in the footwear industry, offers exclusive pricing on select styles—
                               get 30% off plus free shipping online.

    Gympass
    Gympass gives you access to 12,000+ gyms and studios nationwide, virtual personal
    training, and online therapy for as low as $19.99 per month. Partner gyms include Life
    Time Fitness, F45, Barry’s, Gold’s Gym, SoulCycle, and more!

2022 Priest Benefits Guide                                                                                               7
2022 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
Your 2022                       Medical                     Pharmacy                         Dental                        Vision            Life, AD&D           Additional
          Benefits                       Benefits                     Benefits                       Benefits                      Benefits           Disability            Benefits

    PHARMACY
    BENEFITS
    The Archdiocese of Galveston-Houston Medical/Rx plans include comprehensive prescription drug coverage.
    You are automatically enrolled in prescription drug coverage as part of the Priest Medical/Rx Plan. Our
    prescription drug benefits administered by OptumRx.

    Prescription Drug Benefits                                                                                                       Priest Plan
    OptumRx                                                                                                                            In-Network

    Retail Pharmacy
    30-day supply
                                                 Generic                                                                               $5 copay
                                            *
                                         Preferred Brand                                                                              $30 copay
                                   *
                                     Non-Preferred Brand                                                                              $55 copay
    OptumRx Home Delivery
    90-day supply
                                                 Generic                                                                              $0 copay
                                            *
                                         Preferred Brand                                                                              $60 copay
                                   *
                                     Non-Preferred Brand                                                                             $110 copay
    * For certain preferred brand and non-preferred brand drugs, you may be required to try a generic equivalent first. See below for more details.

    About Step Therapy
    The Step Therapy Program encourages safe and cost-effective medication use. The program is designed to
    keep members safe and save money when possible. To receive coverage for certain medications, you may
    need to first try a proven, generic equivalent before using a more costly treatment, if needed. For a complete
    list of drugs covered by your plan, as well as a list of Step Therapy drugs, visit www.optumrx.com.

                                                            Generic Drugs                                      Non-Preferred Brand Drug                Preferred Brand Drug
                                                            You can save on your out-of-pocket                 A name brand drug that may have a       Preferred brand drugs are commonly

    TERMS TO                                                costs by choosing generic drugs.
                                                            Brand and generic drugs are
                                                            regulated by the FDA and are
                                                                                                               therapeutic alternative available as
                                                                                                               either a generic or preferred brand
                                                                                                               drug. These drugs will generally be
                                                                                                                                                       prescribed name-brand drugs that
                                                                                                                                                       has been selected based on its
                                                                                                                                                       clinical effectiveness, safety, and

    KNOW
                                                            chemically and medically the same.                 the most expensive.                     cost. Preferred brand drugs will
                                                            However, generic drugs typically                                                           generally be more expensive than
                                                            cost significantly less. Talk to your              Formulary                               generic drugs, but less expensive
                                                            doctor to find out if generic drugs                The list of prescription drugs covered than non-preferred brand drugs.
                                                            are right for you.                                 by the plan. Also called a “drug list.”

8                                                                                                                                                      Archdiocese of Galveston-Houston
Your 2022             Medical     Pharmacy           Dental           Vision        Life, AD&D       Additional
        Benefits             Benefits     Benefits         Benefits         Benefits       Disability        Benefits

                                                                 Save with Generic Drugs
                                                                 Both prescription and over-the-counter generic drugs
                                                                 can be less costly than brand name drugs. You can
                                                                 save on your out-of-pocket costs by choosing
                                                                 generic medications. Both brand and generic drugs
                                                                 are regulated by the Food and Drug Administration
                                                                 (FDA) and are chemically and medically the same.
                                                                 However, generic drugs tend to cost significantly less
                                                                 than their brand name equivalents! We encourage
                                                                 you to talk to your doctor to find out if generic drugs
                                                                 are right for you.

    OptumRx Mail Saver
    Do you take medicine every day for diabetes, asthma, or another condition? These are called maintenance
    medications. Mail Service Saver is a program that helps you better manage your maintenance medications on
    an ongoing basis. You can save both time and money by filling your prescriptions for maintenance
    medications through OptumRx Home Delivery. Not only is home delivery safe and reliable, it also offers some
    advantages:

     Cost Savings — You may pay less for your
      medication with a 90-day supply from OptumRx
      Home Delivery.

     Convenience — Get free standard shipping on
      medications delivered to your mailbox.

     24/7 Access & Reminders — Speak to a licensed
      pharmacist who can answer your questions any
      time, any day. You can even set up text reminders
      to help you remember to take or refill your
      medications.

    Home Delivery is optional, but highly encouraged. Get started with OptumRx Home Delivery by visiting
    www.optumrx.com or call 1-855-524-0381.

    OptumRx Member Website & Mobile App
    From the OptumRx member website and mobile app, you can easily
    refill a medication, transfer a retail prescription to home delivery,
                                                                               IT’S EASY TO GET
    access the most current drug coverage information, compare potential
    cost savings, and more! To register, visit www.optumrx.com or
    download the OptumRx Mobile App from the App Store or Google Play.
                                                                               CONNECTED
2022 Priest Benefits Guide                                                                                                 9
Your 2022        Medical         Pharmacy            Dental          Vision        Life, AD&D      Additional
         Benefits        Benefits         Benefits          Benefits        Benefits       Disability       Benefits

     LIVONGO
     DIABETES & HYPERTENSION

     The Simpler Way to a Healthier You
     Testing and tracking your blood glucose levels and blood pressure are critical steps to successfully manage
     diabetes and hypertension, but they can be a time-consuming, manual process. Now, there’s a better way!
     Livongo provides you with an advanced blood pressure monitor, blood glucose meter, unlimited test strips, and
     on-demand coaching anytime, 100% paid for by the Archdiocese of Galveston-Houston.

     Join Livongo and You’ll Get:
           FREE advanced blood
           pressure monitor and/or                   Real-time support from                Personalized tips & articles
           blood glucose meter                       coaches when you need it              picked just for you

                                                     Send health summary
           Automatic uploads mean                                                          Optional family alerts keep
                                                     reports to your doctor
           no more logbooks                                                                everyone in the loop
                                                     directly from your meter

                            A more helpful meter
                            Get advice on what to do next. Livongo’s advanced devices give you a personalized tip
                            right after each blood glucose or blood pressure check.

     Unlimited test strips, no cost to you
     With Livongo, test strips are ordered directly from your meter and delivered for free right
     to your door.

                                    Register at join.livongo.com/ARCHGH
                              or call 800-945-4355 with code: ARCHGH
10                                                                                          Archdiocese of Galveston-Houston
Your 2022              Medical                 Pharmacy     Dental          Vision           Life, AD&D   Additional
         Benefits              Benefits                 Benefits   Benefits        Benefits          Disability    Benefits

    DENTAL
    BENEFITS

    Dental coverage is important to your overall health and wellness. The Archdiocese of Galveston-Houston
    provides Dental coverage for our priests through Blue Cross Blue Shield of Texas (BCBSTX). The Dental PPO
    Plan helps you with the cost of preventive, basic, and major dental services.

    This plan gives you the freedom to select any dentist, but you will pay less out-of-pocket when you choose a
    provider in the BCBSTX Dental Network. To find an in-network provider, go to www.bcbstx.com and click on
    “Find a Doctor.” Next scroll to the bottom of the page and select “Find a Dentist.” Enter your search criteria to
    find in-network dentists near you.

    Dental Services                                                                    Dental PPO Plan

    BCBSTX Dental PPO Network                                                     In-Network and Out-of-Network

    Annual Deductible                                                                         $50

    Annual Benefit Maximum                                                            $1,500 per person

    Diagnostic & Preventive Services                                          Plan pays 100%; deductible waived
    Exams, cleanings, bitewing x-rays, sealants

    Basic Services                                                              You pay 20% after deductible
    Endodontics, periodontics, root canals, oral surgery

    Major Services                                                              You pay 50% after deductible
    Crowns, inlays, onlays, prosthodontics, implants

    Out-of-Network Dental Claims
    While benefits appear to be the same for in-network and out-of-network dentists, please remember that if you
    choose an out-of-network dentist, there will be a maximum limit that BCBSTX will reimburse. If an out-of-
    network provider charges over this amount, you may be balance billed by your dentist for the difference
    between the provider’s charge and the maximum reimbursement allowed by the plan. Additionally, you must
    file your own claim to be reimbursed for out-of-network services. You can find the claim form and instructions
    posted under the “Forms” section of the Archdiocese of Galveston-Houston Human Resources website.

2022 Priest Benefits Guide                                                                                                     11
Your 2022                    Medical                   Pharmacy                      Dental                      Vision                   Life, AD&D            Additional
           Benefits                    Benefits                   Benefits                    Benefits                    Benefits                  Disability             Benefits

     VISION
     BENEFITS

     The Archdiocese of Galveston-Houston offers all priests vision coverage through VSP. Eye care is a vital
     component of a healthy lifestyle. Regular eye examinations can not only determine your need for corrective
     eyewear but also may detect general health problems in their earliest stages. Your vision plan makes regular
     exams and purchasing contacts or glasses simple and affordable.

     With your vision coverage, you have access to quality vision care. The plan uses VSP’s network of vision care
     providers, including retail optical centers, optometrists, and opticians. Although you can see any eye doctor you
     choose, you’ll save the most money if you choose an eye doctor from VSP’s extensive network of providers.
     Your plan also offers special pricing for LASIK and PRK correction procedures from contracted providers. To
     access a list of in-network providers and retail centers, or to see a list of contracted LASIK and PRK correction
     providers, visit www.vsp.com or call 1-800-877-7195.

     Vision Services                                                                                                    Vision Plan
     VSP Vision Network                                                               In-Network                                                         Out-of-Network

     Eye Examinations                                                                 $20 copay                                                   Reimbursed up to $50

     Lenses
                                 Single Vision                                        $20 copay                                                   Reimbursed up to $50
                                 Lined Bifocal                                        $20 copay                                                   Reimbursed up to $75
                                Lined Trifocal                                        $20 copay                                                   Reimbursed up to $100
                                    Lenticular                                        $20 copay                                                   Reimbursed up to $125
                     Photochromic/Transition                                          $20 copay                                                    Reimbursed up to $5
                       *
                         Standard Progressive                                         $20 copay                                                   Reimbursed up to $75

     Frames                                                                       $150 allowance                                                  Reimbursed up to $70

                                                                                  $150 allowance
     Elective Contact Lenses                                                                                                                      Reimbursed up to $105
                                                              Applies to materials and exam (fitting & evaluation)

     Benefit Frequency
                              Examination                                                                       Once every 12 months
                  Lenses OR Contact Lenses                                                                      Once every 12 months
                                   Frames                                                                       Once every 12 months

     * $80—$90 copay for Premium Progressive Lenses, $120—$160 copay for Custom Progressive Lenses. All out-of-network progressive lenses are reimbursed up to $75.

12                                                                                                                                                     Archdiocese of Galveston-Houston
Your 2022                       Medical                      Pharmacy                        Dental                         Vision                     Life, AD&D                   Additional
          Benefits                       Benefits                      Benefits                      Benefits                       Benefits                    Disability                    Benefits

    LIFE/AD&D
    INSURANCE
    Life and AD&D
    The Archdiocese of Galveston-Houston provides all priests with Basic Life and AD&D Insurance at no cost to
    you, and you also have the option to purchase Supplemental Life Insurance. Please note retired priests are only
    eligible for the Basic Life Insurance paid for by the Archdiocese, not AD&D Insurance. Review the chart below
    for details. Effective January 1, 2022, these plans will be administered by Voya.

                                                                    Basic Life/AD&D Insurance                                                      Supplemental Life Insurance
                                                                                  Priest Benefit                                                                   Priest Benefit

    Benefit Amount                                                                    $12,000                                                              Increments of $25,000
    Maximum Benefit                                                                   $12,000                                         5x your annual earnings, not to exceed $100,000 2
                                                                              To 67% at age 65                                                                To 67% at age 65
    Age Reduction Schedule
                                                                              To 50% at age 701                                                               To 50% at age 703
    Benefit Paid By                                              Archdiocese of Galveston-Houston                                                                        You
    (1) Benefit reduces on January 1st following the date you attain age 65 and age 70.
    (2) If you are newly eligible, you may elect up to the guarantee issue amount without Evidence of Insurability (EOI). If you waived coverage when you were first eligible or were denied coverage, any amount
       elected will be subject to EOI. If you currently have coverage, any increases in coverage will require EOI. Elections requiring EOI will not become effective until and unless approved by Voya.
    (3) Benefits reduce on the first of the month following the date of the change, to the noted percentage rounded to the next higher multiple of $500 if not already a multiple of $500.

2022 Priest Benefits Guide                                                                                                                                                                                          13
Your 2022       Medical           Pharmacy           Dental            Vision         Life, AD&D       Additional
          Benefits       Benefits           Benefits         Benefits          Benefits        Disability        Benefits

     WORK-LIFE
     BALANCE
     Employee Assistance Program
     We all experience times when we need a little help preparing for and dealing with the stresses of life. Your
     Employee Assistance Program (EAP), which is provided to you at no additional cost, gives you the ability to
     contact master’s-degreed clinicians 24/7 by phone, online, live chat, email, and text. There’s even a mobile app
     for assistance on the go. Receive referrals to support groups, a network counselor, community resources, or
     your health plan. If necessary, you’ll be connected to emergency services.
     Your Employee Assistance Program (EAP) includes up to 3 face-to-face counseling sessions per issue.
     Assistance is immediate, personal, and available when you need it. EAP services can help you with:
         Depression, grief, loss, and emotional wellbeing             Financial and legal concerns
         Life improvement and goal setting                            Stress or anxiety with work or personal life
         Addictions and substance abuse                               Hiring movers or home repair contractors

     To take advantage of the services available to you through your EAP, call 877-533-2363 (TTY 800-697-0353)
     or visit guidanceresources.com to explore a wealth of information online, including videos, guides, articles,
     webinars, resources, self-assessments and calculators. ComPsych is the EAP vendor that Voya utilizes for
     Archdiocese of Galveston-Houston members.

                                    Travel Assistance
                                    You can get support while traveling 100+ miles from home or internationally,
                                    including passport, visa, weather and currency exchange information, help
                                    replacing lost passports or credit cards, referrals to medical providers, emergency
                                    medical evacuation, legal and interpreter services, and more! Travel assistance is
                                    available worldwide 24/7.
                                    In the US, toll-free: 800-859-2821              Everywhere else: +1-202-296-8355
                                    Online: travelsecurity.garda.com                Contract Number: 17372020
                                    Email: ops@europassistance-usa.com

14                                                                                              Archdiocese of Galveston-Houston
Your 2022             Medical    Pharmacy        Dental          Vision        Life, AD&D      Additional
        Benefits             Benefits    Benefits      Benefits        Benefits       Disability       Benefits

    Everest Funeral Planning, Will Prep, and Concierge Services
    Everest is pleased to provide a value-added service that can empower individuals who are dealing with funeral-
    related issues. Everest, the first nationwide funeral planning and concierge service, is an independent
    consumer advocate who works on your behalf. Everest’s sole purpose is to provide the information you need to
    make the most informed decisions about all funeral related issues and then put those wishes into action.

    Pre-Planning Services                                    At-Need Services
    24/7 Advisor Assistance                                  Family Support
      To discuss funeral planning issues                      Family assistance and plan implementation
                                                               Communicate the personal funeral plan to the
    PriceFinder Research Reports                                funeral home, removing the family from a sales-
      The only nationwide database of funeral home
                                                                focused environment
        prices                                                 Provide 24-hour assistance throughout the
      Detailed, local funeral home price comparisons
                                                                funeral process
    Online Planning Tools                                      Expedited life insurance claim process—eligible
      Create a personal profile                                beneficiaries may have access to a portion of
      “10 key decisions” planner                               the life insurance funds in as little as two
      “My Wishes” planning guide                               business days following receipt of the claim
      Reference guide                                          form (varies by state law)
      Information stored and maintained in a secure
                                                             Negotiation Assistance
        data warehouse                                         Gather pricing information and present it to the
    Online Will Prep                                            family in an easy-to-read format
      Online tool allows users to create customized           Negotiate funeral service pricing with local
        legal documents such as Will, Health Care               funeral homes
        Directive, Power of Attorney, and more                 Help the family compare prices of caskets and
      Users are asked a series of easy-to-answer
        questions with helpful explanations and
        examples
      Based on responses, a customized legal
        document unique to the individual’s situation is
        created

    Take advantage of the helpful resources
    available through Everest

          everestfuneral.com/voya

          1-800-913-8318

2022 Priest Benefits Guide                                                                                           15
Your 2022             Medical            Pharmacy          Dental            Vision          Life, AD&D       Additional
         Benefits             Benefits            Benefits        Benefits          Benefits         Disability        Benefits

     Important Contacts
               Benefit                      Vendor                      Phone                            Website/Email

                                       Archdiocese of
         Human Resources                                            713-652-8265                       www.archgh.org/hr
                                     Galveston-Houston

              Medical              Blue Cross Blue Shield
                                                                    800-521-2227                        www.bcbstx.com
           (Group #274679)           of Texas (BCBSTX)

        Prescription Drugs                 OptumRx                 1-855-524-0381                      www.optumrx.com

            Virtual Visits                  MDLive                  888-680-8646                    www.mdlive.com/bcbstx

                                   Blue Cross Blue Shield
             Nurseline                                              800-581-0393                              N/A
                                     of Texas (BCBSTX)

     Diabetes & Hypertension
             Support                        Livongo                 800-945-4355                    join.livongo.com/ARCHGH
     (Registration Code: ARCHGH)

               Dental              Blue Cross Blue Shield
                                                                    800-521-2227                        www.bcbstx.com
           (Group #274852)           of Texas (BCBSTX)

               Vision
                                              VSP                  1-800-877-7195                        www.vsp.com
          (Group #12001362)

           Life and AD&D
                                              Voya                 1-888-238-4840                    www.voya.com/claims
           (Group #723517)

       Employee Assistance                                                                        www.guidanceresources.com
                                             Voya                   877-533-2363
            Program                                                                                     Web ID: MY5848i
                                          (ComPsych)              TTY: 800-697-0353
           (Group #723517)                                                                         Mobile App: GuidanceNow℠

                                                                                                      travelsecurity.garda.com
         Travel Assistance                  Voya              In the US: 800-859-2821
                                                                                               Email: ops@europassistance-usa.com
           (Group #723517)           (Europ Assistance)      Worldwide: +1-202-296-8355
                                                                                                   Contract Number: 17372020

       Funeral Planning, Will            Everest Funeral
                                                                   1-800-913-8318                   everestfuneral.com/voya
         Prep & Concierge                  Concierge

                                     The Archdiocese of
         Benefits Help Line                                         855-664-8164                     agh_benefits@ajg.com
                                     Galveston-Houston

     Know Your Numbers
     Use the space below to write in your identification number
     (located on the front of your BCBSTX ID card)

     Identification Number:
     Medical Group Number:                 274679
     Dental Group Number:                  274852

16                                                                                                    Archdiocese of Galveston-Houston
Your 2022               Medical              Pharmacy                 Dental                Vision               Life, AD&D            Additional
         Benefits               Benefits              Benefits               Benefits              Benefits              Disability             Benefits

    This Priest Benefits Guide highlights recent plan design changes and is intended to fully comply with the requirements of a self-funded Church Plan
    Sponsor as a Summary of Material Modifications and should be kept with your most recent Summary Plan Description.

    This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the
    terms, coverage, exclusions, limitations and conditions of the actual contract language. The policies and contracts themselves must be read for those
    details. Policy forms for your reference will be made available upon request. The intent of this document is to provide you with general information
    regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your
    specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your
    general counsel or an attorney who specializes in this practice area.

    The Archdiocese of Galveston-Houston believes its Medical and Pharmacy Plan as described in this guide is a “grandfathered health plan” under the
    Patient Protection and Affordable Care Act (PPACA). As permitted by PPACA, a grandfathered health plan must preserve certain basic health coverage
    that was already in the Plan when that law was enacted. Being a grandfathered health plan means that your Plan may not include certain consumer
    protections (health and pharmaceutical coverages) of PPACA that apply to other (non-grandfathered) plans, for example, the requirement for the
    provision of preventive health services without any cost sharing. However, the grandfathered plans must comply with certain other consumer
    protections in PPACA, for example, the elimination of lifetime limits on benefits. As a grandfathered plan, this Plan, self-funded by the Archdiocese of
    Galveston-Houston, does not provide medical and pharmaceutical coverage that contravenes with Catholic teachings. Questions regarding which
    protections (Medical and Pharmaceutical coverages) apply and which protections (Medical and Pharmaceutical coverages) do not apply to our
    grandfathered health plan status can be directed to the plan administrator, Charlie Pavlovsky, at 713-652-8261.

2022 Priest Benefits Guide                                                                                                                                         17
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