Two ELCA-Recommended Health Benefit Options for 2021

Jun. 23, 2020

The ELCA Health Plan has always been a community plan, designed to meet the specific needs of ELCA congregations, institutions, social ministry organizations, churchwide organizations, seminaries, and those serving in these ministries.

To answer calls for greater flexibility in benefit features and pricing, Portico has, since 2014, offered four “metallic” ELCA-Primary health benefit options. At that time, the ELCA Church Council approved all four options, while recommending Gold+ as the option most like coverage offered before 2014. And most sponsoring employers have aligned with the ELCA’s recommendation — 83% chose Gold+ for 2020.

Last summer, the 2019 Churchwide Assembly passed a resolution asking the Church Council and Portico to review the ELCA recommendation in the context of a changing church, and look for ways to increase flexibility. Following significant analysis, the Church Council’s recommendation will include not one but two health benefit options for next year.

Important Context

As the cost of health care coverage increased nationally in the years leading up to health care reform, ELCA sponsoring employers and members began to call for greater flexibility – in terms of both price and features like a high deductible health plan paired with a health savings account (HSA). When passage of the Affordable Care Act opened the door for public health exchanges in 2014, Portico introduced four benefit options.

By answering the call for greater flexibility, Portico retained its national membership and preserved the strength of the ELCA community’s health plan — its ability to negotiate preferred pricing, minimize disruption during change of calls, offer quality health coverage, and invest in wellness benefits not offered on the exchanges.

With the flexibility to choose from four options, the Church Council decided to provide sponsoring employers with guidance. It recommended Gold+ as the option most like the 80%-20% cost-sharing design offered prior to 2014. For the average member, that means 80% of health care costs is covered by employer contributions and 20% by member out-of-pocket costs — with a member’s individual cost experience depending on specific use of health care services.

Two Recommended Options

In consultation with the Conference of Bishops in February, the Church Council decided to continue its 80%-20% cost-sharing recommendation for 2021 — with the understanding that Portico will identify at least two 2021 options that, for the average member, approximate this cost-sharing. While pricing for 2021 has not yet been set, those two options are expected to be Gold+, and Silver+ paired with an employer contribution to the member’s HSA.

“In its decision,” said Jeff Thiemann, Portico’s president and CEO, “the Church Council affirmed two important priorities mentioned in the ELCA Philosophy of Benefits — cost sharing and flexibility. This decision affirms that 80%-20% cost sharing will continue to be the recommended level of financial protection for church workers and their families. And it acknowledges that flexibility is important, that members have different health care needs best served by different benefit options.”

This ELCA stamp of approval on the Silver+ option will be good news for members wanting to tap the savings and tax benefits offered by a high deductible health plan paired with an HSA.

“By recommending different benefit designs of similar cost-sharing value,” said Josh Smith, Portico’s senior director of products, “the Church Council is inviting sponsoring organizations to give both options a careful look during Annual Enrollment and select the one that best meets the needs of those they sponsor.”

Sponsoring organizations and members will receive notice of rate changes for 2021 after Portico’s board of trustees approves them in early August. Employers will receive pricing for all four options, including the two ELCA-recommended options later in August, so that they have time to discern and discuss options with members before 2021 Annual Enrollment begins this fall.