Welcome
Our comprehensive employee benefits make it easy for you to piece together the perfect coverage for your specific needs. Read this guide first so you know what benefits are offered before making your selections.
Benefits Worth Checking Out
Your New Benefits Begin: January 1, 2026
Contacts
Availability of Summary Health Information
Your plan offers medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC) available from Human Resources.
Benefits Eligibility
Who is Eligible for Benefits
All Active Priests of Catholic Diocese of Memphis
How to Enroll
Visit www.paylocity.com and log in to your self-service portal, and click on the gray box in the upper left-hand corner that says HR/PAYROLL . You will see a dropdown menu. Click on BSWIFT BENEFITS. A welcome screen will appear with a blue button that says: Visit the Enrollment Center
Questions?
z Contact HR
Qualifying Life Events
You may only change coverage during the plan year if you have a Qualifying Life Event, such as:
z Assignment to a new diocese or religious community
z Retirement or semi-retirement from active ministry
z Change in religious vows or status
z FMLA leave, court judgment, or decree
z Becoming eligible for Medicare, Medicaid, or TRICARE
z Significant change in benefit plan coverage
30 Days
Notify HR and complete your changes within 30 days of the event. You may need to provide documents to verify the change.
Medical Coverage
The medical plan option through Cigna protects you from major financial hardship in the event of illness or injury.
z PPO Plan – This PPO plan has a $2,000 Individual in-network deductible.
Preferred Provider Organization (PPO)
A PPO allows you to see any provider when you need care. When you see providers in the Open Access Plus network for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-of-network providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other network services are covered at the deductible and coinsurance level.
Find an In-Network Provider
z Visit www.mycigna.com
z Call 800-244-6224
Medical Coverage
Medical Benefits Summary
• MDLIVE Primary Care Services
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Prescription Drugs – Retail Up to 30-day supply
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Drugs
1 The amount you pay after the deductible is met.
Telemedicine
Your medical coverage offers telemedicine services through MDLIVE for Cigna Healthcare.
Connect anytime day or night with a board-certified doctor via your mobile device or computer for free, or for the same or less cost than a visit to your regular physician.
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
z Have a non-emergency issue and are considering an after hours health care clinic, urgent care clinic, or emergency room for treatment
z Are on a business trip, vacation, or away from home
z Are unable to see your primary care physician
When to Use Telemedicine
Telemedicine
Wellness
Diagnostic
Do not use telemedicine for
Registration
is Easy
z Log into www.mycigna.com and click on Talk to a doctor
z Call 888-726-3171
z Download the MDLIVE app
Allergies
Stomachache
Urinary
Pink
Rashes
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
Non-Emergency Care
Telemedicine
Access to care via phone, online video, or mobile app whether you are home, work or traveling; medications can be prescribed
24 hours a day, 7 days a week
Doctor’s Office
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
Office hours vary
Retail Clinic
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Hours vary based on store hours
Urgent Care
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend and holiday hours
Emergency Care
Hospital ER
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
24 hours a day, 7 days a week
Freestanding ER
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
24 hours a day, 7 days a week
z Allergies
z Cough/cold/flu
z Rash
z Stomachache
z Infections
z Sore and strep throat
z Vaccinations z Minor/injuries/sprains and strains
z Common infections
z Minor injuries
z Pregnancy tests
z Vaccinations
z Sprains and strains
z Minor broken bones
z Small cuts that may require stitches
z Minor burns and infections
z Chest pain
z Difficulty breathing
z Severe bleeding
z Blurred or sudden loss of vision
z Major broken bones
z Most major injuries except trauma
z Severe pain
15 minutes
4+ hours
Minimal
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your
Cigna Resources
Member Website
myCigna.com serves as your one-stop shop for all Cigna health plan and benefits information. Key features include managing and tracking claims, accessing digital ID cards, finding in-network providers, accessing cost comparison tools, reviewing coverage details, and more. Visit www.mycigna.com to register.
z One Guide – Get help from a personal guide to navigate your Cigna benefits and resources. Call the number on the back of your Cigna ID card, use the click-to-chat function on www.mycigna.com , or call 866-494-2111
z Health Information Line – Speak to a nurse anytime to get answers and recommendations based on your specific health situation. Call the number on the back of your Cigna ID card for 24/7 access.
z Live, 24/7 Customer Service – Contact a representative via phone, chat, or app.
Mobile App
Download the myCigna app to access your Cigna health plan and benefits information while on the go. This app helps you organize and access important plan information on your smartphone or tablet. It is also available in Spanish.
Cigna Digital ID Card
You have one ID card for both your pharmacy and medical needs. Cigna no longer issues and mails physical ID cards.
How to Access Your Digital ID Card
1. Log in at www.mycigna.com or the myCigna app
2. Click or tap ID Cards.
3. View your card, as well as any dependents’ card(s).
4. Email cards directly to doctors.
5. Save your digital ID cards in your Apple Wallet.
Dental Coverage
DPPO Plan
Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may see any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.
Dental Benefits Summary
Restorative2 Crowns, bridges, dentures, implants
1Payment for covered services received from an out-of-network dentist is based on the 70th percentile of Usual, Customary and Reasonable (UCR) charges. 2 A waiting period of 12 months applies to new hires only for major services. Refer to the Cigna Patient Charge schedule for details.
z Visit www.mycigna.com z Call 800-244-6224
Vision Coverage
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see innetwork providers. Coverage is provided through Cigna using the EyeMed vision network.
Vision Benefits Summary
z Visit www.mycigna.com
z Call 888-353-2653
Priest Health Reimbursement Arrangement
Pre-loaded Card
Each year, the Diocese provides priests, active and retired, with a preloaded card through Pinnacle Bank . The $7,000 balance is intended to pay for medical expenses not covered by the other coverages such as deductibles and copays.
z A new $7,000 balance is provided each year on your card.
z The card balance does not carry over from year to year – “use it or lose it.”
z You can continue to submit expenses incurred during the plan year for reimbursement for another 60 days (up until March 1, 2026).
z File a claim using your Pinnacle card, a recurring reimbursement form, or file online or in the Pinnacle mobile app.
Questions?
Refer to your Pinnacle Welcome Kit
Create your online account at www.pnfp.com/HBlogin
Download the Pinnacle mobile app
Contact the Pinnacle Client Service Center 888-282-2605
Life and AD&D Insurance
Life and Accidental Death and Dismemberment (AD&D) insurance through Voya are important to your financial security.
With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies).
Basic Life and AD&D
Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at a flat benefit of $12,000. Your benefit amount reduces to 65% at age 65, to 40% at age 70, and to 25% at age 75. Coverage terminates at retirement unless retiree coverage is provided.
Voluntary Life and AD&D
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D. If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health.
Your benefit amount reduces to 60% of original coverage when you reach age 75; 35% at age 80; 27.5% at age 85; 20% at age 90; 7.5% at age 95, and 5% at age 100. Premium amounts are also reduced accordingly, and automatically adjusted for the new benefit amount.
Designating a Beneficiary
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Voluntary Life and AD&D
• Increments of $10,000 up to $500,000
• New Hire Guaranteed Issue $200,000
If member is already enrolled, they may increase at open enrollment by 2 increments ($20,000) with no Evidence of Insurability (EOI). If member has not previously enrolled, they may purchase 1 increment ($10,000) at open enrollment with no EOI.
Conversion – Portability –Waiver of Premium
Upon termination of employment, with Catholic Diocese of Memphis, you have the option to continue your company-paid Life and AD&D insurance and pay premiums directly to Voya Your company-paid Life and AD&D insurance may be converted to an individual policy. Portability is available for Life coverage if you are enrolled in additional Life coverage. Portability is not available for AD&D. If you are disabled at the time your employment is terminated, you may be eligible for a Waiver of Premium while you are disabled. Contact Human Resources for a Conversion, Portability, or Waiver of Premium application.
Supplemental Benefits
You have the opportunity to enroll in additional coverage that complements our traditional health care programs through Voya. Health insurance covers medical bills, but if you have an emergency, you may face unexpected out-of-pocket costs such as deductibles, coinsurance, travel expenses, and non-medical expenses.
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. The Accident plan helps offset the direct and indirect expenses resulting from an accident such as copayments, deductible, ambulance, physical therapy, rent, and other costs not covered by traditional health plans. See the plan document for full details.
Supplemental Benefits
Critical Illness Insurance
Critical Illness insurance helps pay the cost of nonmedical expenses related to a covered critical illness or cancer. The plan provides a lump-sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs.
Coverage
Advanced dementia including Alzheimer’s disease; amyotrophic lateral sclerosis; benign brain tumor; bone marrow transplant; coma; heart attack; Huntington’s disease; invasive cancer; loss of hearing, sight or speech; major organ transplant; multiple sclerosis; muscular dystrophy; Parkinson’s disease; severe burns; stem cell transplant; stoke; sudden cardiac arrest; type 1 diabetes
Childhood Illnesses
Partial Coverage
Abdominal aortic aneurysm; Addison’s disease; carcinoma in situ; coronary angioplasty; coronary artery bypass; coronary angioplasty; implantable/ internal cardioverter defibrillator; infectious disease requiring hospitalization; myasthenia gravis; open heart surgery for valve replacement or repair; pacemaker placement; ruptured or dissecting aneurysm; systemic sclerosis; thoracic aortic aneurysm; transcatheter heart valve replacement or repair; transient ischemic attack
Hospital Indemnity Insurance
Hospital Indemnity insurance helps you with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment that you receive. These costs may include meals and transportation, childcare, or time away from work due to a medical issue that requires hospitalization.
Employee Assistance Programs
The Employee Assistance Programs (EAPs) from Voya/ComPsych and Methodist Healthcare help you cope with a variety of personal and workrelated issues.
This program provides confidential counseling and support services at little or no cost to you to help with:
z Relationships
z Work/life balance
z Stress and anxiety
z Will preparation and estate resolution
z Grief and loss
z Eldercare resources
z Legal and financial consultation
Contact
Take advantage of either or both EAPs for support at any hour of the day or night.
Voya/ComPsych
z Visit www.guidanceresources.com; use WebID: MY5848i.
z Call 800-697-0353
z Download the GuidanceNow app
Methodist Healthcare
z Visit www.methodisteapcanhelp.org
z Call 901-683-5658
z Scan the code to learn more.
Additional Benefits
Voya offers the following benefits and services at no extra cost to you.
Travel Assistance
If you are traveling more than 100 miles away from home, Voya Travel Assistance can help 24/7 with pre-trip planning, emergency medical needs, translation services, lost baggage or documents, legal referrals, and more.
z Call in the U.S., 800-859-2821 ; everywhere else, 202-296-8355
z Email: ops@gga-usa.com
z Online: https://travelsecurity.garda.com
z Contract Number: 17372020 (for registration)
z Group Number: 73487-0
Will Preparation
Creating a will is an important investment in your future. In just minutes, you can create a personalized will that keeps your information safe and secure. Everest ’s online tool helps you create a basic will, and other essential legal documents. The tool asks a series of questions and then creates the required clauses to create a downloadable document.
1. Go to www.everestfuneral.com/voya
2. Enter your email address and your employer’s name
3. Create a password and complete your online profile
4. Access “Planning Tools”
Funeral Planning and Concierge Services
Everest offers AV funeral concierge service with online tools and live support to help guide you through key decisions. It offers pre-planning, documentation of wishes, and cost comparisons for funeral-related expenses.
z Call 800-913-8318
z Go to www.everestfuneral.com/voya
z Use the group name Catholic Diocese of Memphis and group number 73487-0
Priest Pension Plan
The Diocese of Memphis has a pension plan in which all ordained priests are automatically enrolled. The monthly amount you receive depends both upon your age of retirement, and your length of service to the Memphis Diocese.
z The monthly retirement payments range from $1,127 at age 65, to $4,000 at age 75 or older.
z To receive full payment, your length of service must be a minimum of 30 years. Otherwise, the payments are reduced based upon the ratio of your actual service to 30 years.
z At age 70, you can start to receive the pension even while still working and collecting a salary and benefits.
Questions?
Please email pensionpayments@regions.com .
Retirement Plan
A 403(b) plan can be a powerful tool to help you be financially secure in retirement. Our 403(b) plan through Corebridge Financial can help you reach your investment goals.
How the Retirement Plan Works
You are eligible to participate in the plan if you are at least 18 years of age. You may contribute up to the IRS limit.
You decide how much you want to contribute and can change your contribution amount anytime. All changes are effective as soon as administratively feasible, and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account and may change your investment choices anytime. For more details, refer to your 403(b) Enrollment Guide or contact Corebridge Financial at 800-448-2542 .
Enrollment
You are automatically enrolled at 2% of your earnings. If you want to change or cancel your contribution, you must contact Corebridge Financial at www.corebridgefinancial.com/retire or by calling 800-448-2542.
Employer Contributions
The Diocese matches half of the first 2% of your pay.
Vesting
You are always 100% vested in your own contributions. You are 100% vested in matching company contributions after three years of service.
Investment Options
You may direct your contributions to any of the investments offered within the company 403(b) plan. Changes to your investments can be made by calling 800-448-2542
2026 IRS Contribution Limits
z $24,500
z $8,000 additional contribution if age 50 or older
Legal Notices
Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Catholic Diocese of Memphis and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Catholic Diocese of Memphis has determined that the prescription drug coverage offered by the Catholic Diocese of Memphis medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Catholic Diocese of Memphis at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current Catholic Diocese of Memphis prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage: Contact the Human Resources Department at 901-373-1200
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778.
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
January 1, 2026
Catholic Diocese of Memphis
Colleen Goodspeed, Director Human Resources 5825 Shelby Oaks Drive Memphis, TN 38134 901-373-1200
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Effective Date of Notice: September 23, 2013
Catholic Diocese of Memphis’s Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about:
1. the Plan’s uses and disclosures of Protected Health Information (PHI);
2. your privacy rights with respect to your PHI;
3. the Plan’s duties with respect to your PHI;
4. your right to file a complaint with the Plan and to the Secretary of the U.S. Department of Health and Human Services; and
5. the person or office to contact for further information about the Plan’s privacy practices.
The term “Protected Health Information” (PHI) includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form (oral, written, electronic).
Section 1 – Notice of PHI Uses and Disclosures
Required PHI Uses and Disclosures
Upon your request, the Plan is required to give you access to your PHI in order to inspect and copy it.
Use and disclosure of your PHI may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Plan’s compliance with the privacy regulations.
Uses and disclosures to carry out treatment, payment and health care operations.
The Plan and its business associates will use PHI without your authorization to carry out treatment, payment and health care operations. The Plan and its business associates (and any health insurers providing benefits to Plan participants) may also disclose the following to the Plan’s Board of Trustees: (1) PHI for purposes related to Plan administration (payment and health care operations); (2) summary health information for purposes of health or stop loss insurance underwriting or for purposes of modifying the Plan; and (3) enrollment information (whether an individual is eligible for benefits under the Plan). The Trustees have amended the Plan to protect your PHI as required by federal law.
Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers.
For example, the Plan may disclose to a treating physician the name of your treating radiologist so that the physician may ask for your X-rays from the treating radiologist.
Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims processing, subrogation, reviews for medical necessity and appropriateness of care, utilization review and preauthorizations).
For example, the Plan may tell a treating doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Plan.
Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. It also includes case management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. However, no genetic information can be used or disclosed for underwriting purposes.
For example, the Plan may use information to project future benefit costs or audit the accuracy of its claims processing functions.
Uses and disclosures that require that you be given an opportunity to agree or disagree prior to the use or release.
Unless you object, the Plan may provide relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care. Also, if you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, the Plan will disclose protected health information (as the Plan determines) in your best interest. After the emergency, the Plan will give you the opportunity to object to future disclosures to family and friends.
Uses and disclosures for which your consent, authorization or opportunity to object is not required.
The Plan is allowed to use and disclose your PHI without your authorization under the following circumstances:
1. For treatment, payment and health care operations.
2. Enrollment information can be provided to the Trustees.
3. Summary health information can be provided to the Trustees for the purposes designated above.
4. When required by law.
5. When permitted for purposes of public health activities, including when necessary to report product defects and to permit product recalls. PHI may also be disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if required by law.
6. When required by law to report information about abuse, neglect or domestic violence to public authorities if there exists a reasonable belief that you may be a victim of abuse, neglect or domestic violence. In which case, the Plan will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made. Disclosure may generally be made to the minor’s parents or other representatives although there may be circumstances under federal or state law when the parents or other representatives may not be given access to the minor’s PHI.
7. The Plan may disclose your PHI to a public health oversight agency for oversight activities required by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaints against providers); and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).
8. The Plan may disclose your PHI when required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request.
9. When required for law enforcement purposes, including for the purpose of identifying or locating a suspect, fugitive, material witness or missing person. Also, when disclosing information about an individual who is or is suspected to be a victim of a crime but only if the individual agrees to the disclosure or the Plan is unable to obtain the individual’s agreement because of emergency circumstances. Furthermore, the law enforcement official must represent that the information is not intended to be used against the individual, the immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and disclosure is in the best interest of the individual as determined by the exercise of the Plan’s best judgment.
10. When required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. Also, disclosure is permitted to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
11. When consistent with applicable law and standards of ethical conduct if the Plan, in good faith, believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
12. When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.
Except as otherwise indicated in this notice, uses and disclosures will be made only with your written authorization subject to your right to revoke such authorization.
Uses and disclosures that require your written authorization.
Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, the Plan will not use or disclose your psychiatric notes; the Plan will not use or disclose your protected health information for marketing; and the Plan will not sell your protected health information, unless you provide a written authorization to do so. You may revoke written authorizations at any time, so long as the revocation is in writing. Once the Plan receives your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
Section 2 – Rights of Individuals
Right to Request Restrictions on Uses and Disclosures of PHI
You may request the Plan to restrict the uses and disclosures of your PHI. However, the Plan is not required to agree to your request (except that the Plan must comply with your request to restrict a disclosure of your confidential information for payment or health care operations if you paid for the services to which the information relates in full, out of pocket).
You or your personal representative will be required to submit a written request to exercise this right. Such requests should be made to the Plan’s Privacy Official.
Right to Request Confidential Communications
The Plan will accommodate reasonable requests to receive communications of PHI by alternative means or at alternative locations if necessary to prevent a disclosure that could endanger you.
You or your personal representative will be required to submit a written request to exercise this right. Such requests should be made to the Plan’s Privacy Official.
Right to Inspect and Copy PHI
You have a right to inspect and obtain a copy of your PHI contained in a “designated record set,” for as long as the Plan maintains the PHI. If the information you request is in an electronic designated record set, you may request that these records be transmitted electronically to yourself or a designated individual.
Protected Health Information (PHI)
Includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form.
Designated Record Set
Includes the medical records and billing records about individuals maintained by or for a covered health care provider; enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for the Plan; or other information used in whole or in part by or for the Plan to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the designated record set.
The requested information will be provided within 30 days if the information is maintained on site or within 60 days if the information is maintained off site. A single 30day extension is allowed if the Plan is unable to comply with the deadline.
You or your personal representative will be required to submit a written request to request access to the PHI in your designated record set. Such requests should be made to the Plan’s Privacy Official.
If access is denied, you or your personal representative will be provided with a written denial, setting forth the basis for the denial, a description of how you may appeal the Plan’s decision and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.
The Plan may charge a reasonable, cost-based fee for copying records at your request.
Right to Amend PHI
You have the right to request the Plan to amend your PHI or a record about you in your designated record set for as long as the PHI is maintained in the designated record set.
The Plan has 60 days after the request is made to act on the request. A single 30-day extension is allowed if the Plan is unable to comply with the deadline. If the request is denied in whole or part, the Plan must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI.
Such requests should be made to the Plan’s Privacy Official.
You or your personal representative will be required to submit a written request to request amendment of the PHI in your designated record set.
Right to Receive an Accounting of PHI Disclosures
At your request, the Plan will also provide you an accounting of disclosures by the Plan of your PHI during the six years prior to the date of your request. However, such accounting will not include PHI disclosures made: (1) to carry out treatment, payment or health care operations; (2) to individuals about their own PHI; (3) pursuant to your authorization; (4) prior to April 14, 2003; and (5) where otherwise permissible under the law and the Plan’s privacy practices. In addition, the Plan need not account for certain incidental disclosures.
If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.
If you request more than one accounting within a 12-month period, the Plan will charge a reasonable, costbased fee for each subsequent accounting.
Such requests should be made to the Plan’s Privacy Official.
Right to Receive a Paper Copy of This Notice Upon Request
You have the right to obtain a paper copy of this Notice. Such requests should be made to the Plan’s Privacy Official.
A Note About Personal Representatives
You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms:
1. a power of attorney for health care purposes;
2. a court order of appointment of the person as the conservator or guardian of the individual; or
3. an individual who is the parent of an unemancipated minor child may generally act as the child’s personal representative (subject to state law).
The Plan retains discretion to deny access to your PHI by a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
Section 3 – The Plan’s Duties
The Plan is required by law to maintain the privacy of PHI and to provide individuals (participants and beneficiaries) with notice of the Plan’s legal duties and privacy practices.
This Notice is effective September 23, 2013, and the Plan is required to comply with the terms of this Notice. However, the Plan reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Plan prior to that date. If a privacy practice is changed, a revised version of this Notice will be provided to all participants for whom the Plan still maintains PHI. The revised Notice will be distributed in the same manner as the initial Notice was provided or in any other permissible manner.
If the revised version of this Notice is posted, you will also receive a copy of the Notice or information about any material change and how to receive a copy of the Notice in the Plan’s next annual mailing. Otherwise, the revised version of this Notice will be distributed within 60 days of the effective date of any material change to the Plan’s policies regarding the uses or disclosures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy practices stated in this Notice.
Minimum Necessary Standard
When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. When required by law, the Plan will restrict disclosures to the limited data set, or otherwise as necessary, to the minimum necessary information to accomplish the intended purpose. However, the minimum necessary standard will not apply in the following situations:
1. disclosures to or requests by a health care provider for treatment;
2. uses or disclosures made to the individual;
3. disclosures made to the Secretary of the U.S. Department of Health and Human Services;
4. uses or disclosures that are required by law; and
5. uses or disclosures that are required for the Plan’s compliance with legal regulations.
De-Identified Information
This notice does not apply to information that has been de-identified. De-identified information is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual.
Summary Health Information
The Plan may disclose “summary health information” to the Trustees for obtaining insurance premium bids or modifying, amending or terminating the Plan. “Summary health information” summarizes the claims history, claims expenses or type of claims experienced by participants and excludes identifying information in accordance with HIPAA.
Notification of Breach
The Plan is required by law to maintain the privacy of participants’ PHI and to provide individuals with notice of its legal duties and privacy practices. In the event of a breach of unsecured PHI, the Plan will notify affected individuals of the breach.
Section 4 – Your Right to File a Complaint With the Plan or the HHS Secretary
If you believe that your privacy rights have been violated, you may complain to the Plan. Such complaints should be made to the Plan’s Privacy Official. You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, D.C. 20201. The Plan will not retaliate against you for filing a complaint.
Section 5 – Whom to Contact at the Plan for More Information
If you have any questions regarding this notice or the subjects addressed in it, you may contact the Plan’s Privacy Official. Such questions should be directed to the Plan’s Privacy Official at:
Catholic Diocese of Memphis Colleen Goodspeed, Director Human Resources
5825 Shelby Oaks Drive Memphis, TN 38134 901-373-1200
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
Premium Assistance Under Medicaid and the Continuation of Coverage Rights Under COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Catholic Diocese of Memphis group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Catholic Diocese of Memphis plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information
Catholic Diocese of Memphis
Colleen Goodspeed, Director Human Resources 5825 Shelby Oaks Drive Memphis, TN 38134 901-373-1200
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Outof-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than innetwork costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. You are protected from balance billing for:
• Emergency services – If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s innetwork cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
• Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-ofnetwork. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections. You are never required to give up your protections from balance billing. You also are not required to get care outof-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/ nosurprises for more information about your rights under federal law.
This brochure highlights the main features of the Catholic Diocese of Memphis employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. Catholic Diocese of Memphis reserves the right to change or discontinue its employee benefits plans anytime.