2021 PRIEST BENEFITS GUIDE - Archdiocese of Galveston-Houston
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2021 PRIEST BENEFITS GUIDE
Your 2021 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.
2021 Priest Benefits Guide 2
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YOUR 2021
BENEFITS
The benefits described in this guide are effective January 1—December 31, 2021.
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.
Each year during the open enrollment process, we engage in a detailed review of our benefits programs and
related costs, evaluate coverage options, leverage and contain costs, and identify additional programs and
services to offer. We strive to provide our priests a best-in-class benefits program.
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.
Have questions about your benefits? The Archdiocese of Galveston-Houston Benefits Help Line is here to
help! Call 855-664-8164 or email agh_benefits@ajg.com. Trained advocates are available to answer your
benefit questions Monday through Friday, 7:00 AM to 6:00 PM Central Time.
Open Enrollment
Open Enrollment will begin October 1st and end November 4th, 2020. Any changes you make to your benefit
elections during Open Enrollment will become effective on January 1, 2021. 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/offices-ministries/administration/human-resources. If you do not take action during open
enrollment, your Priest Benefits will automatically roll over to the 2021 plan year.
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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/offices-ministries/administration/human-resources
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
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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
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 Support
Livongo 800-945-4355 join.livongo.com/ARCHGH
(Registration Code: ARCHGH)
Dental Blue Cross Blue Shield
877-442-4207 www.bcbstx.com
(Group #274852) of Texas (BCBSTX)
Vision
VSP 1-800-877-7195 www.vsp.com
(Group #12001362)
Life and AD&D
The Standard 1-833-229-4173 www.standard.com
(Group #756955)
Employee Assistance
The Standard 888-293-6948
Program www.workhealthlife.com/Standard3
(Morneau Shepell) TTY: 800-327-1833
(Group #756955)
USA, Canada, Puerto Rico, USVI & medservices@assistamerica.com
The Standard Bermuda: 800-872-1414 Reference Number: 01-AA-STD-5201
Travel Assistance
(Assist America) Worldwide: +1-609-986-1234 Download the Assist America Mobile App
Text: +1-609-334-0807 on the App Store or Google Play
www.standard.com/mytoolkit
Life Services Toolkit The Standard 800-378-5742
Username: assurance
2021 Priest Benefits Guide 3
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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.
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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
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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
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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.
Jenny Craig® | Sun Basket | Nutrisystem®
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, from professional athletes to kids.
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.
Livekick
Livekick is the future of private fitness. Choose from training or yoga over live video with
a private coach. Get fit and feel healthier with action-packed 30-minute sessions that
you can do from home or in the gym. Get a free 2-week trial and 20% off a monthly plan.
2021 Priest Benefits Guide 7
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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-HoustonYour 2021 Medical Pharmacy Dental Vision Life, AD&D Additional
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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
2021 Priest Benefits Guide 9Your 2021 Medical Pharmacy Dental Vision Life, AD&D Additional
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LIVONGO
DIABETES SUPPORT
The Simpler Way to a Healthier You
Testing and tracking your blood glucose levels is critical to successfully managing your diabetes, but it can be
a time-consuming, manual process. Now, there’s a better way! Livongo provides you with an advanced 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:
Reorder test strips right Real-time support from Personalized tips with
from your meter coaches when you need it each blood glucose check
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 meter gives you a personalized tip right after
each blood glucose 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 beginning January 1, 2021
or call 800-945-4355 with code: ARCHGH
10 Archdiocese of Galveston-HoustonYour 2021 Medical Pharmacy Dental Vision Life, AD&D Additional
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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.
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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.
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LIFE/AD&D
INSURANCE
Life and AD&D
The Archdiocese of Galveston-Houston provides all priests with Basic Life and AD&D Insurance through The
Standard 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.
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 The Standard.
(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.
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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 Identity theft and fraud resolution
Life improvement and goal setting Stress or anxiety with work or personal life
Addictions and substance abuse Online will preparation
Financial and legal concerns
To take advantage of the services available to you through your EAP, call 888-293-6948 (TTY 800-327-1833)
or visit www.workhealthlife.com/Standard3 to explore a wealth of information online, including videos, guides,
articles, webinars, resources, self-assessments and calculators. Morneau Shepell is the EAP vendor that The
Standard 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, Canada, Puerto Rico, USVI & Bermuda: 800-872-1414
Everywhere else: +1-609-986-1234 *Download the Mobile App
Text Message: +1-609-334-0807 by scanning the QR code
Email: medservices@assistamerica.com Reference Number: 01-AA-STD-5201
14 Archdiocese of Galveston-HoustonYour 2021 Medical Pharmacy Dental Vision Life, AD&D Additional
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Life Services Toolkit
The Standard offers a lineup of additional services that can make a difference both now and in the future.
Online tools and services can help you create a will, make advance funeral plans, and put your finances in
order, and obtain other helpful information online.
Services to Help You Now
Estate Planning Assistance
Online tools, found in the Legal Forms section of the Life Services Toolkit website, walk you through the
steps to prepare a will and create other documents such as living wills, powers of attorney and health care
agent forms.
Financial Planning
Consult online services to help you manage debt, calculate mortgage and loan payments, and take care of
other financial matters with confidence.
Health and Wellness
Access to timely articles about nutrition, stress management and wellness help employees and their
families lead healthy lives.
Identity Theft Prevention
Check the Life Services Toolkit website for ways to thwart identity thieves and resolve issues if identity theft
occurs.
Funeral Arrangements
Use the website to calculate funeral costs, find funeral-related services and make decisions about funeral
arrangements in advance.
Take advantage of the helpful resources
available with your Life Services Toolkit
www.standard.com/mytoolkit
(username = assurance)
800-378-5742
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Important Contacts
Benefit Vendor Phone Website/Email
Archdiocese of
Human Resources 713-652-8265 www.archgh.org
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 Support
Livongo 800-945-4355 join.livongo.com/ARCHGH
(Registration Code: ARCHGH)
Dental Blue Cross Blue Shield
800-521-0393 www.bcbstx.com
(Group #274852) of Texas (BCBSTX)
Vision
VSP 1-800-877-7195 www.vsp.com
(Group #12001362)
Life and AD&D
The Standard 1-833-229-4173 www.standard.com
(Group #756955)
Employee Assistance
The Standard 888-293-6948
Program www.workhealthlife.com/Standard3
(Morneau Shepell) TTY: 800-327-1833
(Group #756955)
USA, Canada, Puerto Rico, USVI & medservices@assistamerica.com
The Standard Bermuda: 800-872-1414 Reference Number: 01-AA-STD-5201
Travel Assistance
(Assist America) Worldwide: +1-609-986-1234 Download the Assist America Mobile App
Text: +1-609-334-0807 on the App Store or Google Play
www.standard.com/mytoolkit
Life Services Toolkit The Standard 800-378-5742
Username: assurance
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-HoustonYour 2021 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.
2021 Priest Benefits Guide 17This benefits guide prepared by
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