Table of Content
- Header
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Home Page
- HOW TO ENROLL
- QUALIFYING LIFE EVENTS
- MEDICAL
- Medical Plan Options
- Summary of Benefits and Coverage (SBC)
- Extras from BCBS
- UNDERSTANDING YOUR BENEFITS
- PHARMACY
- Drug Card
- DENTAL
- Dental Plan Options
- VISION
- Vision Plan
- LIFE AND AD&D
- DISABILITY
- FLEXIBLE SPENDING ACCOUNT (FSA)
- DEPENDENT CARE FSA
- WORKSITE BENEFITS
- Understanding Your Benefits
- LONG-TERM CARE INSURANCE
- EMPLOYEE ASSISTANCE PROGRAM (EAP)
- REQUIRED NOTICES
- CONTACT US
- Plan Details
- Overview
- Welcome
- Footer
HOW TO ENROLL
Using your desktop or mobile, you have access to our online benefits enrollment platform 24/7. In your Paycom portal you can:
- View and select benefits for yourself and dependents
- View per-pay-period amounts
- Submit qualifying events
- Add and edit beneficiaries and dependents
Download the Paycom Mobile App from Google Play or the App Store to get started or click on the link below to head to your enrollment portal!
*IMPORTANT: The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire plan year unless you experience a qualifying life event.*
QUALIFYING LIFE EVENTS
Your premiums for medical, dental, vision insurance, and contributions to FSA accounts (Health Care and Dependent Care FSAs) are deducted through a Cafeteria Plan established under Section 125 of the Internal Revenue Code (IRC) on a pre-tax basis. Under Section 125, changes to an employee's pre-tax benefits can be made ONLY during the Open Enrollment period unless the employee or qualified dependents experience a qualifying event and the request to make a change is made within 30 days of the qualifying event.
Under certain circumstances, employees may be allowed to make changes to benefit elections during the plan year, if the event affects the employee, spouse, or dependent’s coverage eligibility. Any requested changes must be consistent with and on account of the qualifying event.
Examples Of Qualifying Events:
- Legal marital status (for example, marriage, divorce, legal separation, annulment);
- Number of eligible dependents (for example, birth, death, adoption, placement for adoption);
- Work schedule (for example, full-time, part-time);
- You, your spouse, or other covered dependent become enrolled in Part A, Part B, or Part D of Medicare
- Death of a spouse or child;
- Change in your child’s eligibility for benefits (reaching the age limit);
- Becoming eligible for Medicaid; or
- Your coverage or the coverage of your Spouse or other eligible dependent under a Medicaid plan or state Children’s Health Insurance Program (“CHIP”) is terminated as a result of loss of eligibility and you request coverage under this Plan no later than 60 days after the date the Medicaid or CHIP coverage terminates; or
- You, your spouse or other eligible dependent become eligible for a premium assistance subsidy in this Plan under a Medicaid plan or state CHIP (including any waiver or demonstration project) and you request coverage under this Plan no later than 60 days after the date you are determined to be eligible for such assistance.
IMPORTANT: If you experience any of these qualifying life events during the year, be sure to reach out to your HR Department within 30 days to make changes to your benefit elections. If you miss that special enrollment window, you will have to wait until the next open enrollment period to make a change.
Click here to learn more about Qualifying Life Events
Click here to learn more about Qualifying Life Events
MEDICAL
BlueCross BlueShield of Texas
NETWORK: BlueChoice PPO
How do I find an In-Network Provider?
Use the helpful link below! In-Network providers can also be found on your provider’s website at www.bcbstx.com under “Find Care”. Select "Find a Doctor or Hospital" and then you can search by provider/facility name or search by specialty.
Did You Know?
- Preventive Services are covered at 100% In-Network and copays & deductibles do not apply.
- You pay less out of pocket if you receive care from an In-Network provider.
- You do not need a referral to see a Specialist.
Medical Plan Options
You have 2 medical plans to choose from. Compare the options in the chart below!
Summary of Benefits and Coverage (SBC)
Looking for more details about how items are covered? Please refer to the formal Summary of Benefits and Coverage (SBC) below. There is one for each plan!
Base Plan SBC
Buy-Up Plan SBC
What is Preventive Care?
What is Preventive Care?
Benefit Terms Explained
Benefit Terms Explained
How To Read An EOB (Explanation of Benefits)
How To Read An EOB (Explanation of Benefits)
PHARMACY
Prescription drugs are a vital part of your health care coverage. If you have prescription drug coverage through Blue Cross and Blue Shield of Texas (BCBSTX), this information can help you and your doctor get the most from your prescription drug coverage. The Pharmacy Benefit Manager for BCBS is Prime Therapeutics. You can access more information about your pharmacy coverage by visiting www.myprime.com.
A drug list is a list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. See if your drug is covered by reviewing your formulary drug list using the link below!
Express Scripts® Pharmacy, the mail order pharmacy for members with BCBSTX prescription drug coverage, provides safe, fast and cost-effective pharmacy services that can save you time and money. With this program, you can obtain up to a 90-day supply of long-term (or maintenance) medications through Express Scripts® Pharmacy.
Ordering Through Express Scripts® Pharmacy
Getting Started Online
You have more than one option to fill or refill a prescription online or from a mobile device:
- Visit express-scripts.com/rx . Follow the instructions to register and create a profile.
- Log in to myprime.com and follow the links to Express Scripts® Pharmacy.
Order Over the Phone
Call 1-833-715-0942, 24/7, to refill, transfer a current prescription or get started with home delivery. Please have your member ID card, prescription information and your doctor’s contact information available.
Review your prescription costs for each plan in the chart below!
DENTAL
BlueCross BlueShield of Texas
NETWORK: BlueCare Dental
How do I find an In-Network Provider?
Use the helpful link below! In-Network providers can also be found on your provider’s website at www.bcbstx.com under “Find Care”. Select "Find a Dentist" and then you can search by provider/center name or search by location.
Research shows there may be a link between oral health and illnesses like heart disease, stroke, diabetes and premature birth. That's why Blue Cross and Blue Shield of Texas created BlueCare Dental Connection. This program offers dental plan members tools and information through the Dental Wellness Center to help you make better dental health care choices.
Did You Know?
You have the freedom to select the dentist of your choice; however, when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf.
Pre-treatment Estimate
If your dental care is extensive and you want to plan ahead for the cost, you can ask your dentist to submit a pre-treatment estimate. While it is not a guarantee of payment, a pre-treatment estimate can help you predict your out-of-pocket costs.
Looking for more details about how items are covered? Click on the links below to view the formal Benefit Summaries. There is one for each plan!
What is Dental Insurance?
What is Dental Insurance?
Dental Plan Options
You have 2 dental plans to choose from. Compare the options in the chart below!
VISION
BlueCross BlueShield of Texas
NETWORK: EyeMed
How do I find an In-Network Provider?
Use the helpful link below! In-Network providers can also be found on your provider’s website at https://member.eyemedvisioncare.com/bcbstx/en
DID YOU KNOW?
Eyes can give doctors a clear picture of overall wellness. That’s why vision care—and vision benefits—can help employees stay healthy. A comprehensive eye exam can detect early signs of serious health problems, such as:
- Diabetes
- Heart disease
- High blood pressure
- High cholesterol
- Glaucoma and cataracts
Looking for more details about how items are covered? Click on the link below to view the formal Benefit Summary.
What is vision insurance?
What is vision insurance?
A summary of your vision benefits is shown in the chart below!
LIFE AND AD&D
Basic Life and Accidental Death & Dismemberment (AD&D)
Life insurance is an important part of your financial security as it helps protect your family from financial risk and sudden loss of income in the event of your death. AD&D (Accidental Death & Dismemberment) insurance is equal to your Life benefit in the event of your death being a result of an accident, and may pay benefits for particular injuries sustained.
Basic Life / AD&D insurance is a company paid benefit, provided to you at no cost. The benefit on this plan is equal to 4x your annual earnings up to $500,000. You can get up to $265,000 in coverage without answering any health questions. Keep in mind, your life insurance benefit will reduce to 65% of the original amount at age 70 and to 50% of the original amount at age 75.
Voluntary Life and AD&D
In addition to your employer provided Basic Life insurance coverage, you have the opportunity to enroll in Voluntary Life insurance coverage. Coverage is also available for your spouse and/or child dependents, however, it is required that you elect coverage for yourself in order to elect coverage for your dependents. See the grid to the right for the plan specifics!
*Guaranteed Issue (GI) and Evidence of Insurability (EOI)
When you are first eligible (at hire) for Voluntary Life and AD&D, you may purchase up to the Guaranteed Issue (GI) for yourself and your spouse without providing proof of good health (EOI).
Any amount elected over the GI will require EOI. If you elect voluntary life coverage and are required to complete an EOI, it is your responsibility to complete the EOI and send to the provider (address will be listed on your form). In addition, your spouse will need to provide EOI to be eligible for coverage amounts over GI, or if coverage is requested at a later date.
DISABILITY
What is disability insurance?
What is disability insurance?
Short-Term Disability
Everyday illnesses or injuries can interfere with your ability to work. Even a few weeks away from work can make it difficult to manage household costs.
This employer paid Short Term Disability coverage provides financial protection for you by paying a portion of your income, so you can focus on getting better and worry less about keeping up with your bills.
Elimination Period - Benefits begin on the 14th day of an injury or illness.
Benefit Duration - Payments may last up to11 weeks (You must be sick or disabled for the duration of the waiting period before you can receive a benefit payment).
Coverage Amount - Covers 60% of your weekly income, up to a maximum benefit of $1,500 per week.
Long-Term Disability
This employer paid coverage pays a monthly benefit if you have a covered illness or injury and you can't work for a few months - or even longer! You're generally considered disabled if you're unable to do important parts of your job - and your income suffers as a result.
Elimination Period - Benefits begin on the 91st day of an injury or illness.
Benefit Duration - Payments may last up to Social Security Normal Retirement Age (SSNRA) (You must be sick or disabled for the duration of the waiting period before you can receive a benefit payment).
Coverage Amount - Covers 60% of your monthly income, up to a maximum benefit of $7,500 per month.
FLEXIBLE SPENDING ACCOUNT (FSA)
Flexible Spending Accounts (FSA) allow you to reduce your taxable income by setting aside pre-tax dollars from each paycheck to pay for eligible out-of-pocket health care expenses for yourself, your spouse and your dependent children.
MAXIMUM ANNUAL CONTRIBUTION
For the 2022 plan year, you can contribute up to $2,850
ROLLOVER BENEFIT
Up to $570 of unused funds. All other remaining funds will be lost.
ELIGIBLE EXPENSES
- A full list of qualified FSA expenses can be found in IRS Publication 502 at www.irs.gov.
- You can learn more about FSA qualified expenses and also make purchases by visiting the FSA Store at www.fsastore.com.
Health Care FSA with Flores
Health Care FSA with Flores
DEPENDENT CARE FSA
Dependent Care FSA
Dependent Care FSA
The Dependent Care FSA can reimburse you for daycare expenses provided for your dependents so that you (and your spouse, if you are married) can work. Care must be for a dependent child under the age of 13 or a dependent of any age that lives in your household and is incapable of self-care
MAXIMUM ANNUAL CONTRIBUTION
For the 2022 plan year, you can contribute up to $5,000 ($2,500 if married and filing separately).
WORKSITE BENEFITS
ACCIDENT INSURANCE
A serious injury can cost you a lot of money – not only in medical bills but in things like income from lost work hours. Some injuries are minor, but others are debilitating and require significant medical care. If you get hurt, accident insurance pays you money that you can use to cover personal expenses, bills, and out-of-pocket medical costs. Accident Insurance can pay a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events
What Does it Cover?
This plan pays a benefit for things like fractures, dislocations, burns, concussions, lacerations, ambulance rides, hospital admissions, surgeries, therapy, and even chiropractic services; just to name a few! Accident insurance will not typically cover things like check-ups or hospitalization due to illness. Accident insurance will not cover you for injuries suffered before you purchased the plan.
CRITICAL ILLNESS INSURANCE
When a serious illness strikes, your finances can be endangered, along with your health. Even if you have health insurance, the out-of-pocket costs of treatment, hospitalization and missing work can add up fast. Critical Illness Insurance can help you weather a crisis without draining your savings.
What Does it Cover?
This plan pays a benefit if you are diagnosed with heart attack, stroke, blindness, major organ failure, end-stage kidney failure, coma, cancer, and more.
HOSPITAL INSURANCE
Even if you have medical insurance, a trip to the hospital can leave you with significant unexpected expenses, like co-payments, deductibles and other out-of-pocket costs. Unum Hospital Insurance can help, by providing payments you can use to manage your expenses during a stressful time.
What Does it Cover?
You can receive benefits when you’re admitted to the hospital for a covered accident, illness, or childbirth.
Who Gets Paid?
You get paid! When you are paid a benefit from any of these policies, your health insurance company pays your doctor or hospital, but your Unum Worksite insurance pays you. You can use the money however you want.
Accident Insurance
Accident Insurance
Critical Illness Insurance
Critical Illness Insurance
Hospital Insurance
Hospital Insurance
LONG-TERM CARE INSURANCE
This coverage is available to you, your spouse, your children, your siblings, and even you and your spouse’s parents and grandparents!
Long term care insurance may help you avoid a far more difficult decision: whether to exhaust your savings or liquidate your assets to pay for a period of long term care. This policy may help you be prepared for the financial realities and help you maintain control of some important decisions, such as:
- Who would take care of me?
- Where can I choose to receive care?
- Would I be a burden on my children if my savings couldn't cover my care?
What is long term care?
Whether it's due to a motorcycle accident or a serious illness, it is the type of care you may need if you couldn't independently perform the basic activities of daily living: bathing, dressing, using the toilet, transferring from one location to another, continence and eating, or if you suffered severe cognitive impairment from a condition such as Alzheimer's disease.
Won't my other insurance pay for long term care?
Unfortunately, no.
- Medical insurance and Medicare are designed to pay for specific care for acute conditions — not for long term help with daily living.
- Medicaid is available only after most financial resources are gone, except for certain exempt and unavailable assets.
Only long term care insurance may cover those costs and allow you to maintain as much of your assets as possible.
IMPORTANT: Once eligible for the plan as a new hire, you will have 30 days to sign up for Guarantee Issue coverage. Anyone who enrolls after the Guarantee Issue enrollment period or choose benefits over the Guarantee Issue limits will be required to fill out a medical questionnaire.
Guarantee Issue:
As an employee, you are eligible for benefit amounts on a Guarantee Issue basis of up to and including $4,000 and a Facility Benefit Duration of 3 or 6 years. This does not require completion of the Long Term Care Insurance Application (medical questionnaire) if you apply during your initial eligibility period.
The Long Term Care Insurance Application (medical questionnaire) is required if enrolling after your initial eligibility period or if you choose to buy $5,000, $6,000 or the Unlimited Duration coverage.
- All Family Members must complete the Benefit Election form, the Long Term Care Insurance Application (medical questionnaire) and must be approved for coverage in order to enroll in the Long Term Care plan.
What is LTC Insurance?
What is LTC Insurance?
EMPLOYEE ASSISTANCE PROGRAM (EAP)
More about EAPs
More about EAPs
Your EAP is designed to help you lead a happier and more productive life at home and at work. Call for confidential access to a Licensed Professional Counselor who can help you.
Counselors can help you with:
- Stress, depression, anxiety
- Family and parenting problems
- Relationship issues, divorce
- Anger, grief and loss
- Job stress, work conflicts
WORK/LIFE BALANCE
You can also reach out to a specialist for help with balancing work and life issues. Just call and one of our Work/Life Specialists can answer your questions and help you find resources in your community.
Ask your Work/Life Specialists about:
- Child care
- Financial services, debt management, credit report issues
- Elder care
- Identity theft
- Legal questions
- Even reducing your medical/dental bills!