Action Required
The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.
You can, however, modify your elections under certain circumstances, called "Qualifying Events". These are events such as marriage, divorce, birth or adoption of a child, loss of eligibility under another plan. If you experience a qualifying event, you may make changes to your benefits within 30 days of the event or 60 days if the event is due to birth or adoption of a child.
EMPLOYEE ELIGIBILITY
You are eligible to participate if you are full-time and work a minimum of 30 hours per week. Your coverage will be effective 1st of the month following 60 days from your date of hire.
STEP 1
Enrollment this year will be online with Employee Navigator. Watch for an email this week inviting you to register and make your plan selections (even if you are waiving benefits). In the meantime, watch the videos and look at the documents below.
STEP 2
If you are enrolling in Sedera:
Existing Members: This year there are no changes! It will be a very simple process. You do not need to reenroll on the Sedera portal if you want to continue your memberships as it is today. All memberships will be renewed based on Members’ current selections if they do not take any action. If you need to make a change to your current membership, you will follow the link you will receive from Sedera the first week of October.
New Members:
Click the following link and enter the Employer code below.
https://sederamcs.org/?trackingEntity=bdd43aba-83d5-492f-9326-92642442e706
Employer Verification Code: 1513
Apex MEC (Minimum Essential Coverage) - Preventative Care through Apex / Pinnacle
Your ID cards are accessed from the Health Wallet app. See flyer to the right and presentation below.
This plan will cover your preventative care at 100% and also provides the framework for an HSA banking account. Also, if you enroll in the MEC plan you will qualify for a 7.25% discount on your Sedera membership. You do need to stay in network for your preventative care. All preventative care mandated by ACA is covered. You can see a complete list here.
PHCS network search instructions:
●Go to www.multiplan.com
●Click on Find a Provider in the upper right corner
●Click on the green Select Network button & choose PHCS
●Click the green Select Network box
●Choose PHCS in the pop-up box
●Select Preventive Services Only
Telemedicine - You will also access telemedicine through MD Live on this app.
~~~NOTE~~~
We will be moving to Options Plus effective 12/1/21. This will have the same network but is an enhanced plan with better customer service. Watch for details towards the beginning of November.
Cost Sharing Plan
Sedera is a cost sharing community that will share the cost of the large events in life.* The Sedera plan doesn't have a network. Please reference the Sedera materials and view the video presentations below for details.
There is no ID for this plan and no network. You will present yourself as a cash payer and start a "Need" on the member portal if the total goes over your chosen IUA (Initial Unshareable Amount). See "Sedera Select + Presentation" link below.
Discounts available:
7.25% for having the MEC plan
14.5% if you have a qualified personal Direct Primary Care membership (proof required). Contact HR if you have a DPC (Direct Primary Care) Click here to search.
*Pre-existing limitations apply.
See how to enroll above.
Plan Enhancements!
We are moving our dental to Dental Select.
Click on the link below to see the full dental summary.
Dental Select Vision Plan
DID YOU KNOW?
Guest & Brady offers voluntary vision coverage through the VSP network to help pay for eye exams, prescription glasses and contact lenses. See summary below.
Life is full of challenges...
Protecting your way of life shouldn’t be one.
If something happened to you, would your family have the income they need? Help protect their way of life with voluntary benefits from Colonial Life.
Disability insurance replaces a portion of income if a covered accident or sickness prevents you from earning a paycheck.
Accident insurance helps offset the unexpected medical expenses that can result from a covered accidental injury.
Life insurance enables you to tailor coverage for your individual needs and helps provide financial security for your family members.
Cancer insurance helps offset cancer diagnosis and treatment expenses that medical insurance doesn’t cover.
Critical illness insurance supplements your major medical coverage by providing a lump-sum benefit that you can use to pay the direct and indirect costs related to a covered critical illness.
Hospital indemnity insurance provides a lump-sum benefit for a covered hospital confinement or a covered outpatient surgery.
Choose options your way:
Coverage is available for your spouse and eligible dependents with most products.
Benefits are paid directly to you, unless you specify otherwise.
With most plans, you can continue coverage when you retire or change jobs, with no increase in premiums.
With most plans, you receive benefits regardless of any insurance you may have with other companies.
If you are interested in learning more or enrolling in the Colonial products, please contact Brian Madtes, the Colonial representative directly at 210-827-5648 or you can email colonialtx.cs@icloud.com.
If you opt for Sedera, Apex MEC, and the Colonial Accident plan, this is how and when to use what:
I feel miserable.
I feel miserable.
I asked my son to get the leaves from last Fall out of the gutters 7 times and he still hasn’t done it, so I am going to get a chair and go do it myself, but when I step down from the chair, I lost my balance and broke my leg.
Your 5-year old is getting ready to start kindergarten and somehow is missing 2 required immunization shots. These are 100% covered by your preventative care medical coverage that you will have a medical card for and can present to your doctor. The happy meal that you promised them for being really brave, is all on you though.
Colonial Accident is for accidents.
So, what is an accident?
Apex Management Group is for your preventative care services and you will receive a medical card.
So, what are preventative care services?
Sedera Cost Sharing
So what falls under cost sharing?