Plans effective November 1, 2021

How to Enroll

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

MEC

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.

Health Wallet

Health Wallet

Sedera Select +

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.

Sedera Select + (from Sedera)

Sedera Select + Cost Sharing

Sedera Select + (from Sedera)

Sedera Select + Cost Sharing

Dental Select Dental

Plan Enhancements!


We are moving our dental to Dental Select.


  • Our annual max increased to $2,000
  • We added ortho coverage for children under the age of 19.


Click on the link below to see the full dental summary.

Dental Select Dental Summary

Dental Select Dental Summary

Dental Select Vision

Dental Select VSP Vision Summary

Dental Select VSP Vision Summary

Dental Select Vision Plan


DID YOU KNOW?

  • Eye exams can help detect serious eye and general health conditions sooner: high blood pressure, diabetes, heart disease, high cholesterol
  • Babies should receive their first professional eye exam at 6 months
  • 80% of learning in the first 12 years comes through the eyes

 

Guest & Brady offers voluntary vision coverage through the VSP network to help pay for eye exams, prescription glasses and contact lenses. See summary below.

Colonial

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. 

Colonial Flyers

Colonial Flyers

Q & A


If you opt for Sedera, Apex MEC, and the Colonial Accident plan, this is how and when to use what:


I feel miserable.          

  • You go see your doctor.
  • You are a cash pay customer.
  • You tell the person who asks for your insurance card that you are a cash pay customer.
  • You will pay their cash rate for your office visit. 
  • You have a virus and are not dying but just in case your doctor wants to call in a prescription for you at your local pharmacy.
  • Because you will pay the cash price for your prescription, you ask him for an actual paper prescription so that you can check your Prescription RX Application (Good RX and the Sedera RX Marketplace) on your phone that you have downloaded for free to check to see who has it in your area for the least expensive price.
  • You go get it and pay for it as a cash pay customer.


I feel miserable.

  • I remembered that I can use telemedicine for free and I don’t have to get dressed or brush my teeth.
  • Your doctor says you have a virus and are not dying but just in case your doctor wants to call in a prescription for you at your local pharmacy.
  • Because you will pay the cash price for your prescription, you check your Prescription RX Application (Good RX and Sedera RX Marketplace) on your phone that you have downloaded for free to check to see who has it in your area for the least expensive price and have him call it in to that pharmacy. You can call the doctor back if you need a minute to look it up.
  • You go get it and pay for it as a cash pay customer.



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.

  • You get someone to take you to the Emergency Room.
  • You are a cash customer and no matter how pushy they become, almost nobody pays at the time of service at the ER. They can bill you, like they do every single other customer they have.
  • While you were talking to the doctor, you mentioned that your leg got cut on some rusty yard art as you fell, and he says that you are getting a tetanus shot. If you had received this shot at a routine doctor appointment because it was just time for one, it would have been covered at 100% on your preventative care coverage that you will receive a medical card for. Because it was part of this accident that necessitated the shot, it is not considered preventative.
  • You can fill your prescription for your pain medication and the anti-inflammatory drugs just as spelled out in the previous scenario.
  • When you receive your bills, you submit them as claims with Colonial Life & Accident Insurance Company. They will send you checks for that claim. In this case, your reimbursement should be over $1,000 from Colonial to you personally.
  • You will also submit a claim with Sedera because this is probably going to exceed your deductible, when you receive all the medical bills. If you need surgery, it will quickly exceed your deductible. Sedera will negotiate the cost of any procedures that are necessary, and they will mail you a check before your surgery, if possible, or after the surgery if it was emergency surgery.
  • You then can pay your medical bills associated with this accident.


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?

  1. Broken bones
  2. Burns
  3. Concussions
  4. Lacerations
  5. Back and knee injuries
  6. Accidental injuries that send you to the Emergency Room, Urgent Care, or a doctor’s office

 

Apex Management Group is for your preventative care services and you will receive a medical card.

So, what are preventative care services?

  1. Wow, there’s a lot!!!!
  2. Go look here: https://www.healthcare.gov/coverage/preventive-care-benefits/
  3. There are 3 categories: adults, women, and children
  4. Look at those for a complete list.

 

Sedera Cost Sharing

So what falls under cost sharing?

  1. For reference look here: https://sedera.com/medical-cost-sharing/
  2. Curative care is covered over and above your deductible amount at 100%.
  3. For frequently asked questions look here: https://sedera.com/sedera-faq/
  4. Start a “Need” by logging into your Sedera account and submit any proof of payments made for the unshareable amounts (your deductible). Sedera will call the providers and negotiate a better rate, and actually get those bills reduced before they send a payment to you for the amount that they negotiated your medical bills down to.
  5. So, everything that is curative care falls under cost sharing that amounts over your deductible, which is your portion.