HOW TO ENROLL

ELIGIBILITY


QUALIFYING LIFE EVENTS

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.




Sedera (Cost Sharing) with MEC through Options Plus

  • Existing Sedera Members: 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 June or log on to your Sedera account at www.sedera.com.

  • In addition to completing the election form or Employee Navigator enrollment, new Sedera members (Medical Plan Option 1) must complete their enrollment through the Sedera portal before the 19th of the month to ensure an effective date of the 1st of the following month. If you do not do this your enrollment may not be processed properly.

  • New Sedera Members Enrollment Instructions:
      1. Visit Peek Law Group
      2. Follow the prompts under quote and enroll for selected IUA

There will be three check boxes to pay attention to when you log into the Sedera portal that you will need to check

Cost Sharing Plan with Sedera

Sedera is a cost sharing community, it is not considered insurance. It's for the major events in life that happen. You chose your Initial Un-shareable Amount (IUA) at the level that you are comfortable with. Think about the IUA like an auto deductible, it's per occurrance. Sedera doesn't have a network, so you can see any provider that you want. Please reference the Sedera materials and view the overviews below for additional details.

There is no ID card for Sedera. As you accumulate invoices & receipts, you as the member would submit those to Sedera for processing. You will present yourself as a cash payer at each appointment. If the provider would be willing to bill you, that's the best case scenario as that is exactly what Sedera was made for. After Sedera receives your invoices, they will contact those providers & negotiate that bill down on your behalf for any invoices that are over $1000. Most provides will require payment up front, however the cash pay price is usually significantly lower. Once you reach that IUA threshold, you would simply start a "Need" on the Sedera member portal then Sedera will cost share the remainder of the eligible expenses with you as the member. So those eligible reimbursement amounts will be paid to you as the member.

Telemedicine is included with your Sedera membership.

CareClix gives you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits.

GET THE CARE YOU NEED

CareClix doctors can treat many medical conditions, including:

• Cold & flu symptoms

• Allergies

• Pink Eye

• Respiratory infections

• Sinus problems

• Skin problems

• And more!

careclix.com

(855) CARECLX

*Pre-existing limitations apply.

MEC (Minimum Essential Coverage) - through Options Plus

When you enroll in Sedera you will have the option to enroll in one of these MEC plans.

These plans will cover your preventative care at 100% The HDHP MEC provides the framework of a High Deductible Health Plan which allows the member to set up a Health Savings Account. The member can fund that account with pre-tax dollars to pay for eligible medical expenses. You do have to stay in the network when accessing preventative care or any benefits related to the MEC plan. 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 for the H S A MEC

Please be aware, anything billed by a hospital is not considered an eligible expense on the MEC plans.

Learn More About Your Benefits

Sedera

Sedera

REQUIRED NOTICES

Federal regulations require employers to provide certain notifications and disclosures to all eligible employees. The booklet linked below is dedicated to those disclosures for your 07/01/2025 - 6/31/2026 plan year. If you have any questions or concerns please contact your HR Department.