AppSumo

Table of Content

  1. Header
  2. Open Enrollment 2022
    1. HOW TO ENROLL
    2. QUALIFYING LIFE EVENTS
    3. MEDICAL
    4. Medical Plan Options
    5. Summary of Benefits and Coverage (SBC)
    6. Extras from BCBS
    7. Health Savings Account (HSA)
    8. PHARMACY
    9. DENTAL
    10. Your Dental Plan Option At-A-Glance
    11. VISION
    12. Vision Plan Option At-A-Glance
    13. LIFE AND AD&D
    14. DISABILITY
    15. ADDITIONAL VOLUNTARY BENEFITS
    16. EMPLOYEE ASSISTANCE PROGRAM
    17. CONTACT US
    18. Welcome
  3. Footer

It's time for Open Enrollment!

Enrollment Dates: 8/1/2022 through 8/10/2022


Open enrollment is your once a year opportunity to make changes to your benefit elections! You can change your plans, add or remove dependents, add new coverage, or waive coverage that you no longer need.

QUALIFYING LIFE EVENTS

Your premiums for medical, dental, vision insurance, and HSA 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 teammate's pre-tax benefits can be made ONLY during the Open Enrollment period unless the teammate 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, teammates may be allowed to make changes to benefit elections during the plan year, if the event affects the teammate, 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 People Team 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.

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 (link below) 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.



BCBS Logo

Medical Plan Options

You have 2 medical plans to choose from. Compare the options and rates in the charts below!








Rates Table
Video: Primary Care vs Urgent Care vs ER

Video: Primary Care vs Urgent Care vs ER

Video: Learn about your HDHP Plan

Video: Learn about your HDHP Plan

Video: Prescription Drugs Benefits Overview

Video: Prescription Drugs Benefits Overview

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!

HDHP Summary of Benefits

HDHP Summary of Benefits

PPO 1500 Summary of Benefits

PPO 1500 Summary of Benefits

Extras from BCBS

As a BCBS member, you have access to a plethora of services and resources!


This is only a brief description of some of the plan benefits. For more complete details, including benefits, limitations and exclusions, please login to your BAM portal.


Blue Access for Members (BAM)

Through Blue Access for Members (BAM) our secure member website, you can access health plan information, resources and tools. The information can vary, depending on your plan.

  • Review benefits, account balances, claims status and more.
  • Order a replacement ID card or print a temporary card.
  • View and print an Explanation of Benefits (EOB) for a claim.


Blue Access Mobile

Blue Access Mobile makes it easy for you to access your information while on the go. You can view coverage details, health and wellness information, check claim status and access member ID card information. You can also sign up to get text or email alerts and tips


Valuable Member Programs

As a BCBSTX member, you have access to a range of programs that can help you get and stay healthy.

  • Health and wellbeing programs can help you manage your health conditions, get pregnancy support, talk to a nurse 24/7 and more.
  • Blue365® offers discounts on health-related products, health and fitness clubs, weight-loss programs and much more.


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 Home (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:


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.




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, please use the link below to access your network providers, through this link go to, "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 (link below) 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!




Video: Dental Plan Information

Video: Dental Plan Information

Your Dental Plan Option At-A-Glance

A summary of your dental benefits and rates are shown 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 Vision Benefits (eyemedvisioncare.com)



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.




Video: What is Vision Insurance?

Video: What is Vision Insurance?

A summary of your vision benefits and rates are shown in the chart below!



LIFE AND AD&D

Blue Cross Blue Shield



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 $50,000 for each teammate. The $50,000 in coverage is guaranteed without answering any health questions.  Keep in mind, your life insurance benefit will reduce to 35% of the original amount at age 70 and further reduced by 55% of the original amount at age 75.



Voluntary Life and AD&D

In addition to the AppSumo 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.




SuppLife Rate Grid

DISABILITY

Blue Cross Blue Shield

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 voluntary 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 8th day of an injury or illness.

Benefit Duration - Payments may last up to 25 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 $1,000 per week.


Long-Term Disability

This 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 180th day of an injury or illness.

Benefit Duration - Payments may last up to age 65 - Reducing Benefit Duration (RBD-ADEA1) (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 $6,000 per month.


** Through your Long Term Disability Program, available to all benefit eligible teammates, BCBS has partnered with ComPsych Corporation to provide you and your family with confidential, face-to-face, telephonic and online/web-based support on a wide variety of important and relevant topics — such as stress management, dependent/elder care, nutrition, fitness, and legal and financial issues. **




ADDITIONAL VOLUNTARY BENEFITS

Blue Cross Blue Shield


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.


Travel Resource Services


Through Blue Cross Blue Shield:

Our Travel Resource Services provider, Assist America, offers around-the-clock emergency and information services that can help you access emergency assistance when you are traveling 100 or more miles away from home. See flyer for information below.


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 Blue Cross Blue Shield insurance pays you. You can use the money however you want.