Employee Benefits Effective 1/1/2023
Welcome
Helping you and your family reach and maintain good health is very important to Texas Fence. Texas Fence is pleased to offer a selection of benefits designed with your health and financial wellbeing in mind. We review our benefit programs each year to ensure we consider the best combination of benefit coverage, network access and affordability for employees.
Eligibility
Regular employees working at least 30 hours per week are eligible to participate in benefits offered by Texas Fence. When you enroll in the benefits program, you may also cover your eligible benefits.
If you need to review the plan information you can also click on the informational videos below.
Enrollment
How To Enroll In Benefits
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
Enroll through Employee Navigator (see link below) by 12/15/2021.
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 December.
New Sedera Members: In addition to completing the election form or Employee Navigator enrollment, new Sedera members must complete their enrollment through the Sedera portal before the 19th of the month to ensure an effective date of 1/1/2022. If you do not do this your enrollment may not be processed properly.
Click the following link and enter the Employer code below.
https://sederamcs.org/?trackingEntity=21ef5575-8a2b-488b-91e4-403ae719d879
Employer Verification Code: 2155
MEDICAL OPTION 1
Option 1 - Sedera (cost sharing) with MEC (Minimum Essential Coverage)
The Sedera combo plan has two parts: Sedera Cost Sharing and a Minimum Essential Coverage (MEC) plan which will cover your preventative care.
Cost Sharing Plan with Sedera
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.
Telemedicine is included with your Sedera membership.
Teladoc 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
Teladoc doctors can treat many medical conditions, including:
• Cold & flu symptoms
• Allergies
• Pink Eye
• Respiratory infection
• Sinus problems
• Skin problems
• And more!
Teladoc.com
1-800-Teladoc (835-2362)
*Pre-existing limitations apply.
See how to enroll above.
MEC (Minimum Essential Coverage) - Preventative Care through ASi
When you enroll in Sedera you are automatically enrolled in this plan.
See presentation below.
This plan will cover your preventative care at 100% and also provides the framework for an HSA banking account. 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
Video Preview
What is a HDHP with HSA?
What is a HDHP with HSA?
MEDICAL OPTION 2
Option 2 - BCBS (fully insured)
The BCBS plans are fully insured medical plans. You have two options:
1. PPO
2. HMO - Choose a Primary Care Provider.* If you need to see a specialist you will need a referral from your primary care physician.
These two BCBS plans are the almost identical to the plans we had last year. The deductible runs on a calendar year and includes Preventive Service coverage at 100% in-network for both plans. The in-network deductibles, copays and out of pocket max are the same on both plans.
You have the option of having a PPO plan with out-of-network services or an HMO plan with in-network only Benefits.
*If you choose to enroll in the HMO plan – you must select a Primary Care Physician. If you do not already have an In-network PCP, you can search for one by going to www.bcbstx.com and selecting “Find Care” then “Find a Doctor or Hospital”. Select “Search as a Guest”. At the top right, select the plan Blue Advantage HMO [BAV] then your zip code. You are then able to search by Specialty – selecting Primary Care Physicians. Once you find a doctor that you like, you will want to write down their name and Provider ID (found by clicking on the doctor’s name) and entering your information in Employee Navigator. You can change your PCP as many times as once a month. The most efficient way to do this is by calling the customer service number on the back of your card and have your Doctor’s information handy in order to tell the customer service representative once connected.
See the link below for the Presentation.
DENTAL
Voluntary Dental through Unum
Unum's dental plan provides comprehensive coverage to help you and your family maintain good dental health.
Unum Dental allows you to see any dentist you choose. To get the most from your benefits and reduce your out-of- pocket costs, choose one of our 111,000 participating network dentists, who will also file your claims. The broad network of dentists is backed by the consistent, high-quality customer service of Unum. You can find in-network providers at unumdentalcare.com.
What else is included?
Carryover benefit rider
Each year, you can earn more benefits if you have one cleaning and one regular exam, and the total claims paid during the year are below the threshold.
Pregnancy benefit
An extra cleaning for expecting mothers.
Wellness benefits
Oral cancer screenings for patients with high risk factors
AlwaysAssist.com
Use AlwaysAssist.com and the mobile app to manage your dental benefits, find providers and learn about good dental health. Features include easy access to ID cards, coverage information, forms and more.
Carryover benefits
Members who take care of their teeth, but use only part of their annual maximum benefit during a benefit period are rewarded with extra benefits in future years! Carryover
benefits will be accrued and stored in the insured’s carryover account to be used in the next benefit year.
VISION
Unum Voluntary Vision
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
•Our network offers members access to a large national network, including independent optometrists and retail stores like Walmart, Sam’s Club, Target Optical, America’s Best and many more.
•Find an in-network provider at unumvisioncare.com.
•Manage benefits online with AlwaysAssist.com and on- the-go with the AlwaysAssist mobile app.
LIFE
Texas Fence provides you with Basic & Voluntary Life/AD&D coverage through Unum.
Basic Life/AD&D
Employees working 30 or more hours per week are eligible for coverage payable to your designated beneficiary in the event of your death. An additional accidental death & dismemberment benefit (AD&D) is payable to you in the event of a covered dismemberment or to your beneficiary if your death is the result of an accident.
Who's Your Beneficiary? Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.
Please consult your Employee Benefits Guide and review the plan SBCs for additional details.