Texas Farm Enrollment Guide 2023
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Plan Year <strong>2023</strong><br />
Effecve January 1, <strong>2023</strong> to December 31, <strong>2023</strong><br />
EMPLOYEE<br />
BENEFITS<br />
ENROLLMENT<br />
GUIDE<br />
1
Table of Contents<br />
¨<br />
¨<br />
¨<br />
¨<br />
¨<br />
¨<br />
Resource Directory ………………………..3<br />
Benefits Overview ………………………….4<br />
Membership <strong>Guide</strong>lines………………….5<br />
Employee Navigator Instrucons…...6<br />
Medical ……………………………………......7-13<br />
Employer Paid Life & AD&D …..……14-15<br />
Open <strong>Enrollment</strong><br />
November 14—November 29, 2022<br />
You will need to complete any enrollment<br />
changes online through Employee<br />
Navigator (see page 6 for instrucons).<br />
<strong>Enrollment</strong> must be completed online<br />
by 11/29/22<br />
¨ Short and Long Term Disability .....16-23<br />
¨<br />
¨<br />
Dental and Vision ……………………….24-28<br />
Voluntary Life & AD&D…………………29-30<br />
Please take me to read the benefit<br />
summaries carefully. This informaon will<br />
help you in deciding the best benefit for<br />
you and your family.<br />
¨<br />
¨<br />
¨<br />
Accident……………………………………….31-32<br />
Crical Illness……………………………….33-35<br />
Addional Informaon ………………….36<br />
2
Resource Directory<br />
Coverage Carrier Phone Website/Email<br />
Medical<br />
Blue Cross Blue Shield<br />
of <strong>Texas</strong><br />
1-800-521-2227 www.bcbstx.com<br />
Employer Paid Life & AD&D<br />
Employer Paid Short Term Disability<br />
Employer Paid Long Term Disability<br />
Dental<br />
Vision<br />
Voluntary Life<br />
Accident<br />
Crical Illness<br />
Principal 1-800-986-3343 www.principal.com<br />
Human Resources Keisha Ray 936-560-8216 HR@pnutrion.com<br />
BXS / Cadence Insurance Lacey Parmer 936-564-1713 Lacey.parmer@cadenceinsurance.com<br />
3
Benefits Overview<br />
<strong>Texas</strong> <strong>Farm</strong> Products is proud to offer a comprehensive benefits package to eligible, full-me employees regularly<br />
scheduled to work at least 30 hours per week. The complete benefits package is briefly summarized in this booklet.<br />
You share the costs of some of the benefits and <strong>Texas</strong> <strong>Farm</strong> Products provides other benefits at no cost to you. In<br />
addion, there are voluntary benefits with reasonable group rates that you can purchase through payroll deducons.<br />
Benefit Plans Offered<br />
· Medical<br />
· Employer Paid Life & AD&D<br />
· Employer Paid Short Term Disability<br />
· Employer Paid Long Term Disability<br />
· Vision<br />
· Voluntary Life<br />
· Accident<br />
· Crical Illness<br />
· Dental<br />
<strong>Enrollment</strong> Changes<br />
In most cases, your pre-tax benefits elecons are unchangeable and remain in effect for the enre plan year. During this<br />
annual enrollment period, you will have the opportunity to review your benefit elecons and make changes for the<br />
coming year. You may only make changes at other mes of the year if you experience a family status change that is a<br />
qualifying event.<br />
Qualifying Events Include<br />
· Marriage, divorce, or legal separaon<br />
· Gain or loss of an eligible dependent for reasons such as birth, adopon, court order, disability, death, marriage or<br />
reaching the dependent child age limit<br />
· Changes in employment that affects benefits eligibility<br />
· Changes in your spouse’s benefits coverage with another employer that affects benefit eligibility.<br />
The change to your benefit elecons must be consistent with the qualifying event. You have 31 days from the date of<br />
a qualifying event to complete an enrollment change form and return it to Human Resources. Your elecon will<br />
become effecve the date of the qualifying event.<br />
The benefits plan year is 1/1/<strong>2023</strong>. The elecons you make will remain<br />
in effect through 12/31/<strong>2023</strong>, unless you, your spouse, or your<br />
dependent child(ren) experience a qualifying event.<br />
4
Membership <strong>Guide</strong>lines<br />
Pre-Tax Payroll Deducons<br />
To help offset your contribuons for the medical, dental and vision plans, we offer these benefits on a pre-tax basis<br />
through the <strong>Texas</strong> <strong>Farm</strong> Products Secon 125 (or “cafeteria”) plan. By making your contribuons for these benefits on a<br />
pre-tax basis, the premium is withheld from your pay before federal, state (in most cases) and FICA taxes are calculated.<br />
This can reduce the amount of taxes you pay per paycheck.<br />
Employee Eligibility<br />
· To be eligible for benefits, you must be a full-me employee working 30 hours or more per week.<br />
· You are eligible to enroll for Medical on the 90th day of employment. All other benefits are effecve the first of the<br />
month following 90 days of employment.<br />
Dependent Eligibility<br />
· You must be enrolled in a benefit plan to enroll your eligible dependents. Your eligible dependents include your:<br />
· Legal spouse<br />
· Children:<br />
* Children up to age 26<br />
* Natural or legally adopted<br />
* Stepchildren of lawful spouse who reside in your home<br />
* Children for whom benefits must be provided through a Qualified Medical Support order<br />
* Grandchildren who are entled to be claimed as your dependents for federal income tax purposes<br />
5
Employee Navigator Instrucons<br />
Open <strong>Enrollment</strong> is available online!<br />
Please visit hps://employeenavigator.com/benefits/Account/Login to review your current<br />
benefits and make any desired plan changes for the new plan year. If you do not request any<br />
changes for the new plan year, your current enrollment WILL automacally renew. Please<br />
review the new plan year informaon closely. Aer you have completed your enrollment, be<br />
sure to click the agree buon on your <strong>Enrollment</strong> Summary page.<br />
If you have already registered an account with Employee Navigator, use the username you<br />
created. If you have forgoen your password you may request a password reset at<br />
hps://employeenavigator.com/benefits/Account/Reset/ResetEmployee.<br />
If you do not have a username, please go to hps://www.employeenavigator.com/<br />
benefits/Account/Register to register. You will be asked for personal idenfying data as well<br />
as the company idenfier which is pnutrion.<br />
If you have any quesons, contact Human Resources at 936-560-8216.<br />
This summary of benefits is not intended to be a complete descripon of the terms of <strong>Texas</strong> <strong>Farm</strong> Product’s insurance benefit plans. Please refer to the<br />
plan document(s) for a complete descripon. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any<br />
other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document,<br />
the official document will prevail. Although <strong>Texas</strong> <strong>Farm</strong> Products maintains its benefit plans on an ongoing basis, <strong>Texas</strong> <strong>Farm</strong> Products reserves the right<br />
to terminate or amend each plan, in its enrety or in any part at any me.<br />
6
Medical Coverage<br />
Your employer will contribute $1,500.00 to your HSA account should you elect this plan;<br />
Contribuons are pro-rated based on me of year you join the plan.<br />
HSA Plan<br />
Non-Network<br />
Individual<br />
Family<br />
$7,000<br />
$14,000<br />
$14,000<br />
$28,000<br />
100 / 0% 70 / 30%<br />
Prevenve<br />
100% of allowable<br />
Office Visit (Primary/Specialist)<br />
Virtual Visit (MD Live)<br />
Urgent Care<br />
100% of allowable aer deducble<br />
100% of allowable aer deducble<br />
<strong>2023</strong> contracted fee: $48<br />
100% of allowable aer deducble<br />
N/A<br />
Diagnosc Test (x-ray, blood work) 100% of allowable aer deducble 70% of allowable aer deducble<br />
Imaging (CT/PET scans, MRI) 100% of allowable aer deducble 70% of allowable aer deducble<br />
Emergency Room<br />
Facility charges<br />
Physician charges<br />
100% of allowable aer deducble<br />
Inpaent Facility<br />
Deducbles are applied to Out of Pocket Maximum. Plan includes embedded deducble.<br />
Family Coverage: When one family member meets the deducble, benefits become available under the plan for that individual.<br />
Tier Level<br />
Generic<br />
Retail (30 day)<br />
Mail Order (90 day)<br />
Brand Name<br />
Specialty Drugs<br />
100% of allowable aer deducble<br />
Prime Specialty Pharmacy Only<br />
Medical – Employee Contribuons<br />
Coverage Type<br />
Employee Only $3.67 $7.95<br />
Employee + 1 $96.18 $208.40<br />
Employee + 2 or more $142.44 $308.63<br />
7
Medical Coverage<br />
Plan A<br />
Non-Network<br />
Individual<br />
Family<br />
Prescripon Drug Deducble<br />
$1,000<br />
$3,000<br />
$100 combined Retail & Mail Service<br />
$3,000<br />
$9,000<br />
80 / 20% 60 / 40%<br />
Prevenve<br />
100% of allowable<br />
Office Visit (Primary/Specialist)<br />
Virtual Visit (MD Live)<br />
Urgent Care<br />
80% of allowable aer deducble<br />
80% of allowable aer deducble<br />
<strong>2023</strong> contracted fee: $48<br />
80% of allowable aer deducble<br />
N/A<br />
Diagnosc Test (x-ray, blood work) 80% of allowable aer deducble 60% of allowable aer deducble<br />
Imaging (CT/PET scans, MRI) 80% of allowable aer deducble 60% of allowable aer deducble<br />
Emergency Room<br />
Facility charges<br />
Physician charges<br />
80% of allowable amount aer $300 Copay<br />
80% of allowable aer deducble<br />
Inpaent Facility<br />
Deducble and copay amounts apply to the Out of Pocket Maximum. Copayment amounts and per admission deducble are applied<br />
but will connue to be required aer the benefit percentages increase to 100%<br />
Tier Level<br />
Retail (30 day)<br />
Mail Order (90 day)<br />
Generic<br />
Preferred/Non-Preferred Brand<br />
Specialty Drugs<br />
Prime Specialty Pharmacy Only<br />
Coverage Type<br />
100% of allowable aer prescripon deducble<br />
80% of allowable aer prescripon deducble<br />
Generic: 100% allowable aer prescripon deducble<br />
Preferred/Non-Preferred Brand: 80% of allowable aer prescripon deducble<br />
Medical – Employee Contribuons<br />
Employee Only $87.26 $189.07<br />
Employee + 1 $183.73 $398.08<br />
Employee + 2 or more $245.70 $532.36<br />
8
Medical Coverage<br />
Plan B<br />
Non-Network<br />
Individual<br />
Family<br />
Prescripon Drug Deducble<br />
$3,000<br />
$9,000<br />
$100 combined Retail & Mail Service<br />
$6,000<br />
$18,000<br />
$8,000<br />
$24,000<br />
80 / 20% 60 / 40%<br />
Prevenve<br />
100% of allowable<br />
Office Visit (Primary/Specialist)<br />
$40 / $60 Copay<br />
Virtual Visit (MD Live) $40 Copay N/A<br />
Urgent Care<br />
$75 Copay<br />
Diagnosc Test (x-ray, blood work) 80% of allowable aer deducble 60% of allowable aer deducble<br />
Imaging (CT/PET scans, MRI) 80% of allowable aer deducble 60% of allowable aer deducble<br />
Emergency Room<br />
Facility charges<br />
Physician charges<br />
80% of allowable amount aer $500 Copay<br />
80% of allowable aer deducble<br />
Inpaent Facility<br />
Deducble and copay amounts apply to the Out of Pocket Maximum. Copayment amounts and per admission deducble are applied<br />
but will connue to be required aer the benefit percentages increase to 100%<br />
Tier Level<br />
Retail (30 day)<br />
Mail Order (90 day)<br />
Generic<br />
Preferred/Non-Preferred Brand<br />
Specialty Drugs<br />
(Prime Specialty Pharmacy Only)<br />
100% of allowable aer prescripon deducble<br />
80% of allowable aer prescripon deducble<br />
Generic: 100% allowable aer prescripon deducble<br />
Preferred/Non-Preferred Brand: 80% of allowable aer prescripon deducble<br />
Medical – Employee Contribuons<br />
Coverage Type<br />
Employee Only $23.32 $50.53<br />
Employee + 1 $136.20 $295.09<br />
Employee + 2 or more $200.74 $434.95<br />
9
Medical Coverage<br />
<strong>2023</strong> Maximums:<br />
Individual: $3,850 | All other ers: $7,750<br />
Age 55+ catchup contribuon: $1,000<br />
Your employer will contribute $1,500.00 to your HSA<br />
account should you elect this plan;<br />
Contribuons are pro-rated based on me of year<br />
you join the plan.<br />
Contribuon will not be made unl your HSA<br />
account is opened.<br />
For new HSA elecons, the employee must complete<br />
the HSA Applicaon. It is included in Employee<br />
Navigator as a link on the Health Savings Account<br />
screen. Once completed, return to Human<br />
Resources.<br />
10
Medical Coverage<br />
11
Medical Coverage<br />
12
Medical Coverage<br />
13
Medical Employer Coverage Paid—Basic Life & AD&D<br />
14
Medical Employer Coverage Paid—Basic Life & AD&D<br />
15
Medical Coverage<br />
Employer Paid—STD for Semi Monthly Employees<br />
16
Medical Coverage<br />
Employer Paid—STD for Semi Monthly Employees<br />
17
Medical Employer Coverage Paid—STD for Weekly Employees<br />
18
Medical Employer Coverage Paid—STD for Weekly Employees<br />
19
Medical Employer Coverage Paid—LTD for President, Vice Presidents & Officers<br />
20
Medical Employer Coverage Paid—LTD for President, Vice Presidents & Officers<br />
21
Medical Employer Coverage Paid—LTD for Semi-Monthly and Weekly Employees<br />
22
Medical Employer Coverage Paid—LTD for Semi-Monthly and Weekly Employees<br />
23
Dental Coverage<br />
24
Dental Coverage<br />
25
Vision Coverage<br />
26
Vision Coverage<br />
27
Dental and Vision Rates<br />
Dental—Employee Contribuons<br />
Coverage Type Weekly Semi– Monthly<br />
Employee only $ 5.16 $ 11.17<br />
Employee and Spouse $ 10.42 $ 22.58<br />
Employee and Child(ren) $ 14.10 $ 30.56<br />
Employee and Family $ 19.37 $ 41.96<br />
Vision—Employee Contribuons<br />
Coverage Type Weekly Semi-Monthly<br />
Employee only $ 1.58 $ 3.43<br />
Employee and Spouse $ 3.00 $ 6.49<br />
Employee and Child(ren) $ 3.51 $ 7.62<br />
Employee and Family $ 4.94 $ 10.71<br />
28
Voluntary Life<br />
29
Voluntary Life<br />
Voluntary Life premiums are based on age and the benefit amount chosen. You will be<br />
able to view these premiums when you login to Employee Navigator and make selecons.<br />
30
New benefit offering<br />
Accident<br />
31
Accident<br />
You will be able to view the Accident Plan premiums when you login to Employee Navigator<br />
and make selecons.<br />
32
New benefits offering<br />
Crical Illness<br />
33
Crical Illness<br />
34
Crical Illness<br />
You will be able to view the Crical Illness Plan premiums when you login to Employee Navigator and<br />
make selecons.<br />
35
Addional Informaon<br />
Keep In Mind<br />
· Employees are responsible for notifying Human Resources if a dependent is no longer eligible for<br />
coverage. Failure to notify HR will affect COBRA availability and premium refunds.<br />
· From time to time, other coverage information and accident details may be requested by the carriers—<br />
please respond promptly to expedite processing of claims.<br />
Reminders<br />
· If electing the HSA for the first time you must complete the HSA application found online in<br />
Employee Navigator on the HSA link and turn into Human Resources by November 29th.<br />
If you have questions contact:<br />
Human Resources - <strong>Texas</strong> <strong>Farm</strong> Products Company at 936-560-8216<br />
Lacey Parmer - BXS / Cadence Insurance at 936-564-1713<br />
36
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