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Health Benefit Coverage

The City offers their employees a Preferred Provider Organization Health Benefit Coverage. The plan is partially self-funded and is administered by HealthFirst, Third Party Administrator.

         

What is a Self-Funded Health Plan - Unlike a fully insured plan, where the employer contracts an insurance company to cover the employees and dependents.  In self-funded health care, the employer assumes the direct risk for payment for the claims for benefits.  Employee premiums and funding from the City of Tyler budget are combined to pay for claims.

To learn more about HealthFirst, TPA, covered benefits, claim status and Section 125 claims follow this link: www.hfbenefits.com.  First-time users will need to set up a username and password., using information found on your ID card.  You will be able to check claims status, print a temporary ID card, have access to 24/7 online customer service, view benefits, access claim forms and find links to your provider search website and your pharmacy benefit provider.  If you have problems accessing your information contact HealthFirst Website Support at (903) 581-2600.  

Access Direct Platinum Network

It is important for City of Tyler employees to use doctors and clinics that are in the Platinum Access Direct Network so that cost can be contained.  Not only does it save the plan money but your out of pocket expenses are significantly less.  Keeping cost down by using in-network doctors and clinics can help us control the rise to employee premiums.  Doctors and Clinics that are In-Network have signed a contract stating they will give us deep discounts.  That is why it is important to utilize In-Network physicians.

Finding a provider in East Texas - Your provider network in East Texas is AccessDirect Platinum (ADP).  You may search for providers by name, location or specialty at http://adppo.com/ .

Finding a provider outside East Texas - Outside East Texas, your network is now UnitedHealthcare Options, giving you in-network access to providers all over the United States.  You may search for providers at www.welcometouhc.com.  From the home page click on Benefits, Find a doctor or facility and Search for a Health Plan. Click the Options PPO under Health Plans.  Then click "click here to find a network doctor or hospital under this plan".  Search by provider name or by specialty in or near a specified zip code.

Click here to view a list of ADP In-Network doctors and clinics.  

Schedule of Benefits
DRL Lab
If you use DRL for lab services, 100% of your lab work will be covered by our plan.  For a list of DRL Lab locations click here.
Affordable Care Act

Affordable Care Act 

The Fair Labor Standards Act (FLSA) requires this Summary of Benefits and Coverage (SBC)  to be made available for City of Tyler employees. If you want more detail about your coverage and costs, you can get the complete terms  in the policy or plan document at www.hfbenefits.com or by calling 1-866-219-1592.

New Health Insurance Marketplace Coverage Options and Your Insurance

Employees eligible for Health Insurance

Employees not eligible for Health Insurance

Preventive Services

Preventive Services are covered at 100% if you use a Platinum Access Direct In-Network physician.

To view a list of preventive services by our health plan click here.

Urgent Care
 
Copyright 2017 by City of Tyler