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We all know Health Care Became more As Your Employee Benefit Solu(ons - - PowerPoint PPT Presentation
We all know Health Care Became more As Your Employee Benefit Solu(ons - - PowerPoint PPT Presentation
Presenta(on prepared for: PEO & ASO Brokers We all know Health Care Became more More Expensive More Complicated And Limited in Op(ons We all know Health Care Became more As Your Employee Benefit Solu(ons Partner We simplify what
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We all know Health Care Became more… As Your Employee Benefit Solu(ons Partner
- We simplify what has become so complex
- Help brokers and their clients meet ACA Regula(ons
- Our MEC plans sa(sfy Employer Penalty A and the Individual
Mandate Penalty
- Provide Comprehensive Benefit Plans
- Choice of MEC Op(ons
- Four (4) Year “Rate Lock”
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Four (4) Year Rate Lock All MEC Plans feature a 4-Year Rate Lock
Not to exceed 3% increase in years 2 through 4
All MEC Plans exceed the requirements of the Affordable Care Act sa(sfying Employer Penalty A and the Individual Mandate Penalty
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Health Care Utilization by Frequency…
Is Not: Expensive Big-Ticket Items
- Hospital Stays
- Chronic Disease or Illness
- Specialty Drugs
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Health Care Utilization by Frequency…
What it is: Everyday Health Care Needs
Preven(ve Care Primary Care Specialists Urgent Care Telemedicine Rx Advocacy
By frequency this accounts for 90% of healthcare services delivered
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Plan Comparison
Preventive Advanced Preventive Premier Preventive
Catastrophic Reimbursement No No No Network PHCS/Mul(Plan with RBP Wrap PHCS/Mul(Plan with RBP Wrap PHCS/Mul(Plan with RBP Wrap Preven(ve Care Services 100% (no deduc(ble) 100% (no deduc(ble) 100% (no deduc(ble) Doctor Access $0 Co-pay Telemedicine $0 Co-pay Telemedicine $0 Co-pay Telemedicine Primary Care Physician Office Visit $20 Copay (max 3 visits per year) $20 Copay (max 3 visits per year) Not covered Specialist Office Visit $50 Copay (max 3 visits per year) $50 Copay (max 3 visits per year) Not Covered Urgent Care $50 Copay (max 3 visits per year) $50 Copay (max 3 visits per year) Not Covered Diagnos(c X-ray and Lab $50 Copay (In office, max 5 services) $50 Copay (In office, max 5 services) Not Covered Cat-Scan or MRI $200 Copay (1 per year) $200 Copay (1 per year) Not Covered Outpa(ent Tes(ng $200 Copay (1 per year) $200 Copay (1 per year) Not Covered
Hospital, Surgical, Ambulance
$0 Deduc(ble, 50% coinsurance. Max benefit of $5,000 N/A Not Covered
TPA Services HMA HMA HMA
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Plan Comparison
Preventive Advanced Preventive Premier Preventive
Prescription Benefits
Tier 1 – Low Cost
$1 co-pay $1 co-pay $1 co-pay
Tier 2 – Generics
10% Co-Insurance 10% Co-Insurance 10% Co-Insurance
Tier 3 – Preferred Brand
20% Co-Insurance 20% Co-Insurance 20% Co-Insurance
Tier 4 – Non-Preferred 1
40% Co-Insurance 40% Co-Insurance 40% Co-Insurance
Benefit Max
No max aher co-insurance No max aher co-insurance No max aher co-insurance
Tier 5 – Specialty SHARx Advocacy Program SHARx Advocacy Program SHARx Advocacy Program Tier 6 – Non-Preferred 2 SHARx Advocacy Program SHARx Advocacy Program SHARx Advocacy Program
Monthly Rate Schedule
Employee 194.31 163.75 127.00 Employee + Spouse 316.48 267.24 178.00 Employee + Child(ren) 298.08 251.24 178.00 Employee + Family 422.80 352.30 214.00
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Additional Benefit Information
- Guaranteed issue product
- Minimum Employee Enrollment, 5
- Employer can contribute 0% to 100%
- MEC plans can be stand side-by-side with most
major carriers
- COBRA services are included
- Employee contribu(ons can be pre-taxed with
Sec(on 125 plan
- Benefits are subject to copayments, then 100%
coverage
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Enrollment
- First step: Complete Employer Adop(on Agreement –
20-30 days in advance
- Step Two: Enrollment Kit and Form will be prepared
- Step Three: All Enrollment Forms should be completed
and returned to HR 10 days in advance of Effec(ve Date
- Step Four: Data from Enrollment Forms will need to be
entered into Enrollment File/Spreadsheet to be uploaded
- Step Five: ID Cards will be generated in 10 to 14 business