2. MEC Plan Details
Minimum Essential Coverage Plan –
What is Minimum Essential Coverage?
Minimum Essential Coverage is the type of coverage employees need to avoid the fee for not having insurance under the Affordable Care Act.
In order to be in compliance with the law, employees must maintain minimum essential coverage or pay a fee for each month without it..
What Doesn’t Count As Minimum Essential Coverage?
Minimum essential coverage does not include coverage providing only limited benefits, such as coverage only for vision care or dental care.
Supplemental insurance will not help employees avoid the fee on their own.
Concierge Benefit Service MEC/ Limited benefits plan will help employees avoid the fee.
What is Employer Responsibility?
In 2016, Employers with 50+ FTEs will be subject to a penalty for: (1) failing to offer health care coverage to full time employees; ( 2) offering minimum
essential coverage that is unaffordable; or (3) offering minimum essential coverage where the Plan pays less than 60% of cost.
Do MEC Plans provide solutions?
The January 1, 2015 mandate states employers with 100+ employees must have implemented the Minimum Essential Coverage. Beginning January 1, 2016
employers with 50+ employees must implement Minimum Essential Coverage to satisfy one portion of the ACA’s large employer mandate. While MEC plans
eliminate the $2,000 per employee penalty, employers should be aware that these plans do not protect them from the ACA’s $3,000 penalty per each
employee who goes to a public exchange and qualifies for a federal subsidy.
3. MEC Plan Details
Minimum Essential Coverage Plan – Physician Office Visit, Prescription Drug Coverage & Preventive Care Services
What is a controlled group?
Large employers may think that subdividing into smaller companies may provide relief from the Employer Mandate, PPACA and its
regulations. The IRS defines “controlled group”. The controlled group rules essentially state that all employees which are under common
control are to be treated as employed by a single employer.
3 types of “Controlled Groups”
1. Parent-subsidiary groups, one business owns 80% or more of another business or businesses
2. Brother-sister groups, five or less common owners; common owners must own at least 80 percent of each business; and the combined
identical ownership must be 50 percent or more
3. Combined ownership groups, each organization is a member of either a parent-subsidiary or brother-sister group and at least one
corporation is: the common parent of a parent-subsidiary and a member of a brother-sister group
4. MEC Plan Details
Minimum Essential Coverage Plan – Physician Office Visit, Prescription Drug Coverage & Preventive Care Services
Minimum Essential Coverage meets 2015 ACA Requirements
Routine Physician Office Visits
Accident Benefit
Employee Assistance Program
COBRA Administration
HIPAA Administration
Aggregate Stop Loss
PPACA Summary of Benefits Coverage
National PPO Network
Administrative and Financial Data Compliance
Employee relieve from ACA Penalty
Prescription Drug Plan
Retail and Mail Order Generic Only
Telemedicine
Call/Email/Videochat a Physician 24/7/365
English and Spanish speaking
Medical Bill Negotiation and Surgery Saver
Negotiates medical bills on your behalf
Compare pricing, quality, and availability of Surgery facilities
Discount Cards
Discounts on Vision, Dental, Labs, MRIs and Prescriptions
5. Preventive Care Services
Preventive Care Services
Benefits are payable for eligibility procedures incurred as part of Preventive Care Services only.
Covered Preventive Expense Benefit Level Limits
Included Preventive Care Services specified
by Health Reform Law, USPSTF.
100% Some services are subject to age and visit
limitations unless medically necessary
Preventive Care Services include but are not limited to:
1. Routine Physical Exam
2. Annual Well Woman Exam
3. Annual Routine Mammogram (age 40+)
4. Routine Bone Density Test (age 60+)
5. Well Baby Exam and Well Child Exam
6. Routine Immunizations
7. Routine Hearing Screening (newborn)
8. Influenza/Pneumococcal Vaccine
9. All FDA approved women’s contraception methods
10. Routine Colonoscopy (age 50+)
11. Routine vision screening (age 19+)
For a complete list:
http://www.uspreventiveservicestaskforce.org
Covered Preventive Services Includes:
• Adults
• Children
• Women, including Pregnant Women
List of ACA Preventive Care Services
6. MEC Employer and Employee Responsibility
• Minimum Essential Coverage (MEC) need only to cover 100% of the CMS listed Preventive and Wellness benefits
• Employer with 50 employees or more full time plus part time equivalents can prevent being taxed $2000 per FTE, less 30
employees
• Employees can prevent being taxed on the Individual Mandate coverage penalty. 2015 – greater of 2% of household
income or $325 per adult plus $162.50 per child
• Employers can charge any reasonable amount which typically is 50% of contributions, and cannot charge more than 9.5%
of the household income
• Under a Limited Medical Plan the maximum out of pocket the Federal regulators allow is $6350 for a single employee.
www.conciergebenefitservices.com
7. Limited Benefits
The insurance described in this proposal provides limited benefits. Limited benefits plans are insurance products with reduced benefits and
are not intended to be an alternative to or integrated with comprehensive coverage. This insurance does not coordinate with any other
insurance plan. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical
insurance. Further, this insurance is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.
Our voluntary benefit solutions provide:
• Benefits tailored to the specific needs of your employees.
• Turn-key implementation and setup.
• Ongoing premium reconciliation, carrier reporting and payroll deduction feeds.
We allow you to focus on your core medical plan offerings by providing a complete solution
for your voluntary benefits.
www.conciergebenefitservices.com
8. Limited Benefits
Highlights of Technology Capabilities
• Online and/or paper enrollment
• Enroll, quote, bind and issue
• Custom employee web portal for enrollment and self-service
• Integrate Non-Ternian products into enrollment and billing administration
• Real-time eligibility
• Resource library for insurance certificates, ID cards, plan information, forms
• Member service online chat and email
• Ad-hoc enrollment and eligibility reporting
• Enrollment and premium administration of employer’s self-funded limited benefit medical plan
The insurance described in this proposal provides limited benefits and Minimal Essential Coverage. Limited benefits plans are insurance products with reduced benefits
and are not intended to be an alternative to comprehensive coverage. This insurance does not provide major medical or comprehensive medical coverage and is not
designed to replace major medical insurance.
www.conciergebenefitservices.com
9. Limited Benefit Plan Details – Example of MEC Plan+
OUTPATIENT
• Physician Office Visit Co-pay $10
• Benefit Amount per Day $50 per day x 5 days
• Accident Max Benefit amount per Year up to: $1,000 per year
• Benefits % Payable 80% U&C
PRESCRIPTION
• Retail- Generic Rx Copay $10
• Mail Order – Generic Rx Copay $30
•
• Monthly Benefit Max Individual/Family $200/$400
AD&D
• Accidental Death & Dismemberment Benefit $5,000
OTHER SERVICES
• Telemedicine
• Medical Bill Negotiation
• Surgery Cost Saver
• Employee Assistance Program
• PPO Discounts
• Discount Card for Dental, Vision, Lab Services
10. ACA Compliance and Administration Services
• Communication materials/Implementation Guidelines
• Plan Design and Summary of Benefits and Coverage
• Monthly reporting
• COBRA reporting
• TPA portal access
• HIPAA compliance
• Billing options
• ID Cards
• Claims processing
• 800 number for customer service
• Plan Implementation and Set up
• ACA compliance
Sample ID Card
11. Telemedicine Services
At Concierge Benefit Services, our focus is making your life less complicated. Utilizing technology along with cutting edge
services in the Telemedicine arena has set us apart.
We provide you and your family with access to the most innovative and cost effective approach to a doctor’s office visit and
physician care available.
12. As one of the nation’s premier leaders in the telemedicine industry, Concierge Benefit Services offers consumers access to some of the most cutting edge,
innovative healthcare solutions in the nation.
Our focus is to help consumers save money on their healthcare costs. By providing phone, email and/or video conferencing access to a national network of
U.S., board certified, licensed physicians, our program gives consumers near immediate access to care…anytime they need it, from anywhere.
All physicians are independent providers and are credentialed. The credentialing process is performed by a national third party credentialing agency in
accordance with the National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Committee (URAC) guidelines. Credentialing
includes a thorough review of medical licensure, training, education, work and malpractice history.
Our telemedicine portfolio provides fast and convenient access to quality medical care 24 hours a day, 7 days a week, 365 day a year throughout the United
States. This approach is a very inexpensive alternative to non-emergency related Emergency Room visits, Urgent Care Clinic visits or even Primary Care
Physician visits.
Telemedicine Service- Finally… a doctor’s office that you can access immediately from the comfort of your own home, office, car, ect!
• No more waiting rooms
• No more copays
• 24/7/365 access to a board-certified doctor…anywhere, anytime
• As simple as 1…2…3!
• Call a doctor
• Get diagnosed
• Pick up prescriptions
Telemedicine Services
16. Healthcare Concierge Telemedicine
Return on Investment/Potential Savings
AVG Cost per
Incident w/o Copay
Healthcare Concierge
Cost
$240.00
$6.00
Per Incident
SAVINGS
$234.00
Example: Family of 4 with 3 Doctors Visits per family memeber per Year
Annual Family Saving per
Year
Savings
Total Annual Cost of
Healthcare Concierge for
Family
Out of Pocket
Cost for entire
Famly
$2,880
$179
% of ER visits and Office
visits that can be
handled over the phone
Over
70%
% of Doctor consults that
result in not having to
leave work
Over
50%
Simple Process
1. Call the Doctor
2. Get diagnosed
3. Pick up your prescription
SAVINGS
17. Medical Bill Negotiation
Professional negotiators will negotiate medical bills on your behalf directly with the healthcare
provider to reduce or eliminate the balance due.
Aggregate medical bills of $1,000 (per Incident) or more will be negotiated to save the member
first dollar costs.
• Our average savings have been:
• Over $1,800 per case for those with health insurance and Over $4,000 per case for
individuals with no health insurance coverage
Patient Advocacy and Medical Bill Negotiation Services – Unlimited Use
18. Surgery Cost Saver
An RN will Surgery Cost Saver and Facility Comparison – How important would it be to have
complete transparency in your surgical procedures and cost prior to choosing where you will have a
non-emergency surgical procedure?
l develop a healthcare facility comparison report for non-emergency surgical procedures. The report
will compare pricing, availability, and quality metrics for up to five area facilities.
Average savings:
64% price differential among compared facilities
Average savings over $13,000 per case
Unlimited use
Complete Transparency in your Surgical Procedures and Cost prior to the Surgery
19. Medical Bill Negotiation and Surgery Cost Saver
Cost Containment Services
Patient Advocacy and Medical Bill
Negotiation Services – How great would
it be to have access to professional
medical bill negotiators who negotiate
medical bills on your behalf?
Professional negotiators will negotiate
medical bills on your behalf directly with
healthcare providers to reduce or
eliminate the balance due. Aggregate
medical bills of $1,000 (per Incident) or
more will be negotiated to save the
member first dollars.
Our average savings have been:
• Over $1,800 per case for those with
health insurance
• Over $4,000 per case for individuals
with no health insurance coverage
• Unlimited use.
Surgery Cost Saver and Facility
Comparison – How important would it be
to have complete transparency in your
surgical procedures and cost prior to
choosing where you will have a non-
emergency surgical procedure?
An RN will develop a healthcare facility
comparison report for non-emergency
surgical procedures. The report will
compare pricing, availability, and quality
metrics for area facilities.
Average savings:
• 64% price differential
among compared
facilities
• Average savings over
$13,000 per case
• Unlimited use
20. Discount Services
Discount Health Benefits
• Dental Benefits
15-50% Savings!
• Vision and Hearing Plans
10-60% Savings!
• Labs and Imaging
15-80% Savings!
• Chiropractic and Alternative Medicine
20-40% Savings!
Discount Card Sample
21. Employee Assistance Program
Welcome to SupportLinc, a CuraLinc Healthcare service. With SupportLinc as your Employee Assistance Program, you have
immediate access to expert content and comprehensive tools to assist you in every aspect of your life, all in a secure,
confidential and easy-to-use format.
At some point in our lives, each of us faces a problem or situation that is difficult to resolve. When these instances arise,
SupportLinc will be there to help.
The SupportLinc Employee Assistance Program (EAP) is a confidential resource that helps you deal with life’s challenges and
the demands that come with balancing home and work.
SupportLinc provides professional counseling and referrals for a wide array of personal and work-related concerns.
22. First Health PPO Medical Network
Access to Network discounts to more than 5,000 hospitals and
590,000 physicians and health care professionals. Service
provides members affordable access to physicians by allowing
them to pay a $10 Office Visit Pre-pay before insurance
benefits are applied.
Pharmacy Network
With RxEDO, members can use their card for prescription fills and refills at
over 56,000 participating pharmacies for co-pay benefits that will be processed
in real-time at the point-of-purchase at the pharmacy.
SupportLinc Employee Assistance
The SupportLinc Employee Assistance Program (EAP) helps
you deal with life’s challenges and the demands that come
with balancing home and work. SupportLinc provides
confidential, professional referrals and up to three (3) face-to-
face counseling sessions for a wide array of personal and
work-related concerns.
ternian Administration of MEC – Preventive
Care and Limited Med Benefits
PARTNERS
23. Contact Concierge Benefit Services
Greg Agle
greg@conciergebenefitservices.com
484-467-7314 [p]
www.conciergebenefitservices.com
No Contracts No Hidden Fees Complete Transparency
