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What Does Minimum Essential Coverage Entail?

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What is MEC and What Does It Cover?

Understanding Minimum Essential Coverage (MEC) can be complicated when compared to minimum value, essential health benefits, and actuarial value. 

Let’s start by answering: what is it and what does it cover? Minimum Essential Coverage is a plan that meets the Affordable Care Act (ACA) requirements for health coverage. Some of these programs include:

  • Marketplace plans
  • Job-based plans
  • Medicare
  • Medicaid

All applicable large employers (ALEs) with 50 or more full-time or full-time equivalent employees are required by law to provide ACA-compliant health coverage to their employees. ALEs who do not provide coverage ACA-compliant coverage are subject to fines and penalties from the Internal Revenue Service. 

What Are the Minimum Essential Coverage Option Levels Available?

There are three different plan options available. Understanding the difference between the three helps employers decide which MEC plan is best for their employees.

  • Standard MEC plans are ACA compliant and include coverage for wellness, preventative services, prescription discounts, and telehealth services. 
  • Enhanced MEC plans take coverage one step further than standard plans and are aimed at attracting and retaining top talent by also including primary and urgent care visits with low copays, and discounted specialist and laboratory services. 
  • The highest-level MEC plans include the enhanced MEC plan benefits along with added coverage such as prescription coverage and low copays. 

What Do Minimum Essential Coverage Plans with Hospital Indemnity Cover?

The goal of worksite MEC plans is to provide affordable healthcare coverage for the average person. MEC plans with added hospital indemnity policies can offset high deductibles and full out-of-pocket expenses so that an emergency does not become a financial crisis. The 10 health benefits they include are:

  1. Ambulatory Patient Services (outpatient services)
  2. Emergency Services 
  3. Hospital Visits 
  4. Maternity and Newborn Care
  5. Pediatric Services (including oral and vision)
  6. Mental Health and Substance Use Disorder Services (including behavioral health treatment) 
  7. Prescription Drugs
  8. Rehabilitative and Habilitative Services and Devices 
  9. Laboratory Services 
  10. Preventative and Wellness Services and Chronic Disease Management 

How Much Do You Save With MEC?

ALEs who fail to provide 95% of their full-time employees with ACA-compliant benefits are subject to high fines and penalties. Use our calculator to find out how much your business can save by providing Minimum Essential Coverage benefits while staying compliant with federal regulations.

Use our MEC Benefits calculator to see how much your business can save by offering MEC coverage.

What is the Difference Between MEC and Minimum Value?

Minimum value is a higher threshold than MEC. Minimum value is when a plan pays 60% of the actuarial value of allowed benefits under the plan. If a large employer offers benefits and meets Minimum Essential Coverage requirements, but they do not meet the minimum value, they meet the ACA employer requirements.

MEC and Essential Health Benefits

Essential health benefits are the core benefits that “qualified health plans” must cover. MEC also has a lower threshold than essential health benefits. If a group health plan doesn’t provide all of the benefits under essential health benefits, the coverage will likely meet Minimum Essential Coverage, so companies will be ACA-compliant.

Why is it Important to Understand the Differences?

Each of these coverage specifications is important to ensure large employers provide proper coverage to their employees. As an employer, you must understand your legal liability in providing benefits, as well as understanding what coverage you need to offer your employees to give them the best options and ensure compliance with the ACA. 

Curious why offering health insurance to your employees is so important? It encourages and promotes a healthier, happier, and stronger workforce. Read our article that explains why healthy employees improve work productivity here.

Pros and Cons of COBRA vs. Private Health Insurance

When seeking out health insurance coverage past when it’s partially covered by your previous employer, how do you choose between picking COBRA or private health insurance? Both have pros and cons. The right choice, however, depends on your unique circumstances.

Let’s discuss the pros and cons of COBRA vs. private health insurance.

What is COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is not insurance itself. Alternatively, COBRA is a law that was passed in 1985.

This law, COBRA, allows employees to continue on their existing health insurance plan if:

  • They are reduced to work less than 30 hours a week, or
  • Leave their job voluntarily or involuntarily

Under COBRA, the employee continues on his or her insurance plan but is then responsible to cover the entire cost. It is no longer the employer’s responsibility to cover health insurance premiums as they had previously.

COBRA, however, is not available to everyone. COBRA is only available to employees who worked at a public or private company with 20 or more employees.

What is Private Health Insurance?

Private health insurance, on the other hand, is any health insurance policy plan that is not run by a government-run insurance plan (i.e. Medicare, Medicaid, Obamacare).

This type of coverage, though not government-run, must comply with state and federal insurance regulations.

Depending on the type of insurance policy, regulations include: 

  • Affordable Care Act (ACA) essential health benefits
  • Maternity care
  • Meeting minimum essential coverage (MEC) requirements
  • Providing minimum value to avoid employer mandate penalty
  • Capping in-network and out-of-pocket costs

Pros and Cons of COBRA

Pros of COBRA

 

  • COBRA allows you to keep your same health insurance policy in the event you lost your job voluntarily, involuntarily, or through a reduction of work hours.
  • COBRA is an added security in case an unexpected life event occurs while you are unemployed.
  • Beneficiaries continue the same coverage for preexisting conditions and prescription drugs.
  • With COBRA offering an extension of your health coverage, you don’t have to pay for medical expenses out of pocket (i.e. doctor’s visits). Instead, you are still privy to the same group rate as the one you had with your previous job.

Lastly, you can use COBRA coverage for 18 to 36 months depending on why you need it. Plus, it can be extended depending on qualifying events.

 

Cons of COBRA

  • COBRA coverage is not cheap. Why? Because you’re now responsible for paying your portion of your health insurance: The cost you
    r employer contributed to your premium, in addition to the 2% service fee on the cost of your insurance.

A COBRA premium can cost on average $400 to $700 a month per person.

Calculate the Cost of COBRA

In order to calculate the cost of COBRA continuation coverage, add how much the employer contributes to the health plan, plus how much the employee contributes to the health plan, then multiply the sum by 2% for the service fee. 

 

Please see the formula below:

(Employer contribution to coverage + Your Contribution) x 0.02% = COBRA Premium)

 

For example, an employer who contributes $400 a month for an employee who contributes $200 a month would bring the total to $600 towards contributions. Multiplied by the 2% charge, the COBRA cost each month would cost $612 each month.

Pros and Cons of Private Health Insurance

Pros of Private Health Insurance

 

  • If you use private health insurance, you have the flexibility to choose a policy that works best for you. 
  • In addition to building your own policy, sometimes you can also choose your own physician.
  • Those who choose to use this type of health insurance coverage are also privy to greater coverage options and flexibility, shorter wait times, and better facilities

 

Cons of Private Health Insurance

  • Private health insurance is even more expensive than COBRA. Some policies may only cover up to 80% of the cost of care.
  • Private health insurance may offer limited coverage options depending on disease and condition.

 

Insurance premium costs are on the rise and show no sign of slowing down. As time goes on, the price of private health insurance is expected to continue increasing. Research found the national monthly average of insurance costs in 2022 sat at $541.

The Bottom Line

Both COBRA and private health insurance will help provide the security of having health insurance if you no longer have access to employee benefits. Weigh the pros and cons of each to see which policy fits your needs best.

Still have questions? Reach out to our expert team of brokers and visit our COBRA page to learn more.

Why Innovative Hia is the Gold Standard of Service

At Innovative Hia, we serve employers who want to offer their employees affordable benefits. We simplify the complexity of providing those benefits and ensure compliance with the Affordable Care Act.

We’re in the business of providing health care to everyday people, ensuring peace of mind through trust and transparency.

We pride ourselves on our personal service, speed of  implementation, and innovative approach to providing benefits coverage.

Today, we’d like to chat a bit more about the exceptional service we provide and why SBMA is, therefore, the gold standard of customer service for minimum essential coverage (MEC) insurance providers.

(Hint: Our one-stop-shop benefits portal plays a large role in our successful customer service efforts!)

Let’s dive in.

WHAT PROBLEM DO WE SOLVE?

With us, you get peace of mind, security, and the insurance your employees want at a price everyone can afford. Providing affordable benefits to your employees not only ensures you employees remain motivated and excited about work, but they also ensure you remain in compliance with the ACA.

WHAT MAKES INNOVATIVE HIA BENEFITS DIFFERENT?

Our customer service is what sets us apart. We work when you work. Our carrier partners have given us exclusive offerings to complement our medical plans, giving you the best possible price. Our quick execution and advanced approach to benefit coverage is second to none.

HOW INNOVATIVE HIA SUPPORTS THE ONBOARDING AND OFFBOARDING PROCESSES

At SBMA, we support businesses beyond providing affordable minimum essential coverage (MEC). We are proud to support the employee onboarding process so your human resources (HR) teams have more time to focus on the daily tasks that keep your business running.

This is why we offer a complete insurance solution that covers:

  • Implementation
  • Enrollment
  • Administration, and
  • Reporting

Our benefits professionals are fully equipped to support onboarding and offboarding procedures to eliminate the hassle for businesses.

How? Using our benefits portal.

OUR BENEFITS PORTAL

Employee benefits administration can be a pain for any HR department. At SBMA, we aim to simplify the process by giving you access to everything you need in one place.

Our one-stop-shop portal is proprietary and unlike any other. Our portal grants you access to all of the tools necessary to support a new hire (from beginning to end).

We eliminate the headache of unnecessary paperwork with benefits management portal access. You can:

  • Make plan changes
  • Order ID cards
  • Check a claim status online
  • Track onboarding and offboarding
  • And more

Resources are only a click away.

Besides creating a seamless onboarding process with our all-in-one portal, we also provide video tutorials for our partners. These resources provide instructions that assist navigation through the portal.

Read on to view our enrollment portal walkthrough.

What Is A Medical Captive And Is It Bad?

A medical captive is a type of insurance arrangement that allows businesses and employers to self-insure their health care costs. This means the company will assume financial responsibility for any medical expenses, rather than purchase coverage from a traditional insurer. It also means they can take advantage of potential cost savings by controlling how their healthcare dollars are spent.

While a medical captive can be a great option for businesses that want more control over their healthcare costs, there are some drawbacks as well. In this blog post, we will explore the pros and cons of medical captives and help you decide if this type of health insurance is right for your business.

What is a Medical Captive?

A medical captive is a type of insurance company that provides coverage exclusively to its parent or affiliated healthcare organizations. The purpose of setting up a medical captive is to insure the risks inherent in providing healthcare, such as rising malpractice costs, increased patient care costs and unpredictable losses from litigation. Medical captives are usually established by large hospitals, health systems, universities and physician groups, who use them to protect themselves against specific risks associated with the delivery of healthcare services.

How Captives Operate

Medical captives are typically funded by reinsurance companies or other insurance carriers and structured as either a single-parent captive or a group captive. Single-parent captives are owned by one parent organization and provide coverage for just that entity’s risks. Group captives provide coverage for a group of organizations, allowing them to pool their risks and receive more favorable terms.

How Captives Are Regulated

Medical captives are regulated by state insurance commissioners. They must file annual financial statements with the appropriate state authority, comply with all applicable laws and regulations, maintain adequate capital and surplus levels and secure an independent audit each year.

Additionally. . . 

In addition to providing coverage for medical malpractice and other healthcare risks, medical captives can also provide self-insurance for operational and administrative expenses such as marketing costs, employee benefits and worker’s compensation. Captives can also offer additional services such as risk management consulting, claims administration and loss control services.

Medical captives are an increasingly popular option for healthcare organizations looking to manage their risk and save on insurance costs. They offer the potential to reduce overall costs while providing greater control over how they are managed and protected.  However, it is important to understand that medical captives are not a substitute for traditional health insurance – rather, they provide an additional layer of protection that can help mitigate certain risks.  As such, it is important to consult with an experienced insurance broker or captive manager to ensure a medical captive is the right choice for your organization.

Is a Medical Captive Bad? 

Medical captives are not inherently bad, as long as they are used responsibly. In some cases, a medical captive can be an efficient and cost-effective way to manage health care costs. However, it’s important for businesses to do their research and understand the risks associated with this type of arrangement before committing to it. There is a potential for loss if a medical captive is not managed properly. 

Additionally, it’s important to consider the pros and cons of this type of arrangement in comparison to traditional insurance coverage. Ultimately, the decision about whether or not a medical captive is right for your business should come down to careful consideration of all potential outcomes.

The Pros of a Medical Captive:

  • More control over medical costs – By creating their own plan, businesses can have more control over the medical costs they incur.
  • Reduced administrative costs – Since medical captives are self-funded, administration costs are typically much lower than with other types of health insurance plans.
  • Flexible coverage – Businesses can tailor medical captives to the specific needs of their employees. This gives businesses more flexibility when it comes to deciding what medical services and treatments are covered.

The Cons of a Medical Captive:

  • Riskier proposition – Since medical captives are self-funded, businesses may be taking on more risk than they would with a traditional health insurance plan.
  • Higher medical costs – While medical captives can help to control medical costs, they may still be higher than those of other health insurance plans.
  • Difficult to set up – Medical captives can be complex and difficult to set up, as businesses need to comply with regulations and laws in order to create a medical captive.

 

As you can see, medical captives have both advantages and disadvantages to consider. It’s important to do your research and understand the risks and benefits associated with medical captives before deciding if this type of health insurance plan is right for your business. With the right information, medical captives can be a great way to provide healthcare coverage to your employees while minimizing medical costs. 

Things to Consider

If you decide to pursue a medical captive, it’s important to understand all the details involved. You should:

  • Select a structure that is appropriate for your business
  • Consider the financial implications of entering into a captive arrangement
  • Fully research potential service providers before committing
  • Set up an internal team responsible for managing the captive and handling any claims that may arise 

Doing your research and understanding the risks involved can help ensure that a medical captive is the right choice for your business and will allow you to take advantage of its potential benefits.

The Bottom Line

Overall, a medical captive can be a great way to manage healthcare costs if used responsibly. It’s important to understand all the details before committing to this type of arrangement and to make sure it is the right choice for your business. By doing your research, you can make an informed decision about whether or not a medical captive is the right choice for you.

If you still have questions regarding medical captives, reach out to us! 

Or to learn more, read about the differences between standard market insurance and captive insurance programs.

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ACA is Here to Stay

The Affordable Care Act, also known as Obamacare, was one of the biggest healthcare overhauls in recent history. It aimed to provide affordable health insurance coverage for all Americans. After several failed attempts to repeal the act, it seems that ACA is here to stay. 

In this blog post, we will take a closer look at what this means for American taxpayers and businesses.

What Is the Affordable Care Act (ACA)?

The Affordable Care Act was passed in 2010 and since then it has been under constant threat of repeal. The law required all Americans to have health insurance coverage or face a tax penalty. It also expanded Medicaid coverage and provided subsidies to help people afford private health insurance plans.

 

In 2017, Republican lawmakers attempted to repeal the Affordable Care Act but were unsuccessful. This led to a lot of uncertainty about the future of the law. However, it now seems that ACA is here to stay, at least for the time being.

What Does this Mean for American Taxpayers?

For starters, it means that the tax credits and subsidies that help people afford their health insurance coverage are still in place. It also means that the Medicaid expansion, which has provided coverage for millions of low-income Americans, is still in effect.

 

Taxpayers will continue to be responsible for funding the ACA. This includes the subsidies that help people pay for health insurance and the Medicaid expansion. The good news is that, because the ACA is no longer being repealed, there will be no need for major changes to the tax code.

What Does this Mean for Businesses?

The Affordable Care Act requires businesses with 50 or more employees to provide health insurance coverage for their workers. This requirement is still in place, so businesses will need to continue to comply with it.

 

There may be some changes to the way this is done in the future. For example, the government may provide more subsidies to help businesses cover the cost of health insurance. 

 

Overall, the news that ACA is here to stay is good news for American taxpayers and businesses. It provides stability and certainty in an uncertain time.

Final Thoughts

The Affordable Care Act has provided many benefits, including increased access to healthcare, lower costs for prescription drugs, and free preventive care services. These benefits are worth billions of dollars each year and help to improve the lives of millions of Americans.

 

There is still some uncertainty about the future of the Affordable Care Act, but for now, it seems that the law is here to stay. This is good news for American taxpayers and businesses who have benefited from the law’s many provisions.

 

If you’re interested in learning more about the ACA, read these articles published by SBMA: the advantages of the ACA and  what business owners should know about ACA benefits. 



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Open Enrollment 2022-2023: What You Need to Know

What is Open Enrollment?

Open enrollment is the one period of the year where employees can sign up for health insurance or change a health insurance plan provided by the employer. Remember that this period also allows employees to disenroll in health insurance if they no longer wish to have coverage. 

 

The only exception to enrolling, changing a health insurance service, or disenrolling is through a qualifying event. Qualifying events can vary depending on the state the employee resides in.

Qualifying events include:

  • Marriage
  • Divorce
  • Having or adopting a child
  • Loss of insurance due to employment change or termination of employment 
  • Death of someone covered on the plan 
  • A dependent no longer qualifies as a dependent
  • Moving to a new state 
  • Becoming a U.S. citizen

When is Open Enrollment for Health Insurance? 

Open enrollment periods range depending on the healthcare provider and the state the employee lives in. Nationally, open enrollment periods begin on November 1st 2022 through January 15th 2023. In order for coverage to begin January 1st 2023, enrollees must enroll by December 15th.

 

Check here for Affordable Care Act (ACA) open enrollment dates by state. 

Is There Health Insurance That Doesn’t Use Open Enrollment?

Yes, a few health insurance policies do not have the same open enrollment restrictions that others do. This means that there aren’t restricted time periods when employers can sign up for insurance. It is available to them year-round.

 

Different types of health insurances that don’t follow open enrollment rules include:

  • U.S. government’s Children’s Health Insurance Program (CHIP)
  • Medicaid 
  • Short-term health insurance 
  • Travel insurance 
  • Supplemental insurance programs 
  • Medigap 

How Can Offering Voluntary Benefits Save Your Business Money? 

Voluntary benefits are offered by employers to their employees at no additional cost to the employer. They are often referred to as employee-paid benefits or supplemental insurance. The employer makes the benefits available to the employee, but the employee pays the full cost of the plan. It is not split between the two. 

 

This form of insurance is rising in popularity because it allows employees the flexibility to choose the type of insurance or health coverage that best fits their lifestyle instead of paying for coverage the employee does not want or need. 

 

Employer benefits of offering voluntary benefits include:

  • Reducing out-of-pocket health care costs
  • Access to group rates 
  • 100% of the insurance cost is paid by the employee 
  • Gives your employees choice in healthcare plans 
  • It is available to part-time and full time employees 
  • Helps your company attract and retain top talent (77% of workers say that benefits packages are an important part of deciding on accepting or rejecting a job offer)
  • Saves you billing time through automatic payroll deductions

 

At Innovative HIA, we provide comprehensive coverage plans for employers to provide affordable benefits to employees. Here, our voluntary benefit plans encompass:

  • Health
  • Dental
  • Vision 
  • Wellness/Lifestyle 
  • Financial 
  • Security 
  • Personal and miscellaneous 

Why is Employee Insurance Enrollment Important? 

Employee health insurance is important for businesses, especially Applicable Large Employees (ALE). Under the Affordable Care Act (ACA), ALEs who do not provide health insurance are penalized for every employee who is not offered health insurance.

 

This year, fines can range from $2,700 to $4,000 per employee not offered coverage. In comparison, offering our ACA compliant Minimum Essential Coverage (MEC) is an affordable way for ALEs to maintain coverage compliance. Look below for a cost comparison of how providing MEC benefits to employees saves your business money.

 

Besides avoiding hefty fines, employee health insurance provides the support employees need if they ever fall ill, and keeps employees healthy. One of the main benefits of coverage is that covered preventative care visits monitor any health concerns that may arise an employee cannot physically see or feel yet. 

 

Healthy employees are more present and productive at work. Employees who are supported through covered care gain access to resources that combat preventable illness, and are more likely to be positive, engaged and determined to do their best during work.

 

Another benefit of maintaining a healthy workforce is that it reduces the costs you as an employer must front when an employee takes sick leave or if you have to find someone to cover a shift.

Actionable Ways to Increase Benefit Enrollment 

Actively encourage employees to sign up and renew health insurance during open enrollment, and especially before, so employees have time to prepare and choose a plan best suited for them.  

 

Employers can encourage employees to sign up for health insurance during open enrollment 2022 through:

  • PDF one-pagers: One-pagers have information about health benefits that are easily distributed around the office.
  • Pamphlets: Similar to a one-pager, pamphlets have information, graphics, and contact information for the employee.
  • Offer a point of contact: A knowledgeable employee within your business can answer FAQs and help employees find the right plan.
  • Text or email campaigns: Sometimes the most effective method of communication is through technology.
  • Pay stubs: Add information about enrollment to paystubs because employees receive them regularly.

Curious about how else your business can increase health insurance enrollment this year? Read our article here on how opt-in vs opt-out insurance policies make a bigger difference than you’d think.

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Healthcare Insurance Brokers: How to Increase Your Margins

Healthcare insurance brokers are constantly looking for ways to provide the best for their clients while increasing their margins. If this is the case for you, look no further!

Innovative HIA provides the most competitive rates for Minor Medical coverage plans. Our mission as a benefits administrator is to help you—as a healthcare insurance provider—deliver the best for your clients (and a little extra commission wouldn’t hurt).

Below are a few tips on how to increase margins as a healthcare insurance broker (Hint: we saved the best tip for last!)

How to Increase Your Margins as a Healthcare Insurance Broker

As a healthcare insurance broker, you are always looking for ways to provide the best possible coverage for your clients while also increasing your own margins. 

There are a few key ways that you can do this:

Get Higher Commissions

One way to increase your margins is to simply get higher commissions from the insurance carriers you work with. This can be done by negotiating better terms with the carriers, or by simply switching to carriers that offer higher commissions. (But more on this later!)

Get Better Insurance Rates

Another way to increase your margins is to get better insurance rates for your clients. This can be done by:

  • Hopping around for the best rates
  • Using discounts, or
  • Simply being aware of the different rates that are available

Increase Your Efficiency

Finally, you can also increase your margins by increasing your efficiency as a healthcare insurance broker. This means finding ways to work faster and more efficiently, saving you time and money long-term.

How Brokers Can Earn Higher Commissions with Innovative HIA

We told you we saved the best tip for last! Working with Innovative HIA is the easiest way you can increase your margins as a healthcare insurance broker.

At Innovative HIA, our ACA-compliant policies start at a base price with a set commission built-in. Additionally, we work with our brokers to ensure you feel comfortable with the commission you’re earning – no one knows how much your time is worth except for you and we want you to be satisfied with your rate.

Brokers that work with Innovative HIA can set their insurance rates to reflect the market and effort they put into managing their accounts. 

Increase Your Margins by Working with Innovative HIA!

By following these tips as a healthcare insurance broker, you can easily increase your margins. This will allow you to provide even better coverage for your clients while also making more money yourself. So don’t wait, start increasing your margins today!

Get in touch with Innovative HIA today to learn more or read on to learn how brokers can get their employer groups engaged!

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Why Innovative HIA is the Gold Standard of Customer Service

At Innovative HIA, we pride ourselves on offering:

  • Affordable Benefits
  • ACA Compliance, and
  • Exceptional Service


Today, we’d like to chat a bit more about the third element—the exceptional service we provide—and why Innovative HIA is, therefore, the gold standard of customer service for Minor Medical insurance providers.

(Hint: Our one-stop-shop benefits portal plays a large role in our successful customer service efforts!)

Let’s dive in.

How Innovative HIA Supports the Onboarding and Offboarding Processes

At Innovative HIA, we support businesses beyond providing Minor Medical coverage. We are proud to support the employee onboarding process so your human resources (HR) teams have more time to focus on the daily tasks that keep your business running.

This is why we offer a complete insurance solution that covers:

  • Implementation
  • Enrollment
  • Administration, and
  • Reporting

Our benefits professionals are fully equipped to support onboarding and offboarding procedures to eliminate the hassle for businesses.

How? Using our benefits portal.

Our Benefits Portal

Employee benefits administration can be a pain for any HR department. At Innovative HIA, we aim to simplify the process by giving you access to everything you need in one place.

Our one-stop-shop portal is proprietary and unlike any other. Our portal grants you access to all of the tools necessary to support a new hire (from beginning to end).

We eliminate the headache of unnecessary paperwork with benefits management portal access. You can:

  • Make plan changes
  • Order ID cards
  • Check claim status online
  • Track onboarding and offboarding
  • And more

Resources are only a click away.

Besides creating a seamless onboarding process with our all-in-one portal, we also provide video tutorials for our partners. These resources provide instructions that assist navigation through the portal.

Read on to view our enrollment portal walkthrough.

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Preventative Services Covered by Minor Medical

Minimum essential coverage is health insurance that meets the Affordable Care Act requirements. Employers have a requirement to offer at least Minimum Essential Coverage to any benefit-eligible employee. Non-compliance can result in a penalty of $214.17 PER eligible employee per month without coverage.

At Innovative HIA, we aim to offer affordable, flexible, and compliant coverage for all employers.

What Does Minor Medical Cover?

Our Minor  Medical plans cover 100% of preventive services and wellness visits to the doctor. In addition, all members have access to 24/7/365 telehealth services and discounts on generic and brand prescriptions. 

These plans are the most affordable option under Minimum Essential Coverage. 

What Does Major Medical Cover?

Major Medical covers the preventative services and wellness visits mentioned above, as well as primary care and specialist visits with a $15 copay. As well as urgent care, labs, and X-rays with a $50 copay. 

24/7/365 telehealth services are included under this plan, along with access to behavioral health telehealth services

Prescriptions under the Major Medical plan are covered based on your coverage tier.

*$50 fee max 3 per year

Preventative Services Covered Under Minor Medical

Both plans cover preventative services and wellness visits. The services covered depend on age and gender. Here’s a look at the coverage offered under preventative services:

Covered Preventative Services for Adults

  • Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
  • Alcohol misuse screening and counseling
  • Aspirin used to prevent cardiovascular disease in men and women of certain ages
  • Blood pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal cancer screening for adults over 50
  • Depression screening for adults
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over
  • Hepatitis B screening for people at higher risk
  • Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 –1965
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines for adults — doses, recommended ages, and recommended populations vary: Hepatitis A, Hepatitis B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis and Varicella
  • Lung cancer screening for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Statin preventive medication for adults 40 to 75 years at higher risk
  • Syphilis screening for all adults at higher risk
  • Tobacco use screening for all adults and cessation interventions for tobacco users
  • Tuberculosis screening for certain adults with symptoms at higher risk

Covered Preventative Services for Women

  • Anemia screening on a routine basis for pregnant women
  • Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer (counseling only; not testing)
  • Breast cancer mammography screenings every 1 to 2 years for women over 40
  • Breast cancer chemoprevention counseling for women at higher risk
  • Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
  • Cervical cancer screening
  • Chlamydia Infection screening for younger women and other women at higher risk
  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
  • Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before
  • Domestic and interpersonal violence screening and counseling for all women
  • Folic acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • HIV screening and counseling for sexually active women
  • Human Papillomavirus (HPV) DNA Test every 5 years for women with normal cytology results who are 30 or older
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Preeclampsia prevention and screening for pregnant women and follow-up testing for women at higher risk
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Sexually transmitted infections counseling for sexually active women
  • Syphilis screening for all pregnant women or other women at increased risk
  • Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Urinary tract or other infection screening, including urinary incontinence
  • Well-woman visits to get recommended services for women under 65

Covered Preventative Services for Children

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Bilirubin concentration screening for newborns
  • Blood pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Blood screening for newborns
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age 3
  • Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Fluoride varnish for all infants and children as soon as teeth are present
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns, and for children once between 11 and 14 years, once between 15 and 17 years, and once between 18 and 21 years
  • Height, weight, and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents ages 11 to 17 years at high risk
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns
  • Immunization vaccines for children from birth to age 18 — doses, recommended ages and recommended populations vary: Diphtheria, Tetanus, Pertussis, Haemophilus influenza type B, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Meningococcal, Pneumococcal, Rotavirus and Varicella
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Maternal depression screening for mothers of infants at 1, 2, 4, and 6-month visits
  • Medical history for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Obesity screening and counseling
  • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
  • Phenylketonuria (PKU) screening for this genetic disorder in newborns
  • Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Vision screening for all children.

 

Read on for more information on minor medical insurance plans and what they cover.