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:
Ambulatory Patient Services (outpatient services)
Emergency Services
Hospital Visits
Maternity and Newborn Care
Pediatric Services (including oral and vision)
Mental Health and Substance Use Disorder Services (including behavioral health treatment)
Prescription Drugs
Rehabilitative and Habilitative Services and Devices
Laboratory Services
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.
https://innovativehia.com/wp-content/uploads/2022/12/iStock-1359838986-2.jpg13182275magdihttps://innovativehia.com/wp-content/uploads/2020/08/InnovativeHIA_logo2-1030x407.pngmagdi2024-03-25 19:21:312024-04-05 15:45:07What is MEC and What Does It Cover?
As a parent, we’re sure you’re excited that the summer chaos, coordinating camps and activities, and simply having your children around 24/7 have ended!
As you know, going back to school typically means your child gets sick more frequently. So, how can you safeguard your child and the rest of your family’s wellness this back-to-school season?
Below are a few tips.
Stay Up-to-Date on Immunizations and Vaccines
Vaccination requirements typically vary on a state-by-state basis or even in a school-specific district. To find out precisely what immunizations your child needs, contact your local school board.
The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a few specific vaccines based on your child’s age. These are as follows:
By Age Two
A vaccination series of the following vaccines should be completed in all children by age two:
Hepatitis B
DTaP (diphtheria, tetanus, and pertussis)
Hib (Haemophilus influenzae)
Polio
Pneumococcus
MMR (measles, mumps, rubella)
Varicella (protects against chicken pox)
In addition, annual flu vaccines are recommended for infants from six to 24 months, as this age group is at high risk of complications from contracting the flu.
Hepatitis A vaccines may also be recommended starting at age 2 for those in high-risk groups or areas.
Age Four to Six
Typically, boosters are recommended between ages four to six for DTaP, Polio, and MMR. Those who are younger than nine and have not received the flu vaccine, need two doses of the vaccine given more than one month apart. After age nine, annual vaccination is recommended.
Children with asthma or lung diseases, sickle cell anemia, HIV, diabetes, and heart or kidney disease should receive the influenza vaccination annually.
Age 11 to 12
At around age 11 to 12, a pediatrician visit is recommended to review vaccinations and ensure all necessary immunizations have been provided. At this age, a hepatitis B, MMR, or varicella vaccine may be given if missed or incomplete at earlier ages.
Your child may also receive a combination of boosters for tetanus and diphtheria (if five years have passed since the last Td vaccine). Children with a high risk of complications from the flu should receive an annual vaccine.
Attend Annual Checkups
Annual doctor’s office visits and check-ups can help prevent greater health issues later on down the line. These check-ups can help identify hearing and vision issues, malnutrition, and other lifestyle imbalances.
Hearing and Vision Issues
Vision and hearing losses are often overlooked in children at a younger age. These issues are difficult to identify if your child is not getting tested in their annual check-up for vision and hearing ability.
Identifying these issues early on can make a huge impact on your child’s ability to learn and engage both in school and at home.
Malnutrition
A child’s development depends on proper nutrition, both physically and cognitively. Malnutrition is an issue that impacts children globally, including in the U.S.
Annual checks and doctor’s visits can help give you greater insight into how your child is developing compared to other children of the same age. A slight change in nutrition can have a huge impact on your child’s ability to learn.
MEC Covered Services for Children
To make sure your child can receive the care they need to remain healthy during the school year, you need proper insurance coverage.
Minimum essential coverage (MEC) offers an affordable coverage option to keep you and your family healthy at all times.
Some of the services covered for children include:
Alcohol and drug use assessments for adolescents
Autism screening for children at 18 and 24 months
Behavioral assessments for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years
Bilirubin concentration screening for newborns
Blood Pressure screening for children at 0-11 months, one to four years, five to 10 years, 11 to 14 years, and 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 three
Dyslipidemia screening for children at higher risk of lipid disorders at one to four years, five to 10 years, 11 to 14 years, and 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 screen for all newborns; and for children once between 11 and 14 years, 15 and 17 years, and 18 and 21 years
Height, weight, and body mass index measurements for children at 0 to 11 months, one to four years, five to 10 years, 11 to 14 years, and 15 to 17 years of age
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
These services in combination with preventative measures taken at home can help keep your family and your children safe during the back-to-school influx of sickness.
https://innovativehia.com/wp-content/uploads/2022/08/Safeguard-Your-Familys-Wellness-This-Back-to-School-Season.png6281200magdihttps://innovativehia.com/wp-content/uploads/2020/08/InnovativeHIA_logo2-1030x407.pngmagdi2022-09-18 07:00:132022-08-29 04:49:30Safeguard Your Family’s Wellness This Back-to-School Season
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.
https://innovativehia.com/wp-content/uploads/2022/07/iStock-961349792-scaled.jpg17072560magdihttps://innovativehia.com/wp-content/uploads/2020/08/InnovativeHIA_logo2-1030x407.pngmagdi2022-07-31 07:00:202022-07-29 18:03:49Preventative Services Covered by Minor Medical
Innovative HIA’s Minor Medical plan (also known as Minimum Essential Coverage) provides expecting mothers the resources to screen for potential risk factors that impact the mother and baby. Some conditions or complications that arise during pregnancy are not easily recognizable and may require screening and testing for a diagnosis. It’s important to routinely check on you and your baby’s health so that if complications arise, your healthcare team is prepared to support your prenatal care. Learn more about pregnancy and minimum essential coverage – what we cover and why it’s important for you and your baby’s health in the short and long term.
What Does Our Minimum Essential Coverage Plan Include for Pregnant Women?
Anemia screening on a routine basis for pregnant women
Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
Gestational diabetes screening for women 24 to 28 weeks pregnant and those at risk of developing gestational diabetes
Hepatitis B screening for pregnant women at their first prenatal visit
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
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
What is Anemia?
Anemia is a blood condition where the blood does not have sufficient healthy red blood cells in the body. Red blood cells carry oxygen to your organs and your baby. This means, that reduced levels of red blood cells cause lower levels of oxygen going to your body’s organs and your baby. Symptoms can include fatigue, weakness, and dizziness.
The most common type of anemia during pregnancy is iron-deficient anemia. In iron-deficiency anemia, the blood cells do not have enough iron in them to create sufficient amounts of the protein hemoglobin that carries oxygen itself on the red blood cell.
Therefore, the red blood cells cannot carry as much oxygen to the organs in the body, or the baby. Think of it like a train. The train with six carriages will transport double the amount of people in the same amount of time that a three-carriage train can.
Folate-deficiency anemia occurs when there isn’t enough intake of vitamin folate. Folate is a B vitamin found in food like broccoli and kale. It’s the basis for the body to make healthy red blood cells that can carry oxygen. Maintaining a consistently balanced diet replenishes folate levels in the body.
Vitamin B12 also helps the body create healthy red blood cells. Vitamin B12 deficiency limits the body’s ability to produce healthy red blood cells that circulate enough oxygen to you and your baby. Sources of B12 are found in meat, fish, and dairy products. Again, maintaining a well-balanced diet helps protect you and your baby from potential birth complications.
Why is Screening Important?
When screened for anemia, the test usually includes a hemoglobin test that measures the amount of iron-rich protein in the red blood cells and a hematocrit test that measures the percent of red blood cells in a blood sample.
Severe untreated anemia can lead to pregnancy complications and potentially preterm delivery. We cover anemia screening because we know the importance of catching and monitoring anemia during pregnancy for you and your baby’s safety.
Breastfeeding Support for Pregnant Women
After delivery, one of the first ways to assist women is through breastfeeding support and counseling. Both the American Academy of Pediatrics and the World Health Organization recommend women exclusively breastfeed infants for the first six months.
For women who choose to breastfeed their infant, our Minor Medical plan provides breastfeeding comprehensive support and counseling from trained providers. The support includes access to breastfeeding supplies for pregnant and nursing women.
According to the CDC, “research has shown that breastfeeding is recognized as the best source of nutrition for most infants.”
Breastfeeding counseling encourages and supports mothers during the breastfeeding process. They help the mother:
Correct breastfeeding positioning, attachment, and effective suckling.
Educate the mother on typical feeding behavior such as eating up to eight times a day, and signs such as rooting for when the baby is hungry.
Encourage the mother to switch the breast used after each feeding.
Reassure the mother that she will produce enough milk for her baby.
We encourage the use of trained providers through our Minor Medical benefits to plan to support mother and child during the important feeding process.
What is Gestational Diabetes and Why is Screening Important?
Our Minor Medical benefits plan covers gestational diabetes screening during the second trimester and for women at risk of developing gestational diabetes. During the 24-28 week period, the second trimester of pregnancy, the pregnant woman’s body is more resistant to insulin which makes glucose, sugar, and levels rise. Women who are obese before pregnancy, or have a family history of diabetes, are at a higher risk of gestational diabetes, which makes it important for them to receive screening as well.
Initial glucose challenge test – you drink a sugary solution and your blood is monitored an hour later to check if the levels are normal or out of range.
Follow-up glucose tolerance test – if the first glucose test was high, a second glucose tolerance test is taken. This one requires blood level monitoring every hour for three hours.
It’s important to screen for gestational diabetes so you can prevent any possible future complications. If diagnosed, you and your provider can develop a treatment plan for you and your baby and monitor your health.
Complications for the baby:
Excessive birth weight
Preterm birth
Breathing difficulties
Low blood sugar
Obesity or type 2 diabetes later in life
Stillbirths
Complications for the pregnant woman:
High blood pressure
Preeclampsia
C-section
Future diabetes
Screening for gestational diabetes allows the mother and child to obtain the resources necessary to reduce complications in the future.
https://innovativehia.com/wp-content/uploads/2022/01/Untitled-design-copy-6.png9241640Amanda Rogershttps://innovativehia.com/wp-content/uploads/2020/08/InnovativeHIA_logo2-1030x407.pngAmanda Rogers2022-02-13 20:11:322022-04-08 17:41:10Record Number of People Enroll in Health Insurance Coverage
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