Minimum Essential Coverage
Self-funded MEC plans have a flat monthly administration rate of $50 for all tiers – E, ES, EC, & Family.
- Pay admin fee monthly
- Pay claims as incurred
- Save hundreds to thousands of dollars per month
What is a MEC Plan?
MEC Plans were created out of necessity to help employers remain compliant under The Affordable Care Act (ACA). They can also be used to provide baseline health benefits when affordability is a must.
In-Network Healthcare
Self-funded MEC plans have a flat monthly administration rate of $50 for all tiers – E, ES, EC, & Family
The plan utilizes the PHCS Practitioner and Ancillary Network by Multiplan to provide negotiated rates that reduce out-of-pocket costs for employees and claims for the employer.
Sample MEC Plan Design
Prescriptions
Generic medications are provided with a $10 co-pay. The cost of generic preventive medications may be less if required by ACA.
$10 Co-pay
Preventive Care
$0 Co-pay
The plan is ACA compliant which requires preventive care to be available at no cost.
Doctor Visits
$30 Co-pay
Employees can visit an in-network primary care physician or specialist up to three times per year.
Labs
$10 Co-pay
Lab work can be performed at an in-network location up to two times per year.
Urgent Care
$50 Co-pay
Employees can visit an in-network urgent care center up to two times per year.
Radiology
$30 Co-pay
X-rays and radiology can be performed at an in-network location up to two times per year.
How self-funded MEC works
Administration
The employer pays MEC claims. If no claims are incurred, there is no cost other than the adminstration fee paid to the TPA.
Network
The MEC plan is contracted with the MultiPlan PHCS Physician Network for reduced rates and national coverage.
Cost Controls
The MEC Plan limits the number of visits per plan year to contain costs. There is No hospitalization coverage.
No Deductible
MEC Plans do not have a deductible. Employees pay a co-pay and the remainder is submitted to the employer by the plan’s Third Party Administrator (TPA).
Compliance
MEC Plans meet the ACA requirement for Minimum Essential Coverage. Employers with 50 or more FTEs must offer MEC or a health plan.
Plan Highlights
- 3 doctor's visits
- 2 urgent care visits
- 2 lab tests
- 2 imaging diagostics
- Colonoscopy for age 45 and over
Self funded MEC Plan Pricing Model
MEC Plan
Employee
$50 per mo., plus claims
Fixed Cost
$50 per employee per month for administration and network access.
Claims
Claims are paid by employer.
MEC Plan
Add Spouse or Child
$0 per mo., plus claims
Pay Claims Only
Adding a spouse or child does not increase the fixed cost. Additional claims are charged to the employer.
MEC Plan
Add familly
$0 per mo., plus claims
Pay Claims Only
Adding a family does not increase the fixed cost. Additional claims are charged to the employer.
Level funded and fully insured MEC plans
In additional to self funded MEC plans, MEC Plans can be level funded in which funds are deposited monthly to cover claims. This helps employers budget for claims that may occur in spurts. MEC plans can also be fully insured with no claims funding. Fully insured MEC plans cost more but some employers prefer certainty over savings. For groups over 25 enrolled, MEC plans can be fully insured and still return a portion of claims funding when claims are low.
Design your MEC plan
Tell us about your franchise and the MEC plan you have in mind. We’ll design a plan based on your group size and funding preferences.