Fact: all Americans must have healthcare coverage. It’s the law. Yet we’ve all had an experience (or know someone that has) where healthcare winds up being very costly, even with insurance. On the other hand, without insurance, you run the risk of penalties and fines. How can you avoid all of this? MECs. MEC stands for minimum essential coverage. These plans outline the minimum requirements for a healthcare plan to qualify as, well, a healthcare plan. We have everything you need to know to remain compliant when it comes to MECs.
The foundation for minimum essential coverage stems from the individual responsibility provision. Simply put, this provision requires you, your team, and each member of your families to have qualifying healthcare coverage (aka MEC).
Some quick background on penalties – if you or anyone on your team does not have health insurance, fines for 2016 are $695 per adult ($347.50 for anyone under 18 years old). Or 2.5% of your household income, whichever is higher. Of course, we want to avoid all of that. (So keep reading).
What qualifies as health coverage?
- Any plan purchased through the Health Insurance Marketplace
- Health coverage through the Peace Corps
- Employer-sponsored plans, including COBRA coverage
- Group health insurance
- Self-insured group plans
- Retiree coverage
- Student health plans purchased through a school or a university
- Medicare Part A insurance (hospital insurance) – this is different than Medicare Part B insurance (medical insurance, which, on its own, does not qualify as coverage under current healthcare laws)
- Refugee Medical Assistance
- TRICARE coverage
- Individual health plans purchased outside of the Marketplace, so long as they meet the following requirements: provides essential health benefits, follows the limits on cost-sharing for things like copayments and deductibles, and abides by current stipulations under the Affordable Care Act
Note that working with licensed brokers like Decisely ensures that your plans remain compliant and that you remain up-to-date on any changes to federal laws and regulations.
What does not qualify as health coverage?
- Solely vision care
- Solely dental care
- Fixed benefit plans
- Short term health plans
- Plans that offer specific discounts on medical services
- Workers’ compensation
Apart from following the Affordable Care Act, minimum essential coverage must also have the following qualities:
- Guaranteed coverage: coverage must be granted other than inability to pay for it
- Guaranteed renewability: coverage must be able to be renewed regardless of an individual’s health condition
- Affordability: plans must cover a minimum of 60% of out-of-pocket expenses
- Fair health insurance premiums: plans must adhere to the amount an individual can be charged based on family size, tobacco use, geography, and age
- Ten essential benefits: plans must cover at least ten essential health benefits
Okay now, get ready — you’ve got the closing sales pitch coming. (It’s worth it to keep reading. We promise.) If your healthcare broker is worth their salt, they can ensure you are offering plans that qualify as minimum essential coverage. MEC plans are awesome if you are an individual that requires routine check ups and for the most part, is in good health. However, opt for a different kind of plan if you (or any of your dependents) have major medical conditions such as cancer. At Decisely, we work with our clients to keep them compliant. The Decisely Compliance Plus Plan is an alternative and innovative way to provide your team with quality healthcare. The Decisely Compliance Plus pPlan is cost effective, and also covers preventative care such as annual exams, baby and child immunizations, labs and X-rays for cancer screenings, colonoscopies, and more. You’ll also have access to an unrestricted network, there are no participation requirements, and there are no pre-existing condition clauses. With low copays and a variety of options, we provide guidance and support so you can make the best decisions for your business. Contact us today to learn more about the Decisely Compliance Plus Plan.