MEC with Limited Benefits v2 (3)

Minimum Essential Coverage Plans (MEC) with Limited Benefits

With

Healthcare Concierge Services

MEC Plan DetailsMinimum 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.

MEC Plan DetailsMinimum 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

MEC Plan DetailsMinimum 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

Preventive Care ServicesPreventive 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 Exam2. Annual Well Woman Exam3. Annual Routine Mammogram (age 40+)4. Routine Bone Density Test (age 60+)5. Well Baby Exam and Well Child Exam6. Routine Immunizations7. Routine Hearing Screening (newborn)8. Influenza/Pneumococcal Vaccine9. All FDA approved women’s contraception methods10. 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

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

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

Limited BenefitsHighlights 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

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

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

Telemedicine ServicesAt 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.

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

Telemedicine Services

Telemedicine Reduces Cost

Telemedicine’s Common Conditions and Common Prescriptions

Healthcare Concierge Telemedicine Return on Investment/Potential Savings

AVG Cost perIncident w/o CopayHealthcare Concierge Cost

$240.00

$6.00

Per IncidentSAVINGS

$234.00

Example: Family of 4 with 3 Doctors Visits per family memeber per YearAnnual 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 Doctor2. Get diagnosed3. Pick up your prescription

SAVINGS

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

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 caseUnlimited use

Complete Transparency in your Surgical Procedures and Cost prior to the Surgery

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

Discount ServicesDiscount Health Benefits

• Dental Benefits15-50% Savings!

• Vision and Hearing Plans10-60% Savings!

• Labs and Imaging15-80% Savings!

• Chiropractic and Alternative Medicine20-40% Savings!

Discount Card Sample

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.

First Health PPO Medical NetworkAccess 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 NetworkWith 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 AssistanceThe 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

Contact Concierge Benefit ServicesGreg [email protected] [p]

www.conciergebenefitservices.com

No Contracts No Hidden Fees Complete Transparency