Minimal Essential Coverage Healthcare2U Direct Primary Care Benefits Proposal Presented By:
About Staff Benefits Management & Administrators What We Do: SBMA provides comprehensive benefits administration you and your company can trust. Our team has a well-deserved reputation of excellence in providing smart, sensible and cost-effective solutions for our clients. SBMA s experts developed a cost-conscious Minimum Essential Coverage (MEC) plan that offers both employers and employees an affordable option to help ELIMINATE PENALTIES. Our Mission: Provide an affordable solution to Affordable Care Act (ACA) challenges Provide experienced healthcare administrators Provide a complete solution from implementation and enrollment to administration and year-end reporting
Non-Compliance Penalties Penalty A: The Employer Mandate Employers must offer a MEC to any benefit-eligible employee. Non-compliance will result in a penalty of $2,260 PER eligible employee. Penalty B: The Employer Mandate Employers must offer a Minimum Value (MV) plan that meets 60 percent actuarial value, including hospitalization services. The MV plan must be offered at a maximum contribution of 9.69 percent of the employee s income. YOU pay the difference. Ex: a $10-an-hour employee, working a minimum 30 hours per week, has a maximum employee contribution of $123.50 per month. If the plan cost is $300, YOU pay the difference of $176.50 per month. Non-compliance will result in a $3,390 penalty PER employee whom enrolls in coverage through the state exchange AND receives a premium subsidy. The Individual Mandate An individual who does not have a MEC will incur a penalty of $695 or 2.5 percent of their salary, whichever is greater.
The SBMA Advantage An Affordable Solution Beginning with the provisions of the ACA, many MEC administrators developed programs with unnecessary benefit addons, which created an unaffordable MEC program. We eliminate the unnecessary add-ons and provide you with a low-cost MEC solution without excessive fees and additions. Brokers and Agents Many companies did not offer benefits prior to the federal regulations mandating group health coverage. As a result, agents or brokers with limited expertise in group health consulting were retained to create a compliant benefit solution. Our MEC product is only offered through approved brokers in the group health insurance industry. A Complete Solution Many organizations implement a strategy without any regard to the new 1094/1095 reporting provisions. Our experts are capable of assisting not only in plan administration, but also in the reporting of the benefits offered to the IRS.
Minimum Essential Coverage (MEC) Election EE Only EE + 1 EE + 2 EE + 3 (or more) Administration $55 $85 $115 $145 Claims Reserve $5 $10 $15 $20 *Year-end claim reserve surplus can be utilized for employee premium holidays and/or administration of policy Total Costs $60 $95 $130 $165
Healthcare2U provides healthcare solutions for employers, their employees and dependents. Healthcare2U s mission is to provide affordable and convenient access to excellent primary medical care, wellness and chronic disease management. We provide coverage for individuals ages 2 to 65 and accept all pre-existing conditions. MEMBERSHIP INCLUDES: OFFICE VISITS: Unlimited office visits with a $10 visit fee No deductible Same-day or next-day guaranteed office visits for acute issues Appointment line staffed by bilingual medical assistants to schedule care for employees and their dependents *** Must call 1-800-496-2805 to schedule all appointments *** TELEHEALTH: 24/7/365 access to our practitioners over the phone with no visit fee CHRONIC DISEASE MANAGEMENT: Treatment and management of 13 chronic diseases for same $10 visit fee (anxiety, arthritis, asthma, blood pressure, CHF, COPD, depression, diabetes, fibromyalgia, GERD, gout, hypertension, thyroid) DISCOUNT PHARMACY CARD: 10 to 85 percent discount pharmacy card WELLNESS: Diet and exercise counseling 1-800-496-2805 (Appointment and Telehealth line) www.healthc2u.com
Preventative Health Services Below are many of the common covered preventive health services available as of January 1, 2016. The complete list of recommendations and guidelines that are covered under the plan can be found at: https://www.healthcare.gov/preventive-care-benefits Note: If a recommendation or guideline for a service does not specify the frequency, method, treatment or setting for the service, the Plan Administrator will use reasonable medical management techniques to determine coverage limitations. Thus, many preventive health services covered under the plan have specific restrictions and/or limitations affecting the circumstances under which coverage will be provided. If you have a question about a particular preventive service and whether it will be covered, please contact the Plan Administrator. Covered Preventative Health Services for Adults 1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked 2. Alcohol misuse screening and counseling 3. Aspirin use to prevent cardiovascular disease for men and women of certain ages 4. Blood pressure screening for all adults 5. Cholesterol screening for adults of certain ages or at higher risk 6. Colorectal cancer screening for adults over 50 7. Depression screening for adults 8. Diabetes (type 2) screening for adults with high blood pressure 9. Diet counseling for adults at higher risk for chronic disease 10. Hepatitis B screening for people at high risk 11. Hepatitis C screening for adults at increased risk, and one time for everyone born 1945-1965 12. HIV screening for everyone ages 15 to 65 and other ages at increased risk 13. Obesity screening and counseling for all adults 14. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk 15. Immunization vaccines for adults. Doses, recommended ages, and recommended populations vary: a. Hepatitis A b. Hepatitis B c. Herpes zoster d. Human papillomavirus e. Influenza (flu shot) f. Measles, mumps, rubella g. Meningococcal h. Pneumococcal i. Tetanus, diphtheria, pertussis j. Varicella 16. Syphilis screening for all adults at higher risk 17. Tobacco use screening for all adults and cessation interventions for tobacco users 18. 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
Preventative Health Services (Continued) Covered Preventative Health Services for Women 1. Anemia screening on a routine basis for pregnant women or women who may become pregnant 2. Breast cancer genetic test counseling (BRCA) for women at higher risk 3. Breast cancer mammography screenings every 1 to 2 years for women over 40 4. Breast cancer chemoprevention counseling for women at higher risk 5. Breastfeeding comprehensive support and counseling from trained providers. Access to breastfeeding supplies, for pregnant and nursing women 6. Cervical cancer screening for sexually active women 7. Chlamydia infection screening for younger women and other women at higher risk 8. Contraception: Food and Drug Administration (FDA) 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 (may not apply if company is exempt) 9. Domestic and interpersonal violence screening and counseling for all women 10. Folic acid supplements for women who may become pregnant 11. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes 12. Gonorrhea screening for all women at higher risk 13. Hepatitis B screening for pregnant women at their first prenatal visit 14. HIV screening and counseling for sexually active women 15. Human Papillomavirus (HPV) DNA test every 3 years for women with normal cytology results who are 30 or older 16. Osteoporosis screening for women over age 60 depending on risk factors 17. Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk 18. Sexually Transmitted Infections (STI) counseling for sexually active women 19. Syphilis screening for women at increased risk 20. Tobacco use screening and interventions 21. Expanded tobacco intervention and counseling for pregnant tobacco users 22. Urinary tract or other infection screening 23. Well-woman visits to get recommended services for women under 65
Preventative Health Services (Continued) Covered Preventative Health Services for Children 1. Alcohol and drug use assessments for adolescents 2. Autism screening for children at 18 and 24 months 3. 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 4. 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 5. Cervical dysplasia screening for sexually active females 6. Depression screening for adolescents 7. Developmental screening for children under the age of 3 8. 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 9. Fluoride chemoprevention supplements for children without fluoride in their water source 10. Gonorrhea preventive medication for the eyes of all newborns 11. Hearing screening for all newborns 12. 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 13. Hematocrit or hemoglobin screening for children 14. Hemoglobinopathies or sickle cell screening for newborns 15. Vision screening for all children 16. Hepatitis B screening for adolescents at higher risk 17. HIV screening for adolescents at higher risk 18. Hypothyroidism screening for newborns 19. Immunization vaccines for children from birth to age 18. Doses, recommended ages and recommended populations vary: a. Diphtheria, tetanus, pertussis b. Haemophilus influenzae type B c. Hepatitis A, Hepatitis B d. Human papillomavirus e. Inactivated poliovirus f. Influenza (flu shot) g. Measles h. Meningococcal i. Pneumococcal j. Rotavirus k. Varicella 20. Iron supplements for children ages 6 to 12 months at risk for anemia 21. Lead screening for children at risk of exposure 22. 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 23. Obesity screening and counseling 24. Oral health risk assessment for young children ages: 0 to 11 months, 1 to 4 years, 5 to 10 years 25. Phenylketonuria screening for newborns 26. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk 27. Tuberculin testing for children at higher risk of tuberculosis ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years