MEC Plans Minimum Essential Coverage – Total Benefit Solutions Inc

MEC (minimum essential coverage) and MVP (minimum value plan) differentiation

May 23, 2025May 19, 2025Loramei RomeoNo Comments

Despite both MEC and MVP plans stem from the ACA they differ significantly from each other. MEC plans meet the ACA’s individual mandate, while MVPs offer substantial coverage to avoid penalties for employers. Both concepts aim to ensure that individuals have access to comprehensive and affordable health care. However, knowing these differences can lead to better health decisions. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

The advantages and disadvantages of MEC plans!

May 21, 2025May 14, 2025Loramei RomeoNo Comments

After being informed themselves, employers should empower their employees with knowledge about the pros and cons of MEC plans and encourage them to explore their options. Pros: Affordable premiums– lower monthly premiums than more comprehensive health plans. Basic Coverage– coverage for essential health benefits. Regulatory compliance– helps ALEs meet regulatory requirements and avoid tax penalties Cons: Very Limited coverage– it doesn’t cover certain healthcare expenses, such as elective procedures or specialty medications. High-out-of-pocket-costs– In exchange for cheaper premiums, members will face higher deductibles, copayments and coinsurance. Minimal flexibility– limited customization options Limited provider networks– it may limit members’ choice for healthcare providers After weighing the advantages and downsides of a… Read More

Examples of MEC plans

May 15, 2025May 14, 2025Loramei Romeo

The centers for Medicare & Medicaid Services provides MEC recognition to healthcare carriers, creating a reliable list of national health plans. Additionally, any plan that falls under the following categories is considered MEC: Minimum Essential Coverage encompasses various health plans, including employer-sponsored options, individual market plans, and government programs like CHIP and Medicare. Understanding these categories is vital for making informed and effective health insurance decisions. Reach out to us for personalized guidance! We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any… Read More

What is the concept of a MEC plan?

May 14, 2025May 14, 2025Loramei Romeo

MEC stands for minimum essential coverage and is a type of healthcare plan that fulfills the minimum criteria established by ACA, the Affordable Care Act. MEC plans are designed with affordability in mind, providing essential coverage at lower premiums compared to traditional health plans. In a few words, MEC plans are a popular way to provide baseline coverage to businesses, individuals, and families simply looking for standard healthcare. Understanding MEC plans is vital for applicable large employers to ensure compliance and employee health. These plans offer essential benefits while helping businesses avoid tax penalties. Small- and medium-sized businesses must evaluate the pros and cons of MEC plans to ensure the… Read More

Individual Coverage HRA: Choice and affordability

February 4, 2025January 31, 2025Loramei Romeo

QSE-HRA or Qualified Small Employer HRA Companies with fewer than 50 employees are qualified for $199 small employer HRA plan document a group health insurance alternative. What is QSE-HRA? To establish a QSE-HRA for qualified groups with less than 50 employees offering no group health plan the plan documents are available for $199 in Basic PDF email version. Qualified Small Employers can offer Health Reimbursement Arrangement (HRA) if they do not offer a group health plan, HRA uses tax-free dollars to reimburse employees who individual health plans. Employers cannot offer another group health plan to qualify QSE-HRA, which includes any other HRA, Health Care Flexible Spending Accounts (FSA), Limited Health… Read More

Small Employer Open Enrollment Period November 15 through December 15

October 24, 2024October 24, 2024Ed MacConnell

While this has been in place for a number of years, we would like to remind you about the Small Employer Open Enrollment Period for fully insured health plans in all states. The Small Employer Open Enrollment Period is the period from November 15 through December 15 each year. During this period, employers that meet the definition of small employer but do not meet the carrier’s participation or contribution requirement will be accepted for a small employer plan with a January 1 effective date. Additionally, select carriers in New York may allow for a December effective date if applicable. Carriers require that employer groups enrolling under the Small Employer Open Enrollment Period submit completed applications… Read More

Departments Issue Final MHPAEA Regulations

October 11, 2024October 11, 2024Mirasol Bandong

The final rules for the Mental Health Parity and Addiction Equity of 2008 (MHPAEA) were released on September 9, 2024, by the Department of Health and Human Services, Labor, and the Treasury in order to guarantee that those seeking treatment for mental health (MH) or substance use disorder (SUD). MHPAEA provides nonquantitative treatment limitations (NQTLs) cannot be applied to MH/SUD unless they are equivalent and applied no more strictly for MH/SUD benefits than for medical/surgical benefits. The final rules amend the definitions of definition of “medical/surgical”, “mental health benefits”, and “substance use disorder benefits” by removing a reference to the state guidelines. The most recent edition of the Diagnostic and Statistical… Read More

Special Enrollment Period Extended: Florida Emergency Declaration – Hurricane Idalia

June 28, 2024June 28, 2024Mirasol Bandong

Please be advised that a state of emergency was extended for certain Florida counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This DST-SEP applies to the Florida counties listed below. Important Compliance Information Who is eligible: This SEP opportunity is ONLY available to beneficiaries who: Details : Impacted Counties: Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Nassau, Orange, Osceola, Pasco, Pinellas,… Read More

Health Care Cyberattack

March 26, 2024June 27, 2024Mirasol Bandong

Although it does not yet know when the recovery from the Change Healthcare hack last month will be completed, UnitedHealth is testing the system to restore it. This week, the care giant said that it is testing technology for processing medical claims. It already has mostly restored systems for handling drug claims and processing payments. The technology utilized to file and handle insurance claims is provided by Change Healthcare. It works with claims from many insurers and processes around 14 billion transactions annually. Some patients might be directed to different pharmacies where billing issues are less of a concern. Industry executives have stated that delays in patient bills are possible. Progress:… Read More

Aetna – Data Collection Requirement for Rx Data Collection Reporting Submission

March 20, 2024March 19, 2024Mirasol Bandong

The deadline for submitting Prescription Drug Data Collection (RxDC) reporting for the reference year 2023 is June 1, 2024. Certain data items that were not necessary for the first submission must be included in this one. As a result, Aetna has created a procedure to help our plan sponsors submit these reports. Important Update: Data Collection Requirement for Prescription Drug Data Collection Reporting Submission Read more HERE We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you… Read More

CONSENT FOR HEALTH INSURANCE BROKER ASSISTANCE

February 21, 2024February 21, 2024Ed MacConnell

CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell of Total Benefit Solutions Inc has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More

Revised Form 720

June 21, 2023June 23, 2023Ed MacConnell

The IRS has released a revised Form 720, Quarterly Federal Excise Tax Return, the proper method to file and report PCORI fees. If you owe a PCORI fee, it must be paid using IRS Form 720 by July 31, following the last day of the policy year or plan year. Form 720 and the fee must be submitted on the same date. If your business does not owe a PCORI fee, IRS Form 720 does not need to be completed. Issuers and plan sponsors will only be required to file Form 720 once a year. Per the IRS, “Issuers and plan sponsors who are required to pay the PCORI fee… Read More

The Benefits of Short-Term Health Insurance

May 5, 2023May 5, 2023Ed MacConnell

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

1095-B Tax Form Available Electronically for Employees of Cigna Fully-Insured Clients

February 12, 2023February 9, 2023Ed MacConnell

Effectively 1/1/23, Cigna transitioned from physically mailing 1095-B tax forms to on-demand electronic availability for customers on fully-insured client medical plans. Just one way Cigna is making healthcare simpler for customers, enrollees can access their 1095-B tax forms anytime, anywhere via myCigna.com® . Click here to read more. As always contact your Total Benefit Solutions group health insurance specialist at (215)355-2121 if you have any further questions or concerns.

What is Limited Medical Insurance?

January 29, 2023January 29, 2023Ed MacConnell

A limited medical plan is a form of supplemental health insurance that can be used with or without a major medical plan. Limited medical plans have a set amount of money for treatment that they give to you to pay for common medical expenses. They recognize that common services like wellness visits can sometimes turn into a financial strain for people. Since this type of insurance does not cover everything due to a predetermined limit on what you receive, you will want to look closely at the benefits before choosing a plan. It can be helpful to pair a limited medical plan with a major medical plan. Doctors visits and… Read More

Turning 26: Your Guide to Health Insurance

September 23, 2022Ed MacConnell

Turning 26: Your Guide to Getting Your New Health Insurance:https://totalbenefits.net/turning-26-your-guide-to-health-insurance/

Understanding the Coding of Health Plans from MEC to Metallic

August 15, 2022July 22, 2022Ed MacConnell

Choosing the right insurance plan for you (and your family) is not an easy task. The Affordable Care Act (ACA) has introduced major changes to the way carriers traditionally marketed their health plans to the public and introduced a volume of new terms, requirements and complexities, many of which may sound confusing to the general public. From terms like “minimum essential coverage” to the various metallic plan categories of Bronze, Silver, Gold and Platinum, a solid foundation of knowledge is essential in order to find the coverage required at an affordable price. The health insurance experts at Total Benefit Solutions Inc are well versed on these terms so when you… Read More

Case Study Library

July 22, 2022July 22, 2022Ed MacConnell

We present a few case studies to illustrate how we have helped our clients solve their complicated employee benefit challenges. Click here to learn more!

Updated FAQ’s on the ACA and Health Insurance

July 17, 2022Ed MacConnell

Kaiser Family Foundation ‘s database of frequently asked questions is searchable by topic. Click here to view the FAQ database.

Affordability of Health Coverage

July 11, 2022June 30, 2022Ed MacConnell

Applicable Large Employers, those with 50 or more full-time employees in the prior year, must offer their full-time employees minimum essential coverage providing minimum value that is affordable. A plan is affordable if the premium for self-only coverage does not exceed a certain percentage of the employee’s household income. The IRS sets the percentage each year. The baseline percentage was 9.5%. In 2022, the affordability percentage is 9.61%. In 2021, it was 9.83%. A plan will be considered affordable if its premium for the lowest cost, single-only plan does not exceed the identified percentage of an employee’s household income. Since household income is not readily available, employers use one of… Read More

Health Insurance Broker Change Leads to Better Results

July 7, 2022July 6, 2022Ed MacConnell

Watch Video The Issue A mid-sized group prospect was unhappy with their current broker and looking for a change. They thought more could be done to help control their employee benefit budget and were looking for guidance. They came to us with a 17% health insurance renewal. Our Solution Our team met with the business owner and Human Resource Director to review the following: The corporate goals and philosophy regarding employee benefits The benefit structure and costs of their present programs Options for cost containment strategies How to integrate wellness into their benefits portfolio Methods for better communication of the benefit programs to employees The Result The customer was pleased… Read More

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