A health plan must provide certain coverage and benefits, to be classified as Minimum Essential Coverage (MEC) by the Affordable Care Act (ACA).
Coverage Scope
MEC plans are designed to meet ACA standards by covering ten essential healthcare benefits, including hospitalization, preventive services, and mental health care. While they offer significant support, it’s important to note that they may exclude certain services, such as elective surgeries or cosmetic procedures.
Cost Structure
MEC plans have a unique cost structure, just like other health plans. The MEC plan’s cost structure consist of the following components.
Premiums– monthly payment that maintain each member’s coverage.
Deductibles– member’s pay out of pocket until they meet a deductible, then the carrier will help pay for the rest of the covered medical services.
Coinsurance– Members must pay a percentage of the cost of covered services after meeting the deductible.
Out-of-Pocket Maximum– when the out-of-pocket maximum is reached, the insurance company typically covers 100% of applicable medical expenses for the rest of the year.
A variety of MEC plan options are suitable to fit your business’ needs as they offer a familiar cost structure and affordable premiums. Explore the advantages and disadvantages of MEC health plans, which can significantly impact your business decision making.
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.