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MEC Plans and the Minimum Requirements of the ACA

Under the Affordable Care Act (ACA) which was passed in 2014, medical insurance plans are required to meet minimum essential coverage or MEC standards. Minimum Essential Coverage simply refers to the type of coverage you as the contractor, must offer your prevailing wage employees in order to avoid penalty. To qualify as an MEC plan, the plan you offer must cover 10 essential health benefits.

10 Health Benefits that your MEC Plan Must Cover

1.     Laboratory Services

The law codifies that full set of preventive screening tests must be covered by individual and small-group insurers, as well as by the insurance offered by employers to its prevailing wage workers.

2. Emergency Services

Emergency visits, under the new law, do not require preauthorization. So when an employee is struck with a sudden and serious condition, his visit to the emergency room will be covered, and he won’t be charged for an out-of-network visit.

3. Prescription Drugs

Under the ACA, new health plans must cover one drug at the minimum for every class and category in the list of US-approved medications. Money spent on medications will be covered as out-of-pocket expenses.

4. Mental Health and Substance Use Disorder Services

Plans before do not have coverage for mental and behavioral health services. Now, patients can now avail of up to $40 per session. Some states can limit the number of covered therapy visits in a year.

5. Maternity and Newborn Care

Prenatal visits are now classified as preventive care and must be covered by health plans. Childbirth and newborn care must now also be covered by insurers.

6. Pediatric Services, Including Oral and Vision Care

Children under 19 can now have their oral care covered. This can include cleaning, x-rays, fillings, and other necessary medical operations. They are now also entitled to eye care, such as eye exams and a pair of glasses or contact lenses yearly.

7. Rehabilitative and Habilitative Services and Devices

Rehabilitation therapies, medical equipment such as canes, wheelchairs, and walkers, and habilitative services are now covered by health plans. For injured employees, their therapies to relieve their pain and help regain their ability to walk or work will now be assured. Those who need help to overcome long-term disabilities can now also expect help from their health plans.

8. Ambulatory Patient Services

Ambulatory services refer to outpatient care. A visit to the doctor must be covered by health plans and insurance, and most health plans provide this coverage even prior the new law was passed.

9. Preventive and Wellness Services and Chronic Disease Management

Under the new law, people are encouraged to see their doctors before they actually get sick and incur huge medical bills.  A free wellness visit to your doctor once a year will now be allowed by health insurance plans.  Insurance companies are required to provide all 50 preventive services as recommended by the US Preventive Services Task Force.

10. Hospitalization

Health insurance plans must cover the hospitalization of its beneficiaries, although they may still pay 20% or more of their hospital bills. Hospital bills, which include boarding and medical services, can easily rise and can easily bankrupt any American family.

Contact a Fringe Benefits Specialist for your Customized MEC Plan

To ensure that the MEC plans you offer for your prevailing wage employees meet the requirement of the law, work with a trusted company that specializes on fringe benefits!

ARCHER JORDAN is a team of benefits professionals who have been in the business for decades. When you work with us, you can be assured that you do not only meet federal law requirements, you also give your employees the best health benefits specially designed for their needs. Call us today and we will help you save thousands of dollars on your prevailing wage fringe benefits.