Frequently Asked Questions
Read our frequently asked questions for fast answers.
Still need help? Call us at 1-866-798-0803
or visit www.paisc.com
Download the schedule of Benefits for the MEC Wellness/Preventive Benefit HERE.
Please note: The MEC Wellness/Preventive Plan will utilize a direct payment process. You will receive information in the mail with
further instructions on how to set up payment. This payment option will require a credit card for payment so the
premium can be automatically deducted.
Can I receive a subsidy on the Exchange?
No, if you enroll into the MEC Wellness/Preventive Plan you will not qualify for a subsidy at the health insurance exchange as this plan will meet the definition of Minimum Essential Coverage. Please DO NOT enroll into the MEC Wellness/Preventive Plan if you wish to obtain or wish to continue receiving Federally subsidized coverage from the health insurance exchange.
Do these plans satisfy the Individual Mandate?
Yes, by enrolling into the MEC Wellness/Preventive Plan you will be meeting your Individual Mandate obligations.
How do I enroll?
Enrolling in the MEC Wellness/Preventive plan is easy. You can enroll by completing an Essential StaffCARE enrollment application and returning it to your manager.
When can I enroll in the plan?
You are able to enroll in the MEC Wellness/Preventive Plan within 30 days of your hire date or during your employer’s annual 30 day open enrollment period. If you do not enroll during one of these time periods, you will have to wait until the next annual open enrollment, unless you have a qualifying life event. You have 30 days from the date of the qualifying life event to enroll. In addition, you may request a special enrollment (for yourself, your spouse, and/or eligible dependents) within 60 days (1) of termination of coverage under Medicaid or a State Children’s Health Insurance Program (SCHIP), or (2) upon becoming eligible for SCHIP premium assistance under this medical benefit.
What is a qualifying life event?
A qualifying life event is defined as a change in your status due to one of the following:
- Marriage or divorce
- Birth or adoption of a child(ren)
- Death of an immediate family member
- Medicare entitlement
- Employer bankruptcy
- Loss of dependent status
- Loss of prior coverage
If you experience a qualifying life event, you must submit documentation of the event along with a change form requesting the change within 30 days of the event. In addition, you may request a special enrollment (for yourself, your spouse, and/or eligible dependents) within 60 days (1) of termination of coverage under Medicaid or a State Children’s Health Insurance Program (SCHIP), or (2) upon becoming eligible for SCHIP premium assistance under this medical benefit.
When does coverage begin?
Coverage begins the 1st of the month following receipt of your first monthly payment.
Does this plan cover medical services?
This plan is in compliance with ACA rules and regulations. It covers wellness and preventive services only.
Are dependents covered?
Yes. Eligible dependents include your spouse and your children up to age 26.
Note: if you are enrolling in both the Indemnity and MEC products and the name(s) or number of children that you wish to cover under the Indemnity plan varies from the name(s) or number of children you wish to cover under the MEC plan, please contact the Essential StaffCARE Customer Service line at 866-798-0803.
Is there a pre-existing clause for the MEC Wellness/Preventive Plan?
There are no restrictions for pre-existing conditions in this plan. Even if you were previously diagnosed with a condition, you can receive coverage for related services as soon as your coverage goes into effect.
When should I expect an ID card?
An ID card and confirmation of coverage letter will be mailed to your home address. If you do not receive these documents within 10 business days of your effective date, or if you have a change of address, please contact the Essential StaffCARE Customer Service at 866-798-0803. Present your ID card to the provider at the time of service. These ID cards are used for identification purposes and providers use them to verify eligibility status.
How can I make changes or enroll if I initially declined?
To make changes or enroll if you initially declined, contact your employer and request a change form. Changes are effective the 1st of the month following the date of the change request. You can cancel or reduce coverage at any time. Please remember that you may only enroll or add additional insured members during an open enrollment period or within 30 days of a qualifying life event.