Does the new Essential StaffCARE program meet the individual mandate required per the Affordable Care Act?see more
Your first plan option is a Fixed Indemnity Medical Plan. This plan pays a specified amount of money per day based on the service provided, regardless of the cost of the service. For those that participate in the medical plan, dental, vision, disability and life benefits are also available for election. Enrolling in the Fixed Indemnity Medical Plan does not satisfy the Individual Mandate and you will be subject to the federal tax. This plan allows you to receive a subsidy from the Health Insurance Exchange.
Your second plan option is the MEC Wellness/Preventive Plan. This plan covers wellness and preventative services, such as immunization and routine health screening, only. This plan is in compliance with ACA rules and regulations, but it does not cover medical services or conditions caused by accident or illness. Enrolling in the MEC Wellness/Preventive Plan satisfies the Individual Mandate and you will not be taxed for failing to purchase insurance required by the Affordable Care Act. This plan does not allow you to receive a subsidy from the Health Insurance Exchange.
You may cancel or reduce coverage at any time. You will only have 30 days from your hire date or first paycheck date to enroll, add additional benefits or add additional insured members. After this time frame, you will only be allowed to enroll, add benefits or add additional insured members during your annual open enrollment period or within 30 days of a qualifying life event.List of Qualifying Life Events
With Option 1, the Fixed Indemnity Medical Plan, If you go to an in-network provider, the benefits will be assigned directly to your provider to pay for all or a portion of the discounted cost of services. If the amount of payment exceeds the cost of the service, you will receive the difference directly from Essential StaffCARE. If the discounted amount exceeds the payment, you are responsible for paying the provider the difference. If you go out-of-network, you will be required to file a claim and the benefit amount will be paid directly to you. To find out if your provider is in-network, visit www.firsthealth.com or call 800-226-5116. See more information on prescription, dental and vision networks by clicking the link below.
With Option 2, the MEC Wellness/Preventive Plan, if you go to an in-network provider, your services will be 100% covered. If you go to an out-of-network provided, your services will be 40% covered. To find out if your provider is in-network, visit www.firsthealth.com or call 800-226-5116.Visit Firsthealth.com
The Fixed Indemnity Medical Plan does not satisfy the individual Mandate. Indemnity programs are defined as "Excepted" benefits in regards to the ACA (they are in the same category of supplemental benefits such as Dental and Vision insurance).
Note: Indemnity programs are not Major Medical Insurance.
The MEC Wellness/Preventive Plan satisfies the Individual Mandate.Visit Healthcare.gov
What if I need to have a prescription filled?
For the Fixed Indemnity Medical Plan, the plan pays you a per day amount up to the annual maximum for generic and brand prescriptions dispensed by a pharmacist. Prescription drug coverage is not provided for drugs administered during a physician office visit or hospital stay. If you choose a participating pharmacy and present your ID card, you will receive a discount off the retail price of the prescription at the time of purchase. Save your receipt to file a claim for reimbursement of the fixed dollar amount. See more information on prescription, dental and vision networks by clicking the link below.
The MEC Wellness/Preventive Plan does not offer prescription benefits.