Healthcare,
Simplified.
To view the Summary of Benefits and Coverage ("SBC") for the MEC/Wellness Preventive plan,
click here.
Please note: The MEC Wellness/Preventive plan is payroll deducted, which means deductions will be taken out of your paycheck for this benefit.
MEC Wellness/
Preventive Plan
- Covers Wellness and Preventive services ONLY
- DOES NOT cover medical services
- Services include immunization and routine health screens
- Covers 100% of cost when In-Network
- ACA-Compliant plan
- Plan DISQUALIFIES you from receiving a subsidy at the Exchange
- Click Here for List of Covered Services
Enroll or Add Benefits/Insured Members
Within 30 days of your hire date
During Employer’s annual 30-day open enrollment period
Within 30 days from the date of a qualifying life event
Otherwise:
Wait until next annual open enrollment
Wait until you have a qualifying life event
Get Covered
Coverage begins the Monday following receipt of your first payroll deduction.
Make a Change
You may cancel or reduce coverage at any time, unless your premiums are deducted pre-tax. To make a change, please contact your employer and request a change form. It may take up to three weeks for changes or cancellation to be reflected on your paycheck. Coverage will continue as long as you have a paycheck deduction.
NETWORK INFORMATION
This benefit plan offers you savings for medical care through discounts negotiated with providers and facilities in the First Health Network. Although not required, choosing an in-network provider helps maximize your benefits. When you use an in-network provider, you will automatically receive the network discount and the doctor’s office will file the claim for you. If you use a doctor who is not part of the network, you will not receive the discount, and you may need to file the claim yourself. To find a participating provider or to verify if your current medical provider is in-network, please call or visit the network websites listed below.
DO NOT CONTACT THE ABOVE NETWORKS FOR QUESTIONS REGARDING YOUR MEDICAL BENEFITS. ALL MEDICAL BENEFIT QUESTIONS SHOULD BE DIRECTED TO THE ESSENTIAL STAFFCARE MEMBER SERVICES LINE AT 1-866-798-0803.
QUALIFYING LIFE EVENTS
If you experience a qualifying life event (QLE), and wish to make changes to your health coverage, you have 30 days from the date of the event to submit supporting documentation, along with a change form, to PAI at the address found on the form. In addition, you may request a special enrollment for yourself, your spouse, and/or eligible dependents either (1) within 60 days 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 these medical benefits. A qualifying life event is defined as a change in your status due to one of the following events:
Marriage or Divorce
Termination
Loss of Dependent Status
Loss of Prior Coverage
Employer Bankruptcy
Medicare Entitlement
Birth or Adoption of a Child(ren)
Reduction of work hours (under 30)
Death of an Immediate Family Member
FREQUENTLY ASKED QUESTIONS
If you enroll in the MEC plan, you will no longer 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.
The Federal Affordable Care Act (ACA) individual mandate no longer imposes a penalty; however, please check your state for any individual mandate requirements or penalties.
The MEC Wellness/Preventive Plan does not include a prescription benefit.
There are no pre-existing condition restrictions for the ESC MEC Plan. If you have been previously diagnosed with a condition, you may receive benefits for related services as soon as your coverage goes into effect. The MEC plan provides coverage for diagnostic and preventive services and does not include services related to treatment of an illness or injury.
The MEC Plan does not offer prescription benefits.
Under the MEC Wellness/Preventive Plan, certain maternity screenings are covered. The MEC Plan does not provide coverage for maternity care. For a full list of covered services, click here.
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.