Start your Benefit Selection
To enroll or waive coverage in the Fixed Indemnity Medical Plan or the MEC Wellness/Preventive Plan, click the “Enroll/Decline Now” link below. For more information and plan details, see below.
Your Group Number is: 217100
Q: What kind of health care options do you have?
A: 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. This plan allows you to receive a subsidy from the Health Insurance Exchange.
Your second plan option is a MEC Wellness/Preventive Plan. This plan is a wellness and preventative program that covers 63 specific services (15 Preventive Services for Adults, 22 Preventive Services for Women and 26 Preventive Services for Children). These services range from screening for specified medical conditions, counseling, vaccinations (for children) and certain supplements including birth control (for women) that are covered at 100%.
Your third plan option is the ESC Bronze plan. This plan is a major medical plan with deductibles, co-insurance and a max out-of-pocket. You will receive a letter in the mail with information directing you to the online enrollment portal. You will receive this letter at the address you provided when you become eligible for this plan.
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 our annual open enrollment period or within 30 days of a qualifying life event. Click here to view a list of qualifying life events.
Q: How will your new medical benefits work?
A: 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.
Option 2, the MEC Wellness/Preventive Plan utilizes the First Health Network. You will receive an insurance card in the mail to use as proof of insurance at the doctor offices and hospitals. Coverage for this plan is on a monthly basis. A list of network providers can be found by clicking the link below.
Option 3, the ESC Bronze Plan utilizes the First Health Network. You will receive an insurance card in the mail to use as proof of insurance at the doctor offices and hospitals. Coverage for this plan is on a monthly basis. A list of network providers can be found by clicking the link below.
Q: What if you need to have a prescription filled?
A: For the Fixed Indemnity Medical Plan, the plan as a 70% co-insurance for generic and 50% for brand drugs. 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. To find a participating pharmacist visit www.paisc.com or call 1-866-798-0803.
For the ESC Bronze Plan, the plan as a 20% co-insurance for generic, 30% for preferred brand, 40% for non-preferred brand, and 50% for speciality drugs. 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. To find a participating pharmacist visit www.paisc.com or call 1-866-798-0803.
The MEC Wellness/Preventive Plan does not offer prescription benefits.
Q: Do the Essential StaffCARE programs meet the individual mandate required per the Affordable Care Act?
A: 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. For more information please visit www.healthcare.gov.
The ESC Bronze Plan satisfies the individual Mandate. For more information please visit www.healthcare.gov.
