Your company is offering you medical coverage through Essential StaffCARE. Our comprehensive guide is designed to help you make the right healthcare choice for you and your family during this complex time in healthcare reform.
Your company is offering you two different plan options for medical coverage. Option 1 is the Fixed Indemnity Medical Plan; Option 2 is the MEC Wellness Preventive Plan. You may enroll in either or both of these plans.
Within 30 days of your hire date
Within 30 days of your 1st paycheck date (FIXED INDEMNITY PLAN ONLY)
During Employer’s annual 30-day open enrollment period
Within 30 days from the date of a qualifying life event
Wait until next annual open enrollment
Wait until you have a qualifying life event
Coverage for the Fixed Indemnity Medical Plan and any ancillaries selected begins the Monday following a payroll deduction and continues as long as you have a deduction from your paycheck. Coverage for the MEC Plan begins the 1st of the month following receipt of your first monthly payment. For example, if your first MEC payment is received in June, your coverage begins in July.
Make direct payments to PAI if you miss a payroll deduction to avoid a break in coverage. After six consecutive weeks without a payroll deduction or direct premium payment, coverage will be terminated and COBRA information will be sent.
You may cancel or reduce coverage at any time, unless your premiums are deducted pre-tax. To make a change, call 800.269.7783 and enter your PIN CODE, found on PAGE 4 of your enrollment packet, plus the last four digits of your Social Security number (SSN). (For example, "142-1234"). If you do not have a PIN CODE, 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.
These benefit plans offer 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.
If you experience a qualifying life event, in order to change your health coverage 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 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:
Q:
CAN I RECEIVE A SUBSIDY ON THE HEALTH MARKET EXCHANGE?
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A:
If you enroll in the Fixed Indemnity Medical Plan, you may still be eligible to receive a subsidy. 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.
Q:
DO THESE PLANS SATISFY THE INDIVIUDAL MANDATE?
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A:
The Affordable Care Act (ACA) mandates that each individual has health insurance. If you do not meet that mandate, you are open to being taxed for not having health insurance. The MEC Plan satisfies the Individual Mandate, and you will not be taxed if you enroll in this plan. The Fixed Indemnity Medical Plan does not satisfy the Individual Mandate, and you may be taxed if you fail to purchase an ACA approved plan.
Q:
IS THERE COVERAGE FOR CONTRACEPTIVES ON THESE PLANS?
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A:
Oral contraceptives are covered under the prescription benefit with the Fixed Indemnity Medical Plan. Non-oral contraceptives are not covered. The MEC Wellness/Preventive Plan does not include a prescription benefit.
Q:
IS THERE A PRE-EXISTING CLAUSE FOR EITHER OF THESE ESC PLANS?
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A:
There are no restrictions for pre-existing conditions for the ESC medical plans. Even if you were previously diagnosed with a condition, you can receive coverage for related services as soon as your coverage goes into effect.
Q:
WHAT IF I NEED TO HAVE A PRESCRIPTION FILLED?
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A:
If enrolled in the Fixed Indemnity Medical Plan, you are automatically covered by the discount prescription drug program. The MEC Plan does not offer prescription benefits. For generic and brand prescriptions, present your ID card at a participating pharmacy to receive discounts. Generic and brand prescriptions are payable based on the schedule of benefits up to the annual prescription drug maximum. To file a claim for reimbursement, save your receipt and remit to Planned Administrators, Inc. Prescription drug coverage is not provided for drugs administered during a physician office visit or hospital stay.
Q:
ARE MATERNITY BENEFITS COVERED?
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A:
Yes. Maternity benefits are covered the same as any other condition.
Q:
ARE DEPENDENTS COVERED?
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A:
Yes. Eligible dependents include your spouse and your children up to age 26.
For all other questions and inquiries, please call:
© IAG BENEFITS 2017
