What Does a MEC Plan Cover? MEC Plan Basics for Employers:

What is an MEC Plan?

Under the Affordable Care Act, employers who have fifty or more full-time employees must provide a plan that meets MEC requirements for all eligible employees and their dependents. MEC stands for “Minimum Essential Coverage,” and these requirements mandate what the health plan you offer should cover, at a minimum.

What Does a MEC Plan Cover?

60% Actuarial Value:

The Affordable Care Act mandates that a plan that meets MEC requirements should cover 60% or more of the average costs of covered benefits. This requirement is called an “actuarial value,” and a plan that covers 70% or more of the average costs of covered benefits, for example, would have an actuarial value of 70%. Most health plans on the market today meet or exceed this 60% actuarial value requirement.

The Ten Essential Health Benefits:

According to healthcare.gov, plans that meet minimum essential coverage requirements under the Affordable Care Act should cover all ten of what are deemed as “essential health benefits.” The below are federal requirements, but keep in mind that specific services covered in each broad benefit category could vary based on the laws of your state. The ten essential health benefits are:

1. Ambulatory patient services and all outpatient care you receive without being admitted to a hospital.
2. Emergency services, even if the employee has an emergency and has to receive care at a facility that is technically out of network.
3. Hospitalization, including inpatient care (i.e., overnight stays) and medically necessary surgeries.
4. Pregnancy, maternity, and newborn care, including care during delivery and care both before and after the birth of a child. This also includes mandatory birth control and breastfeeding coverage.
5. Mental health and substance use disorder services. This includes counseling, psychotherapy, and necessary general behavioral health treatment.
6. Prescription drugs.
7. Rehabilitative and habilitative services and devices, such as any necessary service and device to help an employee who has been injured, has or develops a disability, or has a develops a chronic condition. Plans meeting minimum essential coverage requirements should cover services and devices that help an employee gain or recover mental and physical skills.
8. Laboratory services, including diagnostic lab tests, some preventative screening services, and tests for conditions such as high cholesterol and diabetes.
9. Preventive and wellness services and chronic disease management. This includes screenings for common types of cancers, as well as annual checkups.
10. Pediatric services, including oral and vision care. Keep in mind, however, that adult dental and vision coverage aren’t essential health benefits.

Choosing the Right Health Plan for Your Organization

It’s important to choose a plan that meets the Affordable Care Act’s minimum essential coverage requirements if you’re an organization with fifty or more full-time employees. For all businesses large and small, getting your employees the fantastic health coverage they deserve while staying within your organization’s budget shouldn’t have to be a balancing act. When choosing the right health plan for your employees, it always helps to talk to an expert. Contact Benely for assistance in finding the perfect coverage for your employees today.