About Options Plus MEC Plans

What We Do

Options Plus offers a low cost-conscious minimum essential coverage (MEC) plan that offers employers an affordable option to help eliminate penalties. Our team has a well-deserved reputation for providing smart, sensible and cost-effective solutions for our clients.

 

Our Mission

  • Provide an affordable solution to ACA challenges
  • Provide excellent healthcare administration
  • Offer a complete solution from implementation and enrollment to administration and year-end reporting

Why Us?

Our clients enjoy:

  • Top of the line customer service and administration
  • Software to manage benefits
  • Portal access to make plan changes, order ID cards, check claim status, and much more.
  • Employees can manage their profile themselves; eliminating the burden of day to day maintenance

Value added services include:

  • Additional benefits including dental, vision, hearing, and telemedicine
  • Bilingual enrollment
  • IRS reporting
  • Enrollment platform
  • Call center

What is MEC?

Minimum Essential Coverage (MEC)

Minimum Essential Coverage (MEC) is employer-sponsored health insurance coverage that limits your company’s exposure to penalties under the Affordable Care Act.

Employer Penalties

Penalty: No Employee Coverage

This applies to employers not offering any medical coverage to at least 95 percent of their full-time employees. If one (or more) full-time employee or eligible dependent qualifies for a premium tax credit or cost sharing reduction through a Health Insurance Marketplace, the employer could be subject to a penalty. The first 30 fulltime employees are subtracted from payment calculations. The penalty is assessed per full-time employee for each month an employer does not offer MEC to its employees.

THE ANNUAL PENALTY IS $2,500, PER FULL-TIME EMPLOYEE.


Penalty: Affordable Minimum Value

This applies to employers that provide MEC, but their full-time employees’ contribution is deemed unaffordable (for even just one employee) and/or does not meet minimum value according to the employer mandate requirements. Their full-time employees may obtain health insurance through a Health Insurance Marketplace and qualify for a premium credit or subsidy. The penalty is assessed per full-time employee who receives a premium tax credit or subsidy for each month the employee qualifies.

THE ANNUAL PENALTY IS $3,750 PER YEAR, PER FULL-TIME EMPLOYEE.

Mandates

The Employer Mandate (Penalty A)

Employers must offer at least Minimum Essential Coverage (MEC) to any benefit eligible employee. Non-compliance will generally result in a penalty of $2,500.00 PER eligible employee.


The Employer Mandate (Penalty B)

Employers must offer a minimum value plan that meets 60% actuarial value including hospitalization services. The MV plan must be offered at a maximum contribution of 9.86% of the employee’s income - YOU pay the difference. Non-compliance will generally result in a penalty of $3,750.00 PER eligible employee.

Benefits of MEC Plans

Employers

  • Limits exposure to ACA penalties
  • Tax deductible
  • Predictable cash flow
  • Provide employee benefits
  • Employee retention
  • ERISA platform (eliminates state coverage mandates)
  • No state taxes
  • Identical plan coverage in all 50 states

Employees

  • Meets ACA individual mandate
  • Avoids penalties
  • Full preventative care coverage
  • No out-of-pocket costs

PREVENTATIVE CARE

The Options Plus MEC Plan covers preventative care services for adults, women and children.

Services Covered 

17 Covered Preventive Services for Adults (ages 18 & older)

1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol Misuse screening & counseling
3. Aspirin use to prevent cardiovascular disease for men & women of certain ages
4. Blood Pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. Hepatitis C screening for adults at increased risk, & one time for everyone born 1945 – 1965
11. HIV screening for everyone ages 15 to 65, & other ages at increased risk
12. Immunization vaccines for adults — doses, recommended ages, & recommended populations vary: Hepatitis A, Hepatitis B,Herpes Zoster, Human Papillomavirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis, Varicella
13. Lung cancer screening for adults 55 - 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past
15 years
14. Obesity screening & counseling for all adults
15. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
16. Syphilis screening for all adults at higher risk
17. Tobacco Use screening for all adults & cessation interventions for tobacco users

22 Covered Preventative Services for Women, Including Pregnant Women

1. Anemia screening on a routine basis for pregnant women
2. Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
3. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
4. Breast Cancer Chemoprevention counseling for higher risk women
5. Breastfeeding comprehensive support & counseling from trained providers, & access to breastfeeding supplies, for pregnant & nursing women
6. Cervical Cancer screening for sexually active women
7. Chlamydia Infection screening for younger women & other women at higher risk
8. Contraception: Food & Drug Administration-approved contraceptive methods, sterilization procedures, & patient education & counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
9. Domestic & interpersonal violence screening/counseling for women
10. Folic Acid supplements for women who may become pregnant
11. Gestational diabetes screening for women 24 to 28 weeks pregnant & those at high risk of developing gestational diabetes
12. Gonorrhea screening for all women at higher risk
13. Hepatitis B screening for pregnant women at first prenatal visit
14. HIV screening & counseling for sexually active women
15. Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
16. Osteoporosis screening for women over age 60 depending on risk factors
17. Rh Incompatibility screening for all pregnant women & followup testing for women at higher risk
18. Sexually Transmitted Infections counseling for sexually active women
19. Syphilis screening for all pregnant women or others at increased risk
20. Tobacco Use screening & interventions for all women, & exp&ed counseling for pregnant tobacco users
21. Urinary tract or other infection screening for pregnant women
22. Well-woman visits to get recommended services for women under 65

26 Covered Services for Children

1. Alcohol & Drug Use assessments for adolescents
2. Autism screening for children at 18 & 24 months
3. Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
4. Blood Pressure screening for children at the following ages: 0 to 11 months,1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.
5. Cervical Dysplasia screening for sexually active females
6. Depression screening for adolescents
7. Developmental screening for children under age 3
8. Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to
14 years, 15 to 17 years.
9. Fluoride Chemoprevention supplements for children without
fluoride in their water source
10. Gonorrhea preventive medication for the eyes of all newborns
11. Hearing screening for all newborns
12. Height, Weight & Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
13. Hematocrit or Hemoglobin screening for children
14. Hemoglobinopathies or sickle cell screening for newborns
15. HIV screening for adolescents at higher risk
16. Hypothyroidism screening for newborns
17. Immunization vaccines for children from birth to age 18 — doses, recommended ages, & recommended populations vary: Diphtheria, Tetanus, Pertussis, Haemophilus influenzae type b, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot),Measles, Meningococcal, Pneumococcal, Rotavirus, Varicella
18. Iron supplements for children ages 6 to 12 months at risk for anemia
19. Lead screening for children at risk of exposure
20. Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
21. Obesity screening & counseling
22. Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
23. Phenylketonuria (PKU) screening for this genetic disorder in newborns
24. Sexually Transmitted Infection (STI) prevention counseling & screening for adolescents at higher risk
25. Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
26. Vision screening for all children.

 

This plan provides no coverage for sickness/hospitalization/surgical benefits. Benefits are not limited to the schedule above. For more information on covered services visit:

https://www.healthcare.gov/coverage/preventive-care-benefits/

Benefit Summaries

MEC Benefit Summaries for Website Page
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