Medical Solutions

MEC/MVP and Fixed Indemnity

Minimum Essential Coverage and the Affordable Care Act

Beginning in 2014, the Affordable Care Act includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage (MEC) for themselves and their dependents. Some individuals will be exempt from the mandate or the penalty, while others may be given financial assistance to help them pay for the cost of health insurance.

Minimum essential coverage plans offer the minimum amount of essential coverage required by individuals to avoid the shared responsibility payment1.

Both the SmartMEC and SmartMVP Silver Plans offer employers options that are efficient, affordable and sustainable.

SmartMEC Plans

The SmartMEC and SmartMEC+ Plans offer an integrated solution that helps employers avoid costly penalties and is affordable for employees. It’s a simple way to resolve issues faced by employers such as:

  • Rising cost of health care
  • Unaffordable health plans
  • Complicated administration

Plan Highlights

  • Affordable pricing
  • Provides 100% of the minimum essential benefits required by PPACA
  • Single administrative platform
  • Nationally recognized third party administrator of hourly employee benefits
  • Flexible plan designs to meet benefit levels and price
  • Best in class ancillary benefit add-ons

Variations of the SmartMEC Plans

Employers provide a group health plan consisting of one of the following:

  1. SmartMEC — Minimum essential coverage
  2. SmartMEC+ — Minimum essential coverage with additional office visits, lab and x-ray and/or Rx coverage
  3. SmartMEC Wrap — Minimum essential coverage with fully insured fixed indemnity “excepted” benefits.

Services Covered by the SmartMEC Plan

SmartMEC covers 100 percent of the CMS listed Preventive and Wellness benefits when you visit a network provider.

SmartMVP Silver Plans

The SmartMVP Silver Plans offer an integrated solution that helps employers avoid costly penalties and is affordable for employees. It’s a simple way to resolve issues faced by employers such as:

  • Rising cost of health care
  • Unaffordable health plans
  • Complicated administration

Plan Highlights

  • Affordable pricing
  • Provides 100% of the minimum essential benefits required by PPACA
  • Single administrative platform
  • Nationally recognized third party administrator of hourly employee benefits
  • Flexible plan designs to meet benefit levels and price
  • Best in class ancillary benefit add-ons

Variations of the SmartMVP Silver Plans

Employers provide a group health plan consisting of one of the following:

  1. SmartMVP Silver — 70 percent minimum value plan
  2. SmartMVP Silver+ — minimum value plan plus fully insured fixed indemnity "excepted" benefit plan

1The eligibility standards for exemptions can be found at 45 CFR § 155.605. The IRS regulations at 78 FR 53659-62 (August 30, 2013) provide exemptions from the require¬ment to maintain minimum essential coverage for the following individuals: (1) members of recognized religious sects; (2) members of health care sharing ministries; (3) exempt noncitizens; (4) incarcerated individuals; (5) individuals with no affordable coverage; (6) household income below filing threshold; (7) members of federally recognized Indian tribes; (8) individuals who qualify for a hardship exemption certification; and (9) individuals with a short coverage gap of a continuous period of less than three months in which the individual is not covered under minimum essential coverage.