What is MEC and What Does it Cover?

What is MEC?

Understanding minimum essential coverage (MEC) can be complicated when comparing MEC to Minimum value, essential health benefits, and actuarial value. Let’s start by answering what is MEC and what does it cover? MEC is a plan that meets the Affordable Care Act requirement for getting health coverage. Some of these programs under MEC include marketplace plans, job-based plans, Medicare, and Medicaid.

So what is the difference between MEC and minimum value?

Minimum value is a higher threshold than MEC. Minimum value is when a plan pays 60% of the actuarial value of allowed benefits under the plan. If a large employer offers benefits and meet MEC requirements, but they do not meet the minimum value they meet the ACA employer requirements. 

What about MEC and Essential health benefits?

Essential health benefits are the core benefits that “qualified health plans” must cover. MEC also has a lower threshold than Essential Health Benefits. If a group health plan doesn’t provide all the benefits under the essential health benefits, the coverage will likely meet MEC, so companies will be ACA compliant.

Why is it important to understand the differences? 

Each of these coverage specifications are important to ensuring large employers provide proper coverage to their employees. As an employer, you must understand your legal liability in providing benefits, as well as understanding what coverage you need to be offering your employees to give them the best options and ensure compliance with the ACA.

At SBMA, all of our plans are compliant with MEC regulations to ensure your employees have coverage for whatever comes your way. Want more information? Visit our site to understand your coverage options better.

What is MEC and what does it cover?

When is it safe to go back to a doctor’s office?

When is it safe to go back to a doctor's office?

Hospitals and doctor’s offices seem like the worst place to be during a pandemic. Many medical offices, hospitals, and surgeons canceled non-emergency procedures to accommodate the influx of coronavirus cases. Knowing that the numbers of cases are still high, it may be anxiety-inducing to go back to the doctor for your normal check-up. Businesses have started to reopen, and doctors have started to schedule more non-emergency procedures. Is it safe to go back to the doctor’s office? 

The pressure for hospitals and doctors offices to re-open is great even while patients are wary to return. The financial implications of reopening serve as incentives for some medical offices to reopen, as the pandemic has caused the hospital industry to lose about $50 billion per month. Elective procedures are the lifeblood of hospitals, financially;  without them, hospitals have struggled. 

While doctor’s offices are seen as a place of healing and safety, in the current climate it may be difficult to choose to go back.  Telemedicine offers a solution for those who are worried about seeing their doctor in person. Telemedicine offers a solution for non-emergency care front eh safety and convenience of your own home while still ensuring that your symptoms are reviewed and a medical professional is monitoring your case. 

Health care providers are taking care to keep their patients safe. These precautions include: 

  • COVID-19 screening questionnaires
  • No-touch thermometer temperature check for employees and patients. 
  • Required face masks
  • Implementing social distancing measures in populated areas
  • Employees are tested regularly
  • Patients may be tested a few days before their procedure

While health care providers are covering a lot of bases, there are a few things you can do to keep yourself as safe as possible. Including:

  • Take your temperature before you go to your appointment
  • Wash your hands before you leave the house and sanitize regularly
  • Wear a mask and gloves if you feel it’s necessary
  • Avoid touching your face, especially areas like your nose, eyes, and mouth
  • Show up on time, not before to avoid overcrowding in the waiting room
  • Try to stay away from touching surfaces
  • Practice proper social distancing measures

While you begin to navigate returning to in-person patient care, consider your options and take the proper precautions. 

If you can utilize Virtual Health/ telemedicine, now is the time to use this service.  While telemedicine can’t replace all in-person appointments, it can replace regular checkups, virus check-ins, cold and flu-like symptoms and rashes, and many other non-life-threatening cases.  For those who still feel the need to go into the MD’s office: if you take the proper precautions when you are in-person you can navigate this new normal and stay safe!

return to the doctor's office

How to attract the best employees: Voluntary benefits.

Attract the best employees with voluntary benefits

Looking for ways to attract the best employees in a market where thousands of employees have been laid off? Offering voluntary benefits adds a level of insurance coverage that many workers have not previously had access to. Benefits beyond the traditional 401(k) and health insurance are vital to attracting the right talent for your business. 

What exactly are voluntary benefits?

Voluntary benefit plans are offered through the employer, but are paid, either partially or solely, by the employees. These benefits are typically paid through payroll deductions. Some of these plans offer group rates that employees cannot typically get on their own.

Why do employees look for employers who offer voluntary benefits?

  • It gives employees the choice: Allowing employees to choose the voluntary benefits they need gives your employees higher satisfaction and engagement with your business.
  • It meets the needs of various types of employees: Voluntary benefits cater to various generational, cultural, and economic differences among employees. It can be a challenge to meet the needs of a diverse workforce with a benefits plan that has only one option.
  • It ensures employees are financially stable: Voluntary benefit plans can protect employees financial wellbeing, and give them a sense of security in case something goes wrong. This makes them better, more engaged employees.

Not only do voluntary benefits help your existing employees, but also your future employees. When you offer competitive voluntary benefit packages to your workforce, great talent will be more likely to join your team. 

At SBMA, our benefit plan offers voluntary benefits that most employees will need. Your employees are the backbone of your business, so treat them right! Our plans can be modified to include dental, vision, life, hospital indemnity, accident, and critical illness coverage. Contact us today to see how voluntary benefits packages can improve your company’s ability to attract and retain the best employees.

how can voluntary benefits help you attract and retain employees

Are You Liable for Shared Responsibility Payments?

are you liable for shared responsibility payments?

With all the recent changes to employment due to the global pandemic, navigating ACA compliance can be challenging. ACA noncompliance may lead to shared responsibility payments. Businesses with 50 or more full-time employees must offer affordable, minimum essential health coverage. 

How can your business avoid tax penalties from the IRS? 

The first step to avoid potential shared responsibility payments is to make sure your business stays compliant with the ACA shared responsibility requirement. While this may seem simple, there are few distinctions to be aware of, including determining full-time employment status and full-time equivalents, and identifying the minimum value requirements. 

If employers do not cover at least 95% of full-time employees and their dependents, the employer will be subject to a shared responsibility payment. 

If a full-time employee receives a premium tax credit because they were not offered coverage, the coverage was not affordable, or the minimum value was not provided, the employer may also be subject to a shared responsibility payment. 

Once you have identified how to stay compliant with the ACA shared responsibility requirements, ensure your reporting is accurate and timely. 

Applicable Large Employers (employers with 50 or more employees) are required to file information returns with the IRS, Forms 1094-C and 1095-C. These forms will inform the IRS of the employers that owe shared responsibility payments.

To mitigate the risk of receiving a letter from the IRS for shared responsibility payments, employers should carefully review and complete the forms above. 

If you do receive a shared responsibility payment letter from the IRS, the employer has 30 days to respond. If you do need more time to gather your information, the IRS may be able to extend the 30 days deadline. Either way be sure to respond or ask for an extension as quickly as possible.

If you are required to pay a shared responsibility payment be sure to consult a lawyer to ensure your reporting is accurate. At SBMA, we want to ensure you remain compliant with all ACA requirements. If you receive a letter from the IRS in 1094/1095 filing that we completed, we will refile your forms, free of charge. 

Contact us today to learn more.

shared responsbility payments

Can a Doctor Really Diagnose Over Zoom?

Is zooming your doctor the new normal?

Imagine you’re in quarantine, beginning to feel early symptoms that align with Coronavirus, yet to keep others safe you feel you need to stay home. The symptoms begin to worsen, but you still don’t want to risk others safety by leaving the house. How can you ensure you will be okay without leaving the house? Telehealth services might be your saving grace. This begs the question, can a doctor really diagnose over Zoom?

The American Medical Association is working to maximize telemedicine service options in order to revolutionize healthcare– especially because COVID-19 is highly contagious. Not only does telemedicine help keep potential Coronavirus carriers quarantined, but it also helps those who have had non-urgent medical care postponed due to the pandemic. 

These services can be extremely beneficial for those who still need to go to work, or those who have to take care of their children at home. With children home from school, it can be more challenging to leave them home with a sitter, so what does that mean if you have to go to the doctor? Well, you can just hop on a Zoom call during their nap and get the same results as going to the doctor!

So how exactly does telemedicine work?

Drs. Francavilla Brown and Boyd told AMA that telemedicine “is easier than people think it is to incorporate into a practice.” 

With technological advancements typically come progress and challenges. Physicians who have tried implementing telemedicine have identified these challenges, and have come up with a few solutions. 

One challenge is patients may not have a good signal to support their doctor’s visit. Trouble with a weak signal may make the appointment longer, or impossible for someone who really needs it. Another challenge physicians have identified is booking appointments to be a televisit for doctor’s offices. The patient must call into the office to ensure their appointment is virtual. 

While telehealth services may not be the best option for detecting major issues, it has been great for reassessing and monitoring patients who have known problems. It can also be used to adjust medications, answer questions, and share information. Patients in areas where medical resources are limited also benefit greatly from these services. 

These services also help people avoid unnecessary hospital visits, which helps to give advice at a distance, save time, and reduce costs for both patients and doctors. Not only will it help avoid hospital visits when they aren’t necessary, but it will also give patients in the hospital the ability to discharge sooner by monitoring their vitals with telemedicine.

Zooming your doctor may begin to become the new normal in a post-COVID world. At SBMA, we offer telemedicine services at competitive prices. Contact us to learn more about how our benefit plans with telemedicine services today!

Can a doctor really diagnose over zoom?