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At SBMA Benefits, our goal is to provide a complete solution for employers who want to provide affordable benefits to their workers. Our reliable, fast, and friendly team makes compliance with the Affordable Care Act (ACA) easy and affordable.
Our most popular plan available for employers to offer their employees is our Ultimate MEC plan. We aim to provide affordable coverage that meets the healthcare needs of employees while also meeting ACA requirements.
Ultimate MEC includes a significant number of services to its enrollees. We’re giving you an inside look at what you get with Ultimate MEC and why it’s important.
Preventative care focuses on preventing potential diseases or serious health concerns by assessing environmental factors, genetic predisposition, disease agents, and lifestyle choices. Some examples of preventative care include the following:
- Annual physical exams with your primary care provider (provide a full body check including both physical and mental wellbeing)
- Annual flu shot (typically covered 100% and helps protect from various strains of the flu)
- Mamogram (typically starting after the age of 40, they consist of Xrays to check breast tissue for signs of cancer or other abnormalities)
- Colonoscopy (typically after the age of 50, to check for colon cancer)
- Vaccinations (in addition to the annual flu vaccine, most people receive their vaccinations in their childhood year but ay require various boosters later in life)
Overall, the goal of preventative care is to identify potential issues before they require extensive emergent care and attention. Often when diseases or injuries are caught, later on, they may require more expensive treatments.
Our Ultimate MEC plan covers preventative care 100%.
Primary Care Visits
The American Academy of Family Physicians (AAFP) defines primary care as including “health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings.” Oftentimes, your primary care provider (PCP) is the first point of contact when a patient identifies a health concern. It is their job to work with the patient to identify a diagnosis and treatment plan, be it independently or by working with varying specialists.
The SBMA Ultimate MEC plan provides access to primary care visits with only a $15 copay, or co-payment (a fixed amount that a healthcare beneficiary pays for covered health care services).
On some occasions, visiting your primary care provider (PCP) will end with a referral to a specialist. Your PCP may send you to a specialist if your condition requires a special assessment by a doctor in a more specific field. Some examples of a specialist may include the following:
- Dermatologist: skin, nail, and hair care specialist
- Allergist: treat allergic diseases and identify personal allergies
- Obstetrician/gynecologists (OB/GYN): specialize in the health and well-being of females including reproductive health, cancer prevention in reproductive organs, breast care, labor and delivery, infertility, and menopause
- Otolaryngologists: more commonly known as “EMT” doctors, which stands for ear, nose, and throat
- Cardiologist: specialize in heart health
These are just some of the many different types of specialists that you may be referred to by your PCP if necessary. Often the use of specialists occurs in the event of a more serious illness or problem that your PCP may like a specialist’s insight on.
As is the case with primary care visits, our Ultimate MEC plan covers specialist visits with only a $15 copay.
Urgent care is best utilized for injuries and illnesses that are not emergent enough to require an emergency room visit but need to be assessed within 24 hours. Urgent care may be a suitable option in the event of the following conditions:
- Pink eye
- Ear or sinus infection
While these are not the only conditions that may be able to be treated at an urgent care facility, they represent the types of conditions that are appropriately served at urgent care. More serious injuries or illnesses that need immediate attention should be addressed at an emergency room.
Urgent care visits are covered under our Ultimate MEC plan for only a $50 copay.
Labs may be required by your doctor to provide an accurate diagnosis for an illness or to maintain proper preventative care. Oftentimes doctors conduct annual lab work by drawing blood and testing it to assess various aspects of your health. Additionally, lab work may be helpful to doctors in identifying and diagnosing an ongoing issue that you’re facing. For example, mono is a disease that is often diagnosed by a blood test.
Lab work is covered under our Ultimate MEC plan for only a $50 copay.
X-rays are used for a variety of reasons to identify injuries. X-rays are most commonly used to perform bone scans to identify any breaks or fractures. They may also be utilized to diagnose conditions including pneumonia, arthritis, bone density loss, dental health, and more.
X-rays are covered under our Ultimate MEC plan for only a $50 copay.
Telehealth and benieWallet
Telehealth and benieWallet have been ever more important tools throughout the ongoing global pandemic over the past year. Telehealth offers patients the ability to communicate with their doctors via video chat or direct messaging.
On occasions that you need immediate care or support but your doctor may not be available or accessible, telehealth is an alternative option for your reference. Wondering what you can expect from a telehealth visit with your doctor? We’re answering all your questions here.
Freshbenies encompasses a variety of tools, one of which is benieWallet. These services provide convenient, virtual access to care and support that saves hard cash. Freshbenies helps identify cost-saving opportunities and streamlines health care coverage to be as simple as possible to understand.
Our Ultimate MEC beneficiaries receive full access and use of both telehealth services and freshbenies.
Behavioral health, while similar to mental health, has some differences. Behavioral health assesses the connection between both physical and mental health. For example, it includes issues such as eating and exercise habits in addition to mental challenges.
Mental challenges have become ever more common following the onset of the COVID-19 pandemic. The pandemic brought on a significant lifestyle change that many people have struggled to adapt to. In many cases, this has led to cases of anxiety, depression, and other similar mental challenges.
Mental health is as big of a concern as physical health in many scenarios. As a result, we’ve ensured to include behavioral health coverage in our Ultimate MEC plan.
Ultimate MEC beneficiaries receive access to behavioral health services at a $50 fee for a maximum of 3 uses annually.
Prescription drugs are a critical component of health care coverage to nearly 66% of all Americans. Perscriptions are often used in people that have chronic conditions such as heart disease, diabetes, hypertension, arthritis, and cancer.
That being said, these are hardly the only uses for prescription drugs. They’re also used to treat conditions such as bacterial infections, asthma, pregnancy prevention, acne, common cold and cough symptoms, and more. It’s estimated that around 16% of all health care expenditures were spent on prescription drugs.
Luckily, our Ultimate MEC plan provides coverage for your prescription drug needs as well. Our plan covers generic prescriptions at $10 or less for tier 1 drugs and $25 or less for tier 2 drugs. For brand name prescription drugs, this cost increases to $50 or less for tier 1 and $75 or less for tier 2.
After reviewing all that our Ultimate MEC plan has to offer, you won’t believe how little our enrollees pay per month. Interested in learning more about our most popular plan? Contact one of our trusted brokers or give us a call directly.