Minimum Essential Coverage (MEC) Plan

Self-Funded Minimum Essential Coverage

(For Plans that access the PHCS Network)

Preventative Services (MEC)

MEC Plan
Minimum Essential Coverage Benefits Network Non-network
15 Preventative Services for Adults: 100% 40%
23 Preventative Services for Women: 100% 40%
26 Preventative Services for Children: 100% 40%
PPO Network Multiplan
Option 1:
Option 2:
25-50% ER
(6% discount)
Option 3:
51%+ ER
(12% discount)
For Current Rates, please refer to your Territory Manager
Employee Only $ 67.00 $ 64.00 $ 62.00
Employee + Spouse $ 105.00 $ 100.00 $ 96.00
Employee + Child(ren) $ 158.00 $ 150.00 $ 143.00
Family $ 196.00 $ 186.00 $ 176.00

15 Covered Services for Adults

(ages 18 and older)

  • Abdominal Aortic Aneurysm one time screening for age 65-75
  • Alcohol Misuse screening and counseling
  • Aspirin use for men ages 45-79 and women ages 55-79 to prevent CVD when prescribed by a physician
  • Blood Pressure screening for all adults
  • Cholesterol screening for adults
  • Colorectal Cancer screening for adults starting at age 50 limited to one every 5 years
  • Depression screening for adults
  • Type 2 Diabetes screening for adults
  • Diet counseling for adults
  • HIV screening for adults
  • Immunizations vaccines for adults (Hepatitis A & B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles, Mumps Rubella, Meningococcal, Pneumococcal, Tetanus, Diptheria, Pertussis)
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults
  • Tobacco Use screening for all adults and cessation interventions
  • Syphilis screening for all adults

23 Covered Services for Women

(including Pregnant Women)

  • Anemia screening on a routine basis for pregnant women
  • Bacteriuria urinary tract or other infection screening for pregnant women
  • BRCA counseling and genetic testing for women at higher risk
  • Breast Cancer Mammography screenings every year for women age 40 and over
  • Breast Cancer Chemoprevention counseling for women
  • Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women. Non- network services will be payable as network services
  • Cervical Cancer screening
  • Chlamydia Infection screening
  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs
  • Domestic and interpersonal violence screening and counseling for all women
  • Folic Acid supplements for women who may become pregnant when prescribed by a physician
  • Gestational diabetes screening
  • Gonorrhea screening for all women
  • Hepatitis B screening for pregnant women
  • Human Immunodeficiency Virus (HIV) screening and counseling
  • Human Papillomavirus (HPV) DNA Test: HPV DNA testing every three years for women with normal cytology results who are 30 or older
  • Osteoporosis screening over age 60
  • Routine prenatal visits for pregnant women
  • Rh Incompatibility screening for all pregnant women and follow-up testing
  • Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Sexually Transmitted Infections (STI) counseling
  • Syphilis screening
  • Well-woman visits to obtain recommended preventive services

26 Covered Services for Children

(including Pregnant Women)

  • Alcohol and Drug Use assessments
  • Autism screening for children limited to two screenings up to 24 months
  • Behavioral assessments for children limited to 5 assessments up to age 17
  • Blood Pressure screening
  • Cervical Dysplasia screening
  • Congenital Hypothyroidism screening for newborns
  • Depression screening for adolescents age 12 and older
  • Developmental screening for children under age 3, and surveillance throughout childhood
  • Dyslipidemia screening for children
  • Fluoride Chemoprevention supplements for children without fluoride in their water source when prescribed by a physician
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns
  • Height, Weight and Body Mass Index measurements for children
  • Hematocrit or Hemoglobin screening for children
  • Hemoglobinopathies or sickle cell screening for newborns
  • HIV screening for adolescents
  • Immunization vaccines for children from birth to age 18. Doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicells
  • Iron supplements for children up to 12 months when prescribed by a physician
  • Lead screening for children
  • Medical History for all children throughout development Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Obesity screening and counseling
  • Oral Health risk assessment for young children up to age 10
  • Phenylketonuria (PKU) screening in newborns
  • Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents
  • Tuberculin testing for children
  • Vision screening for all children under the age of 5

Additional Information

  • Minimum Essential Coverage (MEC): MEC plans must cover 100% of the coverage requirements outlined by ERISA and ACA. Generally these are preventative and wellness related test and treatments.
  • Employers that have >50 employees can prevent the $2,000 penalty on all benefit eligible employees by offering a MEC plan.
  • An individual enrolled in a MEC plan can avoid the personal tax assessed for not being enrolled in qualifying coverage by being enrolled in such a plan.
  • An employer can charge any amount they choose to an employee for MEC (not subject to the 9.5% limitation).
  • Participation Requirement is 10 enrolled on MEC.

Contact Riverstone Capital Insurance Services, LLC.

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