MINIMUM ESSENTIAL COVERAGE (MEC) ADMINISTRATION

If you are an employer with 100 or more full-time employees (full-time plus full-time equivalents) you are subject to the employee coverage rules mandated by the Affordable Care Act (ACA). Under the new regulations, employers must offer a plan that provides at least minimum essential coverage (MEC). Employers that do not comply may be fined $2,160 per employee, per year.1

To help you meet the ACA compliance requirements, Symetra offers MEC-Select, a cost-effective solution that provides comprehensive administration and claims payment services for your self-funded MEC plan when combined with a fully insured Select Benefits fixed-payment medical policy.

MEC-Select allows you to offer valuable health benefits while keeping your budget in check. The combined coverage offers a number of advantages:

  • Helps avoid the $2,160 per employee, per year ACA fine
  • Satisfies the ACA individual mandate for minimum essential coverage
  • Allows you to benefit from the cost-control aspects of a self-funded plan
  • Provides an attractive recruitment and retention tool
  • Helps reduce employees' out-of-pocket costs for events and services not covered by a MEC plan

The following section outlines preventive care services of a self-funded MEC plan administered by Symetra as part of a MEC-Select package. All services listed are covered at 100% when employees visit an in-network provider. Wellness or office exams billed by an in-network provider for the purpose of administering covered services are also covered at 100%. Preventive care benefits will not be paid under a MEC-Select plan if covered individuals visit an out-of-network provider.


COVERED PREVENTIVE HEALTH SERVICES

The ACA mandates which preventive services must be included in a MEC plan.

For All Adults​ Includes:
  • Abdominal Aortic aneurysm one-time screening for men between 65 and 75 who have ever smoked
  • Alcohol misuse screening and counseling
  • Aspirin use for men over 45 and women over 55
Full list of services
For Women Only Includes:
  • Anemia screening on a routine basis for pregnant women
  • Bacteriuria urinary tract or other infection screening for pregnant women at 12 weeks or during the first prenatal visit
  • BRCA counseling about genetic testing for women at higher risk
Full list of services
For Children Includes:
  • Alcohol and drug use assessments for adolescents
  • Autism screening at 18 and 24 months
  • Behavioral assessments for children from birth through age 17
Full list of services


DEPENDABLE ADMINISTRATION

When you work with Symetra, all administration is managed in-house by the team at Select Benefit Administrators (SBA). This single point of contact approach allows for:

  • Clear direction on when to fund the MEC claims account and how much is needed.
  • One ID card and one claims payment address for plan participants and providers.
  • Efficient claims processing and benefit payments - SBA determines which claims are paid under the MEC, which are paid under the Select Benefits policies, and when to reimburse for stop loss claims, if applicable.
  • Consolidated billing for Select Benefits policies and the aggregate stop loss policy, if applicable.


Symetra Life Insurance Company (Symetra) provides administrative services only for minimum essential coverage (MEC) plans. Select Benefits insurance policies are designed to provide benefits at a preselected, fixed dollar amount. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions. Select Benefits policies are insured by Symetra, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, and are not available in all U.S. states or any U.S. territory. Select Benefit Administrators is an administrative division of Symetra Life Insurance Company.

1 Excluding the first 30 employees.