Pricing upfront, flexible solutions
Get your employees benefits without breaking the bank, with plans starting at just $45 per employee per month
PPO Network
Fully compliant with ACA and state health mandate rules
Alternative benefits from EAP, mental health, financial support
Wellness and preventative care program you can afford for your entire staff
Provide additional affordable benefits for retention and recruitment
LOW COST • GREAT FLEXIBILITY • PROTECTS YOUR COMPANY FROM ACA PENALTY “A”
These plans are the perfect strategy for employers focused on cost containment, usable daily benefits and compliance with ACA mandates. The plans outlined below are only compliant with Employer Penalty “A” as outlined by ACA. They also satisfy the individual mandate penalty in applicable states.
PPO Benefit Summary
| Monthly Rates | Basic MEC | Virtual MEC | Ultra MEC | Ultimate MEC |
|---|---|---|---|---|
| Employee only | $45 | $59 | $95 | $125 |
| Employee + Spouse | $90 | $118 | $190 | $250 |
| Employee + Child(ren) | $90 | $118 | $190 | $250 |
| Employee + Family | $135 | $177 | $285 | $360 |
| Benefit Summary | Basic MEC | Virtual MEC | Ultra MEC | Ultimate MEC |
|---|---|---|---|---|
| Preventive / Wellness | Covered 100% | Covered 100% | Covered 100% | Covered 100% |
| Primary Care Visits | - | - | $15 copay | $15 copay |
| Specialist Visits | - | - | Network Discount | $15 copay |
| Urgent Care | - | - | $50 copay | $50 copay |
| Labs | - | - | Network Discount | $50 copay |
| X-Rays | - | - | Network Discount | $50 copay |
| Value Adds | Basic MEC | Virtual MEC | Ultra MEC | Ultimate MEC |
|---|---|---|---|---|
| Telemedicine | Unlimited - $0 Co-pay | Unlimited - $0 Co-pay | Unlimited - $0 Co-payv | Unlimited - $0 Co-pay |
| PPO Network | Multiplan | Multiplan | Multiplan | Multiplan |
| Employee Perks Program | BenefitHub | BenefitHub | BenefitHub | BenefitHub |
| benieWALLET | Included | Included | Included | Included |
| Behavioral Health | - | $50 fee max 3 pe r year | $50 fee max 3 pe r year | $50 fee max 3 pe r year |
| Rx Benefits | Basic MEC | Virtual MEC | Ultra MEC | Ultimate MEC |
|---|---|---|---|---|
| Generic Rx | Discount Only | Tier 1: $10 or less Tier 2: $25 or less |
Tier 1: $10 or less Tier 2: $25 or less |
Tier 1: $10 or less Tier 2: $25 or less |
| Brand Rx | Discount Only | Discount Only | Discount Only | Tier 3: $50 or less Tier 4: $75 or less |
Some fine print applies:
Employers must have enough employees to qualify for coverage (find out if you qualify)
Costs include plan documents, MultiPlan network, ID cards, enrollment guides, COBRA administration and claims adjudication and reserve management Virtual Health plans exclude out-of-network services and cover only the services listed above and on the covered services page. Claims are repriced through the MultiPlan PHCS network. For services covered at a network discount, members will be responsible for paying the Remaining balance after the network discount is applied. Discounts vary based on provider contracts and are agreed upon prior to service.
Rx benefits are subject to the formulary drug list. To see a list of covered drugs visit www.sbmabenefits.com/smithrxformulary Virtual Health Benefits are offered through freshbenies . Members have access to 1) physician visits via phone or video, with prescriptions sent directly to the member’s pharmacy, when medically necessary and 2) therapist consultations via video at $50 each (max 3 visits - $85 after). The Basic MEC plan does not include behavioral health services. Minimum participation requirement of 25 lives enrolled. $750 annual fee paid at time of implementation and each subsequent renewal.
BenefitHub is an employee discount program included in all plans.