New 'mini med' option for self-insured employers
The plan meets the ACA minimum essential coverage requirements, but not the ACA minimum value requirements.
A company has developed a group mini medical program designed for the Affordable Care Act (ACA) age.
The company, Coterie Advisory Group Inc. of Scottsdale, Arizona, says its new Fundamental Care health plan will provide affordable, no-deductible health coverage.
Related: New health plan provider rolls out plans targeting self-employed
The plan keeps costs low by providing coverage that’s solid enough for workers to avoid having to pay any ACA “individual shared responsibility” penalties, but too limited for employers to use the coverage to avoid paying ACA “employer shared responsibility” penalties.
‘Minimum essential coverage’ and ‘minimum value’
The ACA requires many people to have what the government classifies as “minimum essential coverage” (MEC), or solid major medical coverage, or else pay a penalty.
Almost any employer-sponsored coverage that covers certain preventive care services can qualify as MEC.
The ACA also requires many employers that are classified as large employers to provide MEC with a minimum actuarial value or else pay a penalty.
The minimum value is about 60% of the actuarial value of the cost of a state’s “essential health benefits” package, or standard benefits package,
For now, Congress has set the individual shared responsibility penalty for individuals at $0.
Employers affected by the employer coverage mandate may still have to pay employer shared responsibility penalties if their permanent, full-time employees apply for coverage through the Affordable Care Act public exchange system and end up qualifying for premium tax credit subsidies.
The Coterie plan
Coterie — an insurance program manager and national marketing agency — says it designed the new health plan to appeal to small, self-insured employers that are too small to have to worry about employer coverage mandate penalties, and to larger employers that want to provide coverage for temporary, seasonal or part-time workers.
The plan costs about 70 percent of what a traditional high-deductible major medical plan would cost, but it has no deductibles and no medical questionnaires, according to Coterie.
The plan will pay for only three days of inpatient hospital care, and it does modest co-payment requirements, Coterie says.
The plan will provide unlimited benefits for preventive care, telemedicine care and outpatient care, the company says.
Eligible employers must agree to pay at least $50 per employee per month for coverage, for a minimum of five employees.
Coterie says the new plans will be reinsured by A-plus-rated insurance companies.
“Coterie is actively looking for benefit advisors and select general agents to help distribute the plans on a national basis in the employee benefits marketplace,” the company says.
Resources
Information about the new program is available here.
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