Prosper Home Care offers a MEC Health Insurance Plan to all employees who meet the eligibility requirements.

Question #1:

What is the Optimed MEC Plan?

Answer:

MEC stands for Minimum Essential Coverage.  This plan satisfies the IRS health insurance requirement and eliminates the tax penalty for not having health insurance.  This is not a major medical plan.

 

Question #2:

Who can enroll in the Optimed MEC Plan?

Answer:

Prosper Home Care is only required to offer this plan to full time employees and only during the open enrollment dates once per year.  However, Prosper Home Care has decided to make this plan available to everyone, as long as they work an average of 30 hours per week.

 

Question #3:

When can I enroll in the MEC Plan?

Answer:

Open enrollment takes place yearly from 8/1 to 8/31 with an effective date of 10/1 the following year.  Any plan enrollments or changes can take place during that time.

Once you are employed with Prosper Home Care continuously for a period of 90 days, you will receive an offer to enroll in the insurance.  You may choose to accept or decline at that time.  If you decide to enroll later, you will have to wait until the open enrollment period listed above unless you have a “Qualifying Event.”  Please see the Qualifying Events page by clicking here.

 

Question #4:

What is the cost of the Optimed MEC Plan to me?

Answer:

Depending on which plan you choose, the cost ranges from $50 per month to $100 per month.  Please see the chart titled MECplus Costs and Coverages by clicking here.

 

Question #5:

Can I cancel the insurance at any time?

Answer:

No.  Per the Affordable Care Act rules, coverage can only be cancelled if there is a Qualifying Event in the employee’s life.  Please see the Qualifying Events page by clicking here.

 

Question #6:

What does the Optimed MEC Plan cover?

Answer:

The Optimed MEC Plan is a preventative service plan with some hospital, critical illness and accident coverage.  This plan is not a major medical plan.  Please refer to the document titled ACA Preventative Services by clicking here.

In short, this plan will pay for 2 wellness visits per insured per year.  This plan does not pay for urgent care or minor illness visits and does not cover ER visits.

 

Question #7:

How do I pay for the Optimed MEC Plan?

Answer:

Once enrolled, Prosper Home Care will set up a payroll deduction from your paycheck.  If for any reason one paycheck is not enough to cover the cost of the plan, Prosper Home Care will either take the remaining deduction from the next check. If the employee misses two deductions in a row, the plan will be cancelled without the ability re-enroll.

 

Question #8:

Can I keep the insurance if I discontinue working at Prosper Home Care?

Answer:

Yes and No.  Once your employment is terminated with Prosper Home Care, either voluntarily or involuntarily, you will receive a notification from Cobra.  Cobra provides employees with the ability to continue coverage for a certain period of time.  The employee will be required to pay full price plus a maintenance fee to continue coverage.

 

Question #9:

Does the Optimed MEC Plan cover prescriptions?

Answer:

Yes.  Through Indemnity Prescription Drug Insurance, prescriptions are discounted or have copays depending on the medication.

 

Question #10:

Does the Optimed MEC Plan cover vision and dental?

Answer:

No.  Because this is not a major medical plan, vision and dental are not included.

 

Question #11:

Do I have access to nurses and doctors if I just have a question?

Answer:

Yes.  Everyone enrolled in the Optimed MEC Plan will able to speak to a nurse 24 hours a day, 7 days a week through TeleMedicine.  The contact information for this service will be included in your plan documents.

 

Question #12:

I just went to the ER because my child had an upper respiratory infection.  Will this be covered?

Answer:

No.  The Optimed MEC Plan covers well visits and major or critical illnesses.  See the definitions of critical illnesses on the Coverage Basics page by clicking here.

 

Question #13:

Are there any age limits on persons covered under the Optimed MEC Plan?

Answer:

Yes.  The covered employee must be between the ages of 18-69.  Spouses covered must also be between the ages of 18-69.  Children are covered between the ages of 1 day and 26 years.

Question #14:

How are claims processed and paid?

Answer:

Once you see your physician, the physician’s office will forward the claim to Optimed, the plan administrators.  Optimed will review the claim and determine its eligibility for coverage.  Then Optimed will pay the physician directly for all or part of the claim depending on eligibility.

 

Question #15:

Do I have to use specific physicians?

Answer:

Yes.  You will need to verify that your physician accepts Optimed MEC Plan insurance prior to scheduling a visit.  If you need help in choosing an appropriate physician, you can call 1-800-482-8770 get a list of participating providers.

 

Question #16:

I just found out that I am pregnant.  Will this pregnancy be covered under the MEC Plan?

Answer:

No.  The Optimed MEC Plan does not cover pregnancy.

 

Question #17:

In researching insurance plans, I have seen the term “Minimum Value Standard.”  What does this mean and is the MEC Plan considered a MVS plan?

Answer:

A health plan meets the minimum value standard if both of these apply: It's designed to pay at least 60% of the total cost of medical services for a standard population. Its benefits include substantial coverage of physician and inpatient hospital services.  Since the Optimed MEC Plan is not a major medical plan, it does not qualify as a MVS Plan.

 

Question #18:

Do I have to accept this insurance or can I get insurance elsewhere?

Answer:

You may choose to enroll in the Optimed MEC Plan or get coverage from an alternate retail source.  The decision is yours.  

 

Question #19:

If I have questions, who can I contact?

Answer:

You may call the office and speak with the Program Manager.  You may also call customer service on the back of your insurance card to get specifics about what is covered, participating physicians and other plan related questions.

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