What is “Minimum Essential Health Care Coverage?”

The Code § 4980H subsection (a) penalty applies only if the employer fails to offer adequate coverage and at least one employee enrolls for subsidized exchange coverage. If it offers “minimum essential coverage” to substantially all full-time employees, an applicable large employer will not be liable for a subsection (a) penalty. Most employer-provided group health coverage will meet the very broad definition of minimum essential coverage. The definition includes any coverage under an “eligible employer-sponsored plan”—a term that means a group health plan or group health insurance coverage offered by an employer to an employee that is (a) a governmental plan, or (b) any other plan or coverage offered in a state’s small or large group market.

IRS regulations clarify that self-insured employer coverage qualifies as an eligible employer-sponsored plan, and further confirm that there is no requirement that employer-sponsored, self-funded, and self-insured large group health plans offer all essential health benefit categories or conform to any of the essential health benefit benchmarks. An HHS FAQ addressed the impact on self-insured, large group market, and grandfathered health plans that are not required to offer essential health benefits. However, these plans are prohibited from imposing annual and lifetime dollar limits on the essential health benefits they do offer. HHS has indicated that these plans may impose non-dollar limits on essential health benefits and annual and lifetime dollar limits on benefits that do not fall within the definition of essential health benefits.

Seneca’s MEHP Platform

Seneca plans are designed to fit your business needs, maximize your employees’ healthcare savings and improve your bottom line. All plans start with Seneca’s core value platform, including 24/7 no cost Telemedicine, Concierge Customer Service and Transparent Healthcare’s Medical Network. Telemedicine increases productivity by decreasing absenteeism. Employees take care of their health and get better faster with 24/7 no cost consultations where doctors can diagnose over the phone and send prescriptions to the nearest pharmacy. Seneca’s concierge customer service helps your employees get the most out of their MEHP Benefits, including finding providers, making appointments and navigating their healthcare options and claims processes. Transparent Healthcare’s Proprietary Medical network delivers significant savings on claims cost and provides a robust medical network for members and their families. Seneca’s MEHP core value platform is designed to keep your employees and your business healthy.

Sample MEHP Benefits

Plan Benefit Flexibility

As an indemnity-based ERISA benefit Plan, the employer has the ability to customize the benefit levels offered to its employees, as long as the benefits meet the requirements of the Affordable Care Act. The Seneca Group works directly with you and your health benefits broker to develop an MEHP that will meet the needs of your business.