Obamacare Driving More Companies to Self-Funded Healthcare Plans

The Affordable Care Act (ACA) has sparked a renewed interest and growth in self-funding as more organizations look for ways to continue to offer quality healthcare benefits to their employees, but also create opportunities for savings. Self-funded health plans are not new. In fact, they have been around for decades. However, many businesses have simply been unaware of their advantages and the differences between self-funded and fully insured plan options.

Organizations of many sizes have turned to third party administrators, such as EBSO, to help design, administer and manage a self-funded plan that manages risk and promotes wellness while keeping costs in line.

As Obamacare gives employees even more reason to identify and manage plan costs, TPAs can provide greater access to health plan data and work closely with you and your plan participants to build individualized programs that manage both cost and quality.

In this FREE whitepaper we examine “5 Reasons Why It’s Time to Consider Self-Funding Your Employee Healthcare Plan.”


Still Still trying to get a handle on the differences between a self-funded and fully-insured plan? Click to watch our short video, Discover the Benefits of Self-Funding and in less than 2 minutes we will explore those differences, give you the advantages of self insured health benefit plan and help you understand how self-funding works.

What You Need to Know About Minimum Essential Coverage (MEC) Plans

Employers with 50 or more employees are required to provide their full-time workers with access to Minimum Essential Coverage (MEC) under the Affordable Care Act (ACA). The mandate is intended to ensure that employees have the opportunity to enroll in an employer-sponsored plan that is both affordable AND comprehensive.

ebso-minimum-essential-coverageWhen the Affordable Care Act officially became law in 2010, applicable larger employers (ALEs) quickly began looking for ways to comply with Minimum Essential Coverage (MEC) requirements. MEC plans were created to gives employer an option that was both affordable and in compliance.

The government has established two tests to determine if MEC requirements are met:

Test One: Minimum Value – To pass this test, at least 60% of medical costs must be paid by the plan, based on the average costs for the standard population. This calculation can be tricky when applied to complex self-funded plans, and a safe harbor checklist is available for plans to use to aid the process. In most self-funded cases, however, this test is easily passed.

Test Two: Affordability – Affordability is determined by examining each unique employee and comparing coverage payments against employee wages earned. Employee premiums cannot exceed 9.5% of their household income or the plan is deemed not affordable. For employees offered multiple plan options by the employer, the calculation is based on the least costly plan option available and not the option selected by the employee, as they may elect higher cost coverage.

With the introduction of MEC plans, many workers who were previously without access to employer sponsored coverage are now able to enjoy preventive care programs and additional benefits that encourage health and wellness. MEC plans also enable ALEs to avoid costly tax penalties associated with the ACA. MEC plans can vary in cost from as little as $400 per employee, per year, depending on the levels of coverage the employer chooses to provide.

Many of the benefits typically included in MEC plans are as follows:

  • Doctor visits
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Prescription drugs
  • Laboratory services
  • Preventive and wellness services
  • Mental health services
  • Habilitative services (to help a person keep, learn or improve skills needed in daily living)
  • Dental care

A Word of Caution For Employers and Enrollees

When enrolling in any health coverage, it is very common for individuals to think they will have a full medical plan. This is not the case with a Minimum Essential Coverage (MEC) plan. While MEC plans absolve covered employees of the individual mandate and employers from the sledge-hammer penalty, they do not include full medical benefits such as hospitalization. In-hospital care is a part of what the ACA describes as Essential Health Benefits, which are required of Minimum Value Plans, however Minimum Essential Coverage plans and Minimum Value Plans (MVPs) are not the same.

While MEC plans provide great preventative care, one of the reasons that MEC plans are so affordable is that while they include a minimum of the 67 preventive benefits required by the ACA, most do not cover a hospital stay or an in-hospital procedure being done. As long as this is communicated clearly and understood fully by enrollees, MEC plans are great solutions for employers who do not currently offer coverage.

A number of Minimum Essential Coverage (MEC) plans are now available. Contact EBSO for more information as you begin your 2016 business planning.