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Group Health – EBP

MHCA EMPLOYEE BENEFIT PLAN

No one would question that the quality of care given to our residents is greatly affected by the dedication and experience level of our employees.  We would also agree that it is difficult to hold on to good employees even after we have spent large sums of money to train them.

The retention of good employees was one of the main objectives in creating the MHCA Employee Benefit Plan.  One of the first questions prospective employees ask today is, “Do you provide medical insurance?”  The second is usually, “How much of the employee portion of the premium do you pay?”  With the issue of medical insurance being so important to these prospective employees, it is difficult to hire the better prospects unless you have a Medical Plan and are paying a reasonable amount toward the employee’s portion of the premium.  Should you be fortunate enough to hire a good employee without offering medical insurance, you remain vulnerable to the loss of that employee, at any time, to some other employer who provides medical coverage.

The Board of Trustees of the MHCA Employee Benefit Plan wants you to know that our program was created to satisfy the need in our industry for quality, reasonably priced medical insurance.  We also want you to know that the cost of medical insurance provided to your employees is a specific reimbursable expense under the Mississippi Medicaid Law.  We therefore encourage you to provide this benefit to your employees, thereby creating a more stable, experienced, and satisfied work force.

In addition to the coverage option the Plan has always offered, the Plan now offers a second option, known as Coverage Option B. The new Coverage Option B is not grandfathered under the Affordable Care Act and, therefore, offers the full range of preventative and wellness benefits established by the Affordable Care Act. However, because Coverage Option B has higher deductibles and Out-of-Pocket maximums, said coverage is offered at a lower premium. Despite the higher deductibles and Out-of-Pocket maximums, Coverage Option B still meets the minimum value requirements of the Affordable Care Act. Offering a second coverage option is intended to provide greater flexibility to employers and employees.

Benefits and Services

COVERED EXPENSES

  • Office Visit Co-pays
  • Physician Services
  • Hospital In-patient & Out-patient Services
  • Annual Out-of-Pocket Limit
  • Emergency Services
  • Approved Therapy Services
  • Preventative Wellness Services
  • Mammography
  • Physical Medicine
  • Newborn Well Baby Care
  • Miscellaneous Supplies & Services
  • Prescription Drug Care

ADDITIONAL COVERAGES

  • Employee Life Insurance

OPTIONAL BENEFITS

  • Dental

ELIGIBLE EMPLOYERS:

  • Long-term care facilities and directly related subsidiaries, which are members of the Mississippi Health Care Association.

ELIGIBLE EMPLOYEES:

  • You are eligible if you are a full-time employee working at least 30 hours per week.  If accepted by the Plan’s Administrator, you will become covered on the first day of the calendar month following the waiting period specified by your employer.

ELIGIBLE DEPENDENTS:

  • Your legal spouse and legal dependents up to the age of 26 regardless of their school status.

BENEFITS(as of 6/01/17)

Deductible:
(does not apply where there is co-pay)
Coverage Option A: $1,200 annual deductible per per-son; family annual maximum 3 x individual.
Coverage Option B: $5,000 annual deductible per per-son; family annual maximum 2 x individual.
Out-of-Pocket Limit:
(does not include deductible; only applies to services provided by network providers)
Coverage Option A: $2,400 per person per year; family maximum 3 x individual.
Coverage Option B: $6,850 per person per year; family maximum 2 x individual.
Prescription Drug Card:
Coverage Option A:
Brand Name – $45 co-pay
Generic – $10 co-pay
Coverage Option B:
Brand Name—70% after deductible
Generic – $20 co-pay
(Coverage Option B has a $100 annual deductible per person)
Mail Order: (90 day supply)
Coverage Option A:
Brand Name – $80 co-pay
Generic – $0 co-pay
Coverage Option B:
Brand Name—70% after deductible
Generic – $40 co-pay

This Plan is an ERISA Trust organized under the provisions of the Employee Retirement Income Security Act of 1974 – U.S. Congress

IMPORTANT NOTICE: (applicable to Coverage Option A only) The Mississippi Health Care Association Employee Benefit Plan (“MHCAEBP”) is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (“PPACA”).  As permitted by PPACA, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered plan means that your plan may not include certain consumer protections of PPACA that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in PPACA, for example, the elimination of lifetime limits on benefits. One of the provisions of PPACA which does NOT apply to MHCAEBP as a grandfathered plan is the new requirement regarding appeal procedures, including the requirement for external review of all claims appeals.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the Plan at:  MHCAEBP,282 Commerce Park Drive, Ridgeland, MS 39157, Phone:  (601) 707-2471, Toll Free:  (888) 927-9227, Admin Fax:  (601) 707-2482
You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform.  This website has a table summarizing which protections do and do not apply to a grandfathered health plan.

How to Participate

Please Contact MHCA EBP:
282 Commerce Park Drive
Ridgeland, MS 39157
Phone:  (601) 707-2471
Toll Free:  (888) 927-9227
Admin Fax:  (601) 707-2482