Medical Benefits

Ensure medical plans are configured correctly (premiums, contributions, Minimum Essential Coverage (MEC), Minimum Value (MV), and self-insured plans. If you are unsure what Minimum Essential Coverage, Minimum Value, or self-insured plans are, please refer to the glossary at the end of the article.

The audit is a two-part process. A one-click report will be utilized to audit plan names, premiums, and contributions. Specific system configuration screens will be used to audit MEC, MV, and self-insured settings.

Open Benefit Premium / Rate Configuration – Annual** Report

  1. From the menu, expand Settings and click Benefit Management.

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  2. Click the benefit package associated with the current tax year.

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  3. Click the Review Configuration tab.

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  4. Click the Excel icon for the "Benefit Premium / Rate Configuration - Annual**" report.

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  5. Confirm medical plan premiums and contributions.

Confirm MEC, MV, and Self-Insured Settings

  1. From the menu, expand Settings and click Benefit Management.

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  2. Click the benefit package associated with the current tax year.

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  3. Click the Configure Benefit Structure tab.

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  4. Click on the individual medical plans.

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  5. From the "Properties" tab, scroll down to the section labeled "Select from the Additional Options below if applicable"
    • If the medical plan is self-insured, check the box for "This plan is Self Insured"; otherwise, leave the box unchecked.
    • If the plan meets MEC, check the box for "This plan meets Minimum essential coverage (MEC) as defined by the ACA"; otherwise, leave the box unchecked.
    • If the plan meets MV, check the box for "This plan meets Minimum Value as defined by the ACA"; otherwise, leave the box unchecked.
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Glossary

Minimum Essential Coverage (MEC)

MEC is defined by Healthcare.gov as any insurance plan that meets the Affordable Care Act requirement for having health coverage. To avoid the penalty for not having insurance for plans 2018 and earlier, you must be enrolled in a plan that qualifies as minimum essential coverage (sometimes called “qualified health coverage”). Starting with the 2019 plan year (for which taxes are filed in April 2020), the penalty no longer applies.

Minimum Value (MV)

Healthcare.gov defines MV as a standard of minimum coverage that applies to job-based health plans. If an employer’s plan meets this standard and is considered “affordable”, an employee will not be eligible for a premium tax credit if he buys a Marketplace insurance plan instead. A health plan meets the MV standard if both of the following apply: -The health plan is 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

Self-Insured

Self-insured health plans are usually present in larger companies where the employer collects premiums from enrollees and takes on the responsibility of paying employees’ and dependent’ medical claims. Employers can contract for insurance services such as enrollment, claims processing, and provider networks with a thirdparty administrator, or the employer can self-administer the plans themselves.

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