BENEFIT PLANS

BASIC PLAN

PREVENTATIVE HEALTH & WELLNESS

BASIC PLAN
PRICING

Preventative Health & Wellness Check

Includes immunizations, screenings, counseling and more. A list of Covered Preventative Services can be found below.

Prescription Discount Card

Get affordable pricing on monthly and occasional prescriptions using National Health Benefits’ prescriptions savings finder.

Total Telehealth Package Through MeMd Including
  • Urgent Care Telehealth – Free
  • Men’s & Women’s Telehealth Services – Free
  • Talk Therapy – $65 Copay Per Session
  • Teen Therapy – $65 Copay Per Session
  • Telepsychiatry – $229 First Session $99 For Follow Up
  • 24/7/365 Phone or Video Appointments
  • Prescription Writing As Necessary

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EXPLANATION OF

PLAN BENEFITS

The Basic Plan is offered to employers looking for Minimum Essential Coverage for their employees at an affordable cost. This is an all-inclusive benefit plan which is a fully self-funded ERISA based plan. This plan meets all the Tax A requirements placed on Applicable Large Employers (ALE’s) by the Affordable Care Act (ACA). The ACA requires that an ALE must provide their eligible employees with this Minimum Essential Coverage (MEC) which is predominantly made up of Preventative Health and Wellness Benefits.

PLEASE NOTE: This plan is only available as an individual plan for employees of ALE’s. This plan is not available to be purchased as a stand alone product for individual contractors or companies with 10 or fewer employees.

HEALTH & WELLNESS VISITS

Included in this MEC coverage are 15 Covered Preventative Services for Adults, 23 additional Covered Preventative Services for Women (including pregnant women), and an additional 26 Covered Preventative Services for Children and Newborns. The majority of the covered preventative services included in this plan allow for screenings, vaccinations, counseling and other preventative tests. It also includes a colonoscopy screening for adults 50 years and older every 5 years as well as an annual mammogram screening for women 40 and over.

MEDICAL & BEHAVIORAL TELEHEALTH

The Total Telehealth Plan included in this package includes Unlimited Free Medical Visits available 24/7/365 from MeMd’s smartphone app or website. These medical visits can range in type from an Urgent Care Telehealth visit to Men’s and Women’s Telehealth Services. Behavioral Health visits can be scheduled with an online provider for a low $60 per visit copay. The Behavioral Telehealth services include Talk Therapy, Teen Therapy and Telepsychiatry. To learn more about our Total Telehealth package, please click here.

PRESCRIPTION DISCOUNT CARD

The Basic Plan (as well as all National Health Benefits plans) includes a discount prescription card available for members who are looking to fill a prescription. Prescriptions can be obtained by utilizing the Total Telehealth package provided by MeMD. The best way to take advantage of our prescription discount program is to use the Prescription Look Up Tool below. This tool will ask you to input the prescription type, dosage and brand as well as the zip code nearest to you. Once processed, the online tool will offer you the 10 closest pharmacy options with the discounted prescription costs for each option.

EMPLOYEE
CONTRIBUTIONS

This plan requires an employer contribution of $30 per employee to maintain the “employer- sponsored” designation requirement of the ERISA Act legislation that this plan is founded on. Employers may contribute more than $30 per employee if they so choose, but the minimum standard contribution starts at $30 per employee.

EMPLOYEE
ELIGIBILITY

An employee who works an average of 30 or more hours per week is considered full-time and therefore entitled to compliant healthcare options made available by their 60th day of employment. If at any time an employee reaches 120 worked hours per month, they must be added to the National Health Benefits employee census. An employee may be removed from the census once they have worked less than 120 hours per month for 3 consecutive months.

PLAN
INCLUSIONS

Our Basic Plan includes all claims fees, administration costs, a Total Telehealth package through MeMd with no copay on medical services, and a Prescription Discount Card. This plan includes all government reporting including Forms 1094’s, 1095’s, 720 Report, Form 5500 section 4980H, PCORI annual filing fee, Cobra Notices, and TPA fees.

This plan is an Affordable Care Act compliant plan which meets the requirements of the Tax A portion of the ACA. CLICK HERE for more information on how National Health Benefits can help you meet the requirements of the Tax B portion of the Affordable Care Act.

COVERED PREVENTATIVE SERVICES

COVERED PREVENTATIVE SERVICES

ALL ADULTS

  • Blood Pressure Screening
  • Cholesterol Screening
  • Type II Diabetes Screening
  • Syphilis Screening
  • HIV Screening
  • Sexually Transmitted Infection Prevention Counseling
  • Tobacco Use Screening For All Adults & Cessation Interventions
  • Aspirin use for men ages 45-79 & women ages 55-79 to prevent CVD when prescribed by a physician
  • Colonoscopy (Colorectal cancer screening for adults starting at age 50, limited to one every 5 years)
  • Diet counseling
  • Immunizations and vaccines (Hepatitis A&B, Herpes, Zoster, Influenza, Measles, Mumps, Tetanus, Rubella, Human Papillomavirus, Meningococcal, Pneumococcal, Diphtheria, Pertussis)
  • Abdominal aortic aneurysm one-time screening for age 65-75
  • Depression screening & counseling
  • Obesity screening

COVERED PREVENTATIVE SERVICES

WOMEN’S SERVICES

  • Breast cancer mammography screening every year for women age 40 and over 
  • Breast cancer chemo prevention counseling 
  • Cervical cancer screening 
  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs 
  • Domestic and interpersonal violence screening and counseling for women 
  • Gonorrhea screening 
  • Syphilis screening 
  • Chlamydia infection screening 
  • HIV screening and counseling 
  • Human Papillomavirus (HPV) DNA testing every three years for women with normal cytology results who are age 30 or older 
  • Osteoporosis screening over age 60 
  • Tobacco use screening and interventions 
  • Sexually transmitted infections counseling 
  • Wellness visits 

COVERED PREVENTATIVE SERVICES

PRENATAL / POSTNATAL SERVICES

  • Anemia screening on a routine basis 
  • Bacteria, urinary tract and infection screening 
  • BRCA counseling and genetic testing for women at higher risk 
  • Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies 
  • Folic acid supplements 
  • Gestational diabetes screening 
  • Hepatitis B screening 
  • Routine prenatal visits 
  • Rh-incompatibility screening including follow-up testing 
  • Expanded counseling for pregnant tobacco users 
  • Delivery, C-Section, Inductions not covered at this time 

COVERED PREVENTATIVE SERVICES

NEWBORN SERVICES

  • Hearing screening 
  • Immunization vaccines for children from birth to age 18 with variable doses, according to recommended ages and populations 
  • Cervical Dysplasia screening and vaccines for Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicella 
  • Congenital Hypothyroidism screening 
  • Gonorrhea preventive medication for eyes 
  • Hemoglobinopathies or sickle sale screening 
  • Phenylketonuria (PKU) screening 
  • Iron supplements for newborns to 12 months when prescribed by a physician 

COVERED PREVENTATIVE SERVICES

ALL CHILDREN SERVICES

  • Autism screening for children, limited to two screenings up to age 24 months 
  • Vision screening, 5 and younger 
  • Developmental screening for children under the age of 3 and surveillance throughout childhood 
  • Lead screening 
  • Dyslipidemia screening 
  • Height, Weight and Body Mass Index measurements 
  • Obesity screening and counseling 
  • Hematocrit or Hemoglobin screening 
  • Oral health risk assessment, up to age 10 
  • Depression screening, 12 and older 
  • Alcohol and drug use assessments 
  • Blood pressure screening 
  • Sexually transmitted infection prevention counseling and screening for adolescents 
  • Tuberculin testing