BENEFIT PLANS
MEGA PLAN
OUT-PATIENT VISITS, VISION & DENTAL
MEGA PLAN PRICING
NO DEDUCTIBLE
Preventative Health & Wellness Check
As included in the Basic Plan
Prescription Discount Card
In-office Copay Program For Providers
PHCS Network Of Healthcare Providers
Highly encouraged but never required
Total Telehealth Package Through Lyric Health Including
- Online Primary Care Physician
- Online Urgent Care
- Online Mental Health Therapy
- Online Dermatology
- Care Navigation
- 24/7/365 Phone or Video Appointments
- Prescription Writing As Necessary
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EXPLANATION OF
PLAN BENEFITS
The Mega Plan is National Health’s most popular plan, offering in-office doctors visits for both sick and well care, urgent care access, dental and vision coverage for a small copay. This plan also offers in-office coverage for chiropractic visits and physical therapy care as well as in-office behavioral therapy options. This plan is offered as a fully Affordable Care Act compliant ERISA based plan. As such, the Mega Plan includes all of the offerings of the Basic Plan (link to the Basic Plan page).
The biggest difference between the two benefit plans is that the Mega Plan includes in-office doctors visits for the most utilized medical services of any healthcare plans. Specifically, Mega Plan members have access to chiropractors, physical therapists, other specialist practitioners, urgent care services, out-patient testing, lab work and more for just a small copay. Please refer to the STATED COPAY CHART BELOW. This plan also includes dental and vision benefits.
PLEASE NOTE: This plan is available to all types of small and large businesses including self-employed individuals and independent contractors.
IN-OFFICE COPAY PRICING CHART
| COVERAGE | COPAY WITH BILLED CHARGES |
|---|---|
| Unlimited Total Telehealth | $0 Copay (Online Only) |
| General Office Visits | $25 Copay With $1000 In Billed Charges |
| Specialist | Behavioral Health Office Visits | $25 Copay With $1000 In Billed Charges |
| Urgent Care Visits | $50 Copay With $2000 In Billed Charges |
| Chiropractic | Physical Therapy Visits | $25 Copay With $1000 In Billed Charges |
| Vision | $25 Copay With $100 Towards Office Visit & $100 Towards Glasses Or Contacts |
| Dental | $25 Copay With Up To $1500 In Billed Charges |
| Lab Work | $25 Copay With $2000 In Billed Charges |
| Out Patient Testing | $200 Copay With $2000 In Billed Charges |
IN-NETWORK OFFICE VISITS
Our Mega Plan gives members access to the PHCS Network of doctors and medical professionals. This is arguably the largest network of providers in the country, giving our members access to a large variety of health professionals nationwide. We strongly encourage our members to utilize this network for their medical needs whenever possible as it allows National Health to maximize their health benefits under their coverage maximums. Members are welcome to utilize medical professionals outside of this preferred network at their discretion. Please note that if a member chooses a provider outside of the provided network, National Health cannot control or limit excessive provider charges that are higher than the negotiated PHCS rate.
MEDICAL & BEHAVIORAL TELEHEALTH
Lyric is a virtual-first healthcare platform built to streamline access, reduce friction, and drive meaningful claims cost reduction by guiding members to the right care, when and how they need it. By combining an integrated suite of virtual care services with 24/7 care navigation, Lyric delivers a seamless, connected healthcare experience from first touch to resolution. Our focus is on fostering the well-being of our members by providing healthcare services that prioritize individuals’ health, ensuring their safety, and advocating for overall wellness.
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.
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.
PLAN
INCLUSIONS
Our Mega Plan includes all claims fees, administration costs, Preventative Health and Wellness Benefits, a Total Telehealth package through MeMd, 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. Additionally, this plan includes access to doctors visits for sick care, urgent care, specialist care, chiropractic care, physical therapy care, dental care, vision care, out-patient testing and lab work for a small copay. Please note that there are maximums on covered billed charges.
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.
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
- Diet counseling
- Syphilis Screening
- HIV Screening
- Sexually Transmitted Infection Prevention Counseling
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Alcohol misuse screening and counseling
- Aspirin use for men ages 45-79 & women ages 55-79 to prevent CVD when prescribed by a physician
- Tuberculosis screening
- Depression screening
- Colorectal cancer screening for adults 45-75 years
- Lung cancer screening for adults 50- 80 years at high risk for lung cancer
- Colonoscopy (Colorectal cancer screening for adults starting at age 50, limited to one every 5 years)
- 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
- Fall prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over
- Statin preventive medication for adults 40-75 years at high risk
- Aspirin use for adults ages 50-59 to prevent CVD and colorectal cancer
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV negative adults at high risk
- Hepatitis B screening for people at high risk
- Hepatitis C screening adults 18-19 years
COVERED PREVENTATIVE SERVICES
WOMEN’S SERVICES
- Birth control (see prenatal/postnatal below)
- Bone density screening for women over 65 years or women 64 years and younger who have gone through menopause
- Breast cancer genetic test counseling (BRCA)
- Breast cancer screening mammogram every 1-2 years for women 40 years and older
- Breast cancer chemoprevention counseling
- Tobacco use screening and interventions
- Urinary incontinence screening for women yearly
- Well-woman visits
- Cervical cancer screening (Pap smear)
- Chlamydia infection screening
- Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant
- Domestic and interpersonal violence screening and counseling for women
- Gonorrhea screening
- HIV screening and counseling
- PrEP (pre-exposure prophylaxis HIV prevention medication for HIV-negative women at high risk
- Sexually transmitted infections counseling
COVERED PREVENTATIVE SERVICES
PRENATAL / POSTNATAL SERVICES
- Breastfeeding support and counseling from trained
- providers, and access to breastfeeding supplies for pregnant and nursing women
- Birth control including: diaphragms, sponges, birth control pills and vaginal rings, intrauterine devices (IUDs, Plan B® and ella®, sterilization procedures, patient education and counseling
- Folic acid supplements
- Gestational diabetes screening for women 24 weeks pregnant or later or higher risk
- Gonorrhea or Syphilis screening for women at higher risk
- Maternal depression screening for mothers at well-baby visits
- Pre-eclampsia prevention and screening
- Rh-incompatibility screening including follow-up testing
- Expanded counseling for pregnant tobacco users
- Urinary tract or other infection screening
COVERED PREVENTATIVE SERVICES
NEWBORN SERVICES
- Bilirubin concentration screening
- Blood screening for newborns
- Fluoride varnish for all infants and children as soon as teeth are present
- Gonorrhea preventive medication for the eyes
- Hearing screening
- Hemoglobinopathies or sickle cell screening
- Hypothyroidism screening
- Immunizations: (Varicella, Hepatitis A&B, Flu Shot, Inactivated Poliovirus. Measles, Mumps, Tetanus, Rubella, HPV, Meningococcal, Pneumococcal,
Diphtheria, Pertussis, Rotavirus, Haemophilus flu type b) - Phenylketonuria (PKU) screening
COVERED PREVENTATIVE SERVICES
ALL CHILDREN SERVICES
- Alcohol, tobacco, and drug use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Blood pressure screening for children
- Depression screening beginning routinely at age 12
- Developmental screening for children under age 3
- Dyslipidemia screening for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
- Sexually transmitted infection prevention counseling and screening for adolescents
- Tuberculin testing
- Vision screening
- Well baby and well-child visits
- Fluoride supplements
- Hearing screening for children and adolescents as recommended by their provider
- Height, weight and body mass index (BMI) measurements taken regularly
- Hematocrit or hemoglobin screening for all children
- Hepatitis B screening for adolescents at higher risk
- HIV Screening for adolescents at higher risk
- Lead screening for children at risk of exposure
- Obesity screening and counseling
- Oral health risk assessment, 6 months to 6 years
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk