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 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 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

COVERAGECOPAY WITH BILLED CHARGES
Free MeMd Urgent Care$60 Copay For Behavioral Telehealth
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

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.

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
  • 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