PrestigePEO offers a full spectrum of medical plan options, ranging from local networks to plans that provide nationwide access. Prices and coverage will vary, so make sure you choose the best option for you and your family. If you are considering a plan in a different network, you must check with your provider to make sure they participate. Check out the PrestigePRO Employee Benefits Portal to review all your options.
Medical Plan Types
For more information on PrestigePEO’s medical plans, please contact your Benefits Specialist.
Preferred Provider Organization Plans (PPO)
A PPO is a medical plan that links select hospitals and doctors to create a network of participating healthcare providers. Under this kind of plan, you’ll pay less if you stay in-network and visit a participating healthcare provider. You can also utilize services at out-of-network healthcare providers for an additional cost, but it’s important to keep in mind that these costs could be significant. Most services under a PPO plan are subject to a copay or an additional fee at the time of service. Some services may also be subject to coinsurance.
High-Deductible Health Plans (HDHP)
This type of medical plan has a higher deductible than traditional insurance plans. While monthly premiums for these plans tend to be less, it is important to remember that all services (except preventive care) will be subject to the deductible first before services are reimbursed. An HDHP is often combined with a Health Savings Account (HSA), a tax-exempt fund that can be used to pay for medical services.
Exclusive Provider Organization Plans (EPO)
An EPO is a managed care plan which only covers medical care via in-network healthcare providers, unless in an emergency. You do not need a referral from your Primary Care Physician (PCP) to see a specialist. You cannot go out of the plan’s network, except for an emergency (sudden and serious illness).
Point-of-Service Plans (POS)
With a POS plan, you’ll pay less if you utilize services from in-network healthcare providers. There are no referrals required to see a Specialist.
Choosing a Medical Plan
The PrestigePRO Employee Benefits Portal will include all plans that are available to you. If you are adding your dependents, make sure they’re included so that your coverage on November 1st will reflect your coverage tier. If you have any questions, please reach out to our benefits team at 833-PEO-BEN1. You can also connect directly to your dedicated specialist via our PrestigeGO mobile app.
Minimum Essential Coverage (MEC) and Minimum Value (MV) Plans Medical Plan Types
What you need to know about offering these and more coverage to your employees.
Affordable Care Act Requirements
Employer Mandates and Penalties For Non- Compliance
ACA requirements state that any employer of at least 50 full-time or full-time equivalent employees give the opportunity to enroll in minimum essential coverage and affordable health insurance. Employers who do not comply with this mandate are subject to penalties. Penalties fall under two categories: Penalty A and Penalty B.
Offering a MEC plan satisfies Penalty A and offering a Minimum Value plan satisfies both penalties A & B.
Why offer ACA Compliant medical plans to your employees?
Employer Mandate
ACA requires employers with 50 or more full-time equivalent employees to offer health coverage to at least 95% of full-time employees and sets a minimum baseline of coverage and affordability. Employers who do not comply face annual penalties.
Employer Penalties
IRS Penalty A
Those companies who are considered large employers that fail to offer coverage could face the following penalty:
Number of Full-time employees minus 30 multiplied by $2,900 = penalty
ex: 100 FT Employees | (100-30) = 70 | 70 * $2,970 = $203,000
IRS Penalty B
For a large employer that offers coverage that isn’t considered affordable and/or doesn’t provide minimum value: $4,350 multiplied by the number of full-time employees who receive a premium tax credit in the marketplace.
Solution
MEC (Minimum Essential Coverage)
IRS Penalty A
PrestigePEO MEC plans help to satisfy IRS penalty A. IRS penalty A states that companies “must offer” benefits to their full-time employees. MEC plans can be used independently or integrated into additional supplementary benefits options.
MV Plans (Minimum Value Plans)
Satisfies IRS Penalty A & B
To avoid Penalty B, the employer must offer at least a minimum-value health plan and set the employee contribution at no more than 8.39% (2024) of the employee’s income. Waivers should be collected to validate the plan was offered and the employee contribution level.
Robust Network
Partnering with MultiPlan/PHCS as our service provider allows for a vast network of access.
1.4M Access Points
164K Ancillaries
5,600 Hospitals
300+ Employees
Provider Lookup
MEC Plans
1.Click the link based on your plan
2.Wellcare – www.multiplan.com/sbmapreventiveservices
3.All other plans – www.multiplan.com/sbmaspecificservices
4.Enter provider type: i.e Primary Care, Ob-Gyn, Lab, etc.
5.Enter zip code, then click on search and your directory will be provided
MV Plans
1.Visit https://www.hstconnect.com/PHCS
2.Enter provider type: i.e Primary Care, Ob-Gyn, Lab, etc.
3.Enter zip code, then click on search and your directory will be provided.
Member Perks
Your MEC plan not only provides coverage on medical services, but you’ll also get discounts on common out of pocket costs.
- MEC Companion Card – Discounts on Dental, Vision, Durable Medical Equipment, Fitness Centers, Pet Care, and more!
- Member Portal and App (MV Plans Only) – Access plan information, ID cards, benefit summaries and more.
- Concierge Services (MV Plans Only) – MedWatch is your benefits concierge for precertification, making appointments and more!
- Free Advanced Imaging (MV Plans Only) – When you use Medmo, MRI’s are fully covered by your plan. No copay!
- Free DME (MV Plans Only) – With Connect DME, receive medical services and equipment at no cost to you.
- 24/7 Virtual Care – Receive care from a board-certified doctor 24/7 no matter where you are via phone or FaceTime.
Telemedicine
The Telemedicine Solution
Our telemedicine benefit provides you and your family access to board certified physicians around the clock (24/7/365) via telephone or secure video.
Telemedicine physicians can give advice, diagnose or treat illness, and even prescribe medication right over the phone. With healthcare costs rising, an office visit with a PCP or Urgent Care Center can range from $155 to upwards of $300, and an ER visit can average almost $1,000*. With this benefit, there is no cost to you or your family for a consultation.
Download the HealthWallet App to schedule your Telehealth appointment.
Commonly Treated
- Allergies
- Arthritic Pain
- Bronchitis
- Cold/Flu
- Conjunctivitis
- Diarrhea
- Ear Infections
- Headache
- Gastroenteritis
- Insect Bites
- Sprains/Strains
- Respiratory Infections
- Sinus Infections
- Upset Stomach
- Urinary Tract Infections
MEC Companion Card
Discounted Services
Simply register your account and review all the ways to save! Instructions, provider lookups, and more are right at your fingertips. Once you make your appointment, present your card and receive discounts at the time of service.
- Dental
Accepted at over 80,000 provider locations nationwide, and covers all dental services and specialties, including orthodontia. Savings can be as high as 50%, and there is no limitation on services or use. - Vision
Accepted by over 11,000 OUTLOOK vision providers. Cardholders receive up to 50% savings on lenses, frames, and other vision needs. - Hearing Aids
Members receive a free hearing test and up to 70% discount on hearing aids at 2,200 providers nationwide. - Vitamins
A wide range of vitamin and mineral supplements are delivered directly to the member’s home at discounted rates. - Lab Services
Members save up to 50% using the online search tool to locate a lab and order their test. Actual savings are displayed immediately. Test results are available within 48-96 hours. - MRI & Imaging
Members receive concierge appointment service and enjoy savings up to 75% and more on MRI, PET, and CT scans, as well as other imaging services at over 4,000locations nationwide. - Diabetic Supplies
A full line of diabetes testing supplies are delivered directly to the member’s home. - & More…
As always, our benefits experts are available to guide you through your options and help determine the best solution for your organization and your employees.