Insurance Services
What are Self-Funded Enhanced MEC Plans & Why Offer Them?
A Self-Funded Enhanced MEC plan is an ACA-compliant option that covers everyday care such as doctor visits, specialist visits, urgent care and preventive services. These plans are often a bridge for businesses that want to offer affordable benefits while staying on budget, as they do not include hospitalization.
Part of the monthly premium is set aside to pay employee claims, with the rest covering PPO network access, claims processing and administrative support.
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Many start with MEC for one to three years before moving to major medical. Some offer major medical to management and MEC to hourly or part-time staff, balancing coverage, cost control and compliance.
What's included in our Enhanced MEC plans?
Our MEC plans go beyond the ACA minimums, offering real, usable benefits employees appreciate.
Plan Highlights
Our Enhanced MEC plans go beyond the ACA minimums, offering affordable everyday healthcare benefits employees can actually use. These plans do not include hospitalization coverage, making them a cost-effective bridge for growing businesses.
• Primary Care Visits: $30 copay
• Specialist Visits: $40 copay
• Urgent Care Access: $50 copay
• Preventive Care: 100% coverage on annual checkups, screenings, and vaccines
• Prescription Savings: Discounts on generic and brand-name medications
• Nationwide Network: Access to providers across the United States
Example:
How a self-funded
MEC claim works
Real World Example:
An employee visited their primary care provider for shoulder pain and chest discomfort. The provider billed $491. Because the plan includes the First Health PPO network, the bill was reduced to $144.71. The employee paid a $30 copay, and the remaining $114.71 was paid directly from the claim funding already built into your monthly $167 rate.
Why it Matters for Your Business:
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The $167 monthly rate per employee includes claim funding, PPO access, claims processing, and full administrative support.
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Businesses typically cover 100% of the monthly premium based on ACA affordability rules, giving employees full access to benefits at no cost to them.
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All eligible claims, like this $144.71 example, are paid from the funding pool you are already contributing to, so no huge surprise bills to the business.
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Any unused claim funding at year-end can roll over or be returned to the business for other uses.
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MEC covers everyday care (doctor, specialist, urgent care) but not hospitalization, keeping costs predictable.
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Self-funded plans direct more dollars to actual care instead of carrier profit, giving you more control and visibility over spending.
Why 65% of Businesses Choose Self-Funding
65% of small and mid-sized businesses now use self-funded plans because they provide predictable costs, tailored benefits, and the potential to retain unused funds.
