Solutions for Businesses

At Midwest Health Group, we will gladly help your employees receive better care at a lower cost to both you and them. We offer comprehensive corporate and small business wellness programs in addition to employee weight loss and nutritional counseling in the Kansas City region and beyond. By joining Midwest Health Group, your employees will also have access to our exclusive line of doctor formulated vitamins. Searching for a health insurance Kansas plan for your employees? While we are not an insurance company, a business membership with the Midwest Health Group can supplement your company’s existing, catastrophic health insurance plan. Take a look at the facts below, our Business FAQs, and a breakdown of the Affordable Care Act for employers.

Covered Services and Fees

Pricing

Midwest Health Group FAQs for Businesses

Can my employees learn about Midwest Health Group prior to joining their DPC program?
Yes, simply send employees to our website. We could even provide a presentation to your employees and answer any questions they may have if you prefer. In addition, individual employees can make an appointment to visit our clinic and speak with the Midwest Health Group staff.
How can I sign-up my business for Midwest Health Group?
You can register your business online or contact us to set up a meeting.
How do my employees enroll in Midwest Health Group’s DPC?
Each member must submit a member registration online to be eligible to join, and then be confirmed as active members on their business plan.
What about part-time employees?
Yes, you can offer our affordable primary care services to any employee regardless of the amount of hours they work.
What about my employees’ families? Can they join too?
Yes, we offer a family plan that would provide even better savings than joining individually.
What cost is there for the business?
That is dependent on you. It can cost the business nothing if the employer elects to have employees pay the membership fee in its entirety through payroll deduction. However, many businesses elect to fully or partially supply the membership fee.
Can Midwest Health Group DPC work with my existing insurance plan?
Midwest Health Group DPC can be a stand-alone health benefit without insurance, but it is best to supplement it with a high-deductible insurance plan for more comprehensive coverage. Creating a self-funded health plan with Midwest Health Group is likely the most cost-effective option. However, many businesses find a combination of Midwest Health Group DPC with a high-deductible insurance plan, and an HSA gives the business and employee a great value that is amicable to each party.
What about worker’s comp, do you provide care to employees on behalf of employers?
For all active DPC members, we can provide any type of medical care to our members within our scope of practice. This care includes evaluation and treatment of injuries resulting from work activities. If the injury requires further care outside our scope of services, we try to find providers that offer deep discounts. We do not provide medical care to employees who are not enrolled and active in our program.
Does Midwest Health Group satisfy the business insurance requirement under the Affordable Care Act requirement?
It is important to understand that the DPC services of Midwest Health Care are only a part of the requirement under Obamacare. We are not health insurance and provide only the primary care services. In order to satisfy the requirements, a wrap-around plan is required with DPC. This could be a high-deductible plan for surgeries, hospital stays, and other catastrophic events. The cost of Midwest Health Group and a high-deductible insurance plan is generally much less expensive than a comprehensive insurance plan like a PPO or HMO.

About the ACA Mandates Specific to Employer Plans

Are Employers Required to Offer a Minimum Level of Coverage Under the Affordable Care Act (ACA)?
Group health plans offered by employers with 50 or more full-time employee or equivalent are generally not required to provide a particular benefits package, but to avoid assessable penalties, the plan must provide minimum essential coverage and meet ACA’s affordability and minimum value standards.
Minimum Essential Coverage
In the employment context, minimum essential coverage is defined by an “eligible employer-sponsored plan,” which is currently defined very broadly to include a self-funded plan, a governmental plan, or any other plan or coverage offered in a state’s small or large group market. However, minimum essential coverage does not include certain excepted benefits such as limited-scope dental or vision benefits or certain independent, non-coordinated benefits (e.g., a cancer-only or hospital indemnity policy that pays a fixed dollar amount per day, regardless of the expenses incurred or availability of other health coverage).
Affordability Standard
To meet the affordability standard, an employee’s required contribution for employee-only coverage must not be greater than 9.5% of the employee’s household income.
Minimum Value Standard
To meet the minimum value standard, the plan must pay at least 60% of the total allowed costs of benefits provided under the plan. This minimum value percentage is determined by dividing the cost of certain plan benefits paid for a standard population—the amount the plan pays, and the amount the employee is responsible for through cost sharing, and then converting the result to a percentage.
Methods for Determining Minimum Value
HHS and the IRS have provided several options to help employers determine the minimum value of a plan:
HHS Minimum Value Calculator
HHS has provided an online actuarial calculator which may be used to determine the minimum value of plans that include certain standard features. Employers are able to input data about certain design and cost sharing features of a plan and the calculator will determine whether the plan satisfies the minimum value test. Taxpayers must use the minimum value calculator to measure standard plan features, unless a safe harbor is applicable, but the percentage may be adjusted based on an actuarial analysis of plan features that are outside the parameters of the calculator.

Proposed Safe Harbor Designs

Under proposed IRS regulations, the following are possible safe harbors for plan designs which may be made available:

Safe Harbor Design 1

  • $3,500 integrated medical and drug deductible
  • 80% plan cost sharing
  • $6,000 maximum out-of-pocket limit for employee cost sharing

Safe Harbor Design 2

  • $4,500 integrated medical and drug deductible
  • 70% plan cost sharing
  • $6,400 maximum out-of-pocket limit
  • $500 employer contribution to a Health Savings Account (HSA)

Safe Harbor Design 3

  • $3,500 medical deductible
  • $0 drug deductible
  • 60% plan medical expense cost sharing
  • 75% plan drug cost sharing
  • $6,400 maximum out-of- pocket limit drug copays of $10/$20/$50 for the first, second, and third prescription drug tiers, with 75% coinsurance for specialty drugs.

Note: These safe harbor designs have not yet been finalized, as they have only been suggested in proposed IRS regulations. The final regulations could impose additional requirements.

Actuarial Certification

The proposed regulations require plans with nonstandard features that cannot determine MV using the MV Calculator or a safe harbor to use the actuarial certification method. The actuary must be a member of the American Academy of Actuaries and must perform the analysis in accordance with generally accepted actuarial principles and methodologies and any additional standards which subsequent guidance requires.

Key Mandates Applicable to All Group Health Plans

Preventive Care Coverage Requirements
Both self-funded health plans and insured group health plans are required to cover certain types of preventive care without any cost sharing such as immunizations, child preventive services, and women’s preventive services. Cost sharing includes copayments, coinsurance charges, and deductibles which are required to provide first-dollar coverage. The interim final regulations on these preventive care requirements establish four categories of preventive care to which these rules apply:

  • Evidence-based services or items which have an effect rating of A or B in the current recommendations of the United States Preventive Services Task Force (Task Force) with respect to involved individuals
  • Routine immunizations in children, adolescents, and adults recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (Advisory Committee) with respect to involved individuals
  • Infant, child, and adolescent evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)

Women’s preventive care and screenings provided for in comprehensive guidelines supported by HRSA:

Well-woman visits: annually, with additional visits as necessary

Screening for gestational diabetes: between weeks 24-28 of gestation, and at the first prenatal visit for high-risk women

Testing for HPV: every three years beginning at age 30

Counseling for sexually transmitted infections: annually

Counseling and screening for HIV: annually

  • FDA-approved contraceptive methods, sterilization procedures, and counseling*: annually, subject to certain religious-employer exemptions
  • Breastfeeding support, supplies and counseling*: with each birth
  • Screening and counseling for interpersonal and domestic violence*: annually

Cost Sharing Limits
Self-funded and fully-insured health plans must limit out-of-pocket expenses incurred by participants to the limits applicable to high-deductible health plans, which are $6,350 for single coverage, and $12,700 for family coverage (indexed for inflation and subject to change). In addition, fully-insured small group health plans (including such plans offered on the federal/state exchanges) will not be permitted to have annual deductibles exceeding $2,000 for single coverage and $4,000 for any other coverage tier (also indexed).

Prohibition of Lifetime and Annual Limits
The ACA prohibits all self-funded and fully-insured health plans from imposing any lifetime or annual dollar limits on the value of any essential health benefits offered by a plan. The interim final regulations do not specifically address whether non-monetary limits, such as day or visit limits (e.g., annual limits on physical or speech therapy visits) are permissible. Until further guidance is issued, it appears that a non-monetary limit paid at a uniform, customary, and reasonable rate might be acceptable (but not if it is combined with a specific dollar limit).

Fully-Insured Plan vs. Self-Funded Plan

Fully-Insured Plan
If an employer’s plan is funded by a health insurance policy or contract, the health insurance policy or contract which provides benefits under the plan will need to provide coverage that offers minimum essential health benefits, the exact definition of which is to be defined by regulations and will be determined by each state (based on a benchmark plan designated), and must include items and services covered within the following 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services ix. Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care.

Self-Funded Plan
Technically, an employer’s self-funded plan does not have to meet any coverage mandates other than the Preventive Care Coverage Requirements described above; however, it seems unlikely that a self-funded plan which only covers the required preventive care would satisfy the Minimum Value requirement described above. Also, to the extent a self-funded plan does cover essential health benefits, the plan cannot impose annual or lifetime dollar limits on such benefits.

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