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Preventive Care Services Provided
Through A Preventive Care "MEC"

PREVENT
- with Minimum Essential Coverage(MEC)

prevent

REDUCE OR ELIMINATE MEDICAL COSTS THROUGH PREVENTION

Preventive care services under the Partially Self-Directed and Provider-Directed Healthcare programs are provided through a self-funded plan of minimum essential coverage (abbreviated as “MEC”). Preventive Minimum Essential Coverage (MEC) covers a list of ACA-required preventive and wellness care services. Included services are adjusted annually.

There are specific preventive care services for women, children, and all adults. The list of services includes yearly wellness checks, flu shots, vaccines, mammograms, colonoscopies, and many other preventive services (see the complete list at www.healthcare.gov).

Preventive Care for the Partially Self-Directed Healthcare Program

Apex Management Group provides the preventive care MEC for the Partially Self-Directed Healthcare (the HDHP/Basic MEC Plan) program. This MEC uses the PHCS network, and there's no charge if the member receives ACA-required preventive care services from an in-network PHCS provider. Services received from out-of-network providers are not covered.

You can check for PHCS providers using these steps:

Go to www.multiplan.com

  • Go to “Select Network” and pick PHCS
  • Check “I Don’t See Any of These Statements”
  • Answer “Front” (when asked “Where is the Logo?”)
  • Enter the name of the specialty of the provider (e.g. primary care, gastroenterologist, etc. or the service)

Apex recommends that you check with BOTH your provider AND with PHCS at 800-922-4362, as in-network providers change frequently.

Preventive Care for the DPC-Direct Primary Care Healthcare Program

The MEC for the DPC-Preventive Care MEC was eliminated for members joining January 1, 2019 or later.

Except for three high-cost preventive care services (screening colonoscopies, screening mammograms, and vaccinations and immunizations for children through age 18), DPC providers generally cover preventive care services. The three referenced services are included in the Sharing Guidelines and are available through the Sedera MCS Community. See sections 8.B.9, 8.B.20, and 8.B.17, respectively of the Access Membership Guidelines for details. There is no Individual Unshareable Amount (“IUA”) requirement for services that meet the requirements listed in those sections of the Guidelines.

Preventive Care for the Provider-Directed Healthcare Program

Redirect Health provides the preventive care services for the Provider-Directed Healthcare option. Redirect Health requires you to call their 800 number to obtain authorization to receive any services from the EverydayCARE program, which is used to obtain all covered services except those that are shareable under the Medical Cost Sharing portion of the program.

Review the 3 types of programs
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SELF-MANAGED PROGRAM OPTIONS
Partially Self-Directed Healthcare
Partially Self-Directed Healthcare
Partially Self-Directed Program Combining Wellness Services, Preventive Care, An Optional Health Savings Account, AND Medical Cost Sharing For Large Expenses
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PHYSICIAN-DIRECTED PLAN OPTIONS
DPC - Direct Primary Healthcare
DPC - Direct Primary Healthcare
Provider-Directed Program Supplementing Direct Primary Care With Wellness Services AND Medical Cost Sharing Plan For Large Expenses, Screening Colonoscopies And Mammograms, And Childhood Immunizations/Vaccinations
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Provider-Directed Healthcare
Provider-Directed Healthcare
Provider-Directed Program Combining Wellness Services, Redirect Health for Preventive Care And Most Small Expenses, AND Medical Cost Sharing For Large Medical Expenses

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