Minimum Essential Coverage (MEC)
Wellness/Preventive Plan Enrollment
Employee Only Monthly Rate - $ 58.81
MEC Preventive Services
In-Network
Non-Network
15 Preventive Services for Adults
100%
40%
22 Preventive Services for Women
100%
40%
26 Covered Preventive Services for Children
100%
40%
PPO Network: First Health Network 1-800-226-5116 www.firsthealth.com
Instructions to Enroll
1. Please visit the link below
 Web Link: www.essentialstaffcare.com/MECenroll
2. Please login using the access code and your social security number
 Access Code: 142 + 230200 + last 4 digits of your SSN
3. Please completely fill out the employee information section.
 Your company’s group number is 230200
4. Please submit application only if enrolling in the plan. If you wish to decline
the plan, please decline on the Benefit Acknowledgement Form.
5. Essential StaffCARE Customer Service at 866-798-0803 (for additional questions)
Frequently Asked Questions
How do I enroll?
Enrolling in the MEC Wellness/Preventive plan is easy. You can enroll by completing the
Essential StaffCARE enrollment application and returning it to your manager.
Can I receive a subsidy on the Exchange?
No, if you enroll into the MEC Wellness/Preventive Plan you will not qualify for a subsidy
at the health insurance exchange, as this plan will meet the definition of Minimum
Essential Coverage. Please DO NOT enroll into the MEC Wellness/Preventive Plan if you
wish to obtain or wish to continue receiving Federally subsidized coverage from the
health insurance exchange
Do these plans satisfy the Individual Mandate?
Yes, by enrolling into the MEC Wellness/Preventive Plan you will be meeting your Individual
Mandate obligations. By purchasing this plan, you will not be taxed for failing to purchase
insurance required by the Affordable Care Act.
Can I keep my current Essential StaffCARE Indemnity plan?
Yes, the fixed medical indemnity benefit plan is a supplement to health insurance plans. It is not a
substitute for essential health benefits or minimum essential coverage as defined by federal health
law.
How do I make a payment?
An ID card and confirmation of coverage letter will be mailed to your home address,
which will include your ID card and instructions for direct payment. If you do not
receive these documents within 10 business days of your effective date, or if you have a
change of address, please contact the Essential StaffCARE Customer Service at 866-7980803. Present your ID card to the provider at the time of service. These ID cards are used
for identification purposes and providers use them to verify eligibility status.
When does coverage begin?
Coverage begins the 1st of the month following receipt of your first monthly payment.
Does this plan cover medical services?
This plan is in compliance with ACA rules and regulations. It covers wellness and preventive
services only. This plan DOES NOT cover medical services. This plan provides coverage for
preventive services such as immunization and routine health screening. It does not cover
conditions caused by accident or illness.
Are dependents covered?
Not for this enrollment. Dependent coverage will begin to be offered starting February 1,
2015. If you would like to add your dependents beginning Feb 1, 2015, please call Bolder
Staffing (303-444-1445) to obtain an Essential StaffCare Plan Change form, and submit this
form before January 5, 2015.
Is there a pre-existing clause for the MEC Wellness/Preventive Plan?
There are no restrictions for pre-existing conditions in this plan. Even if you were previously
diagnosed with a condition, you can receive coverage for related services as soon as your
coverage goes into effect.
How can I make changes or enroll if I initially declined?
To make changes or enroll if you initially declined, contact your employer and request a
change form after January 1st. Changes are effective the 1st of the month following the date of
the change request. You can cancel or reduce coverage at any time.
When can I enroll in the plan?
Official Enrollment dates are from December 8th until December 31st, 2014, but only for this
Employee Only option.
What is a qualifying life event?
A qualifying life event is defined as a change in your status due to one of the following:
Marriage or divorce, birth or adoption of a child(ren), termination, death of an immediate
family member, Medicare entitlement, employer bankruptcy, loss of dependent status, and
loss of prior coverage.
If you experience a qualifying life event, you must submit documentation of the event along
with a change form requesting the change within 30 days of the event. In addition, you may
request a special enrollment (for yourself, your spouse, and/or eligible dependents) within 60
days (1) of termination of coverage under Medicaid or a State Children’s Health Insurance
Program (SCHIP), or (2) upon becoming eligible for SCHIP premium assistance under this
medical benefit.
Minimum Essential Coverage Covered Preventive Services
15 Covered Preventive Services for Adults (ages 18 and older)
Abdominal Aortic Aneurysm - one time screening for ages 65-75
Alcohol Misuse - screening and counseling
Aspirin - use for men ages 45-79 and women ages 55-79 to prevent CVD when
prescribed by a physician
Blood Pressure - screening for all adults
Cholesterol - screening for adults
Colorectal Cancer - screening for adults starting at age 50 limited to one every 5 years
Depression - screening for adults
Type 2 Diabetes - screening for adults
Diet - counseling for adults
HIV - screening for adults
Immunization - vaccines for adults (Hepatitis A & B, Herpes Zoster, Human
Papillomavirus, Influenza (flu shot), Measles, Mumps Rubella, Meningococcal,
Pneumococcal, Tetanus, Diptheria, Pertussis)
Obesity - screening and counseling for all adults
Sexually Transmitted Infection (STI) - prevention counseling for adults
Tobacco Use - screening for all adults and cessation interventions
Syphilis - screening for all adults
23 Covered Preventive Services for Women, Including Pregnant Women
Anemia - screening on a routine basis for pregnant women
Bacteriuria - urinary tract or other infection screening for pregnant women
BRCA - counseling and genetic testing for women at higher risk
Breast Cancer Mammography - screenings every year for women age 40 and over
Breast Cancer Chemoprevention - counseling for women
Breastfeeding - comprehensive support and counseling from trained providers, as well
as access to breastfeeding supplies, for pregnant and nursing women. Non-network
services will be payable as network services.
Cervical Cancer - screening
Chlamydia Infection - 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 all women
Folic Acid - supplements for women who may become pregnant when prescribed by a
physician
Gestational Diabetes - screening
Gonorrhea - screening for all women
Hepatitis B - screening for pregnant women
Human Immunodeficiency Virus (HIV) - screening and counseling
Human Papillomavirus (HPV) DNA Test - HPV DNA testing every three years for women
with normal cytology results who are 30 or older
Osteoporosis - screening for women over age 60
Rh Incompatibility - screening for all pregnant women and follow-up testing
Tobacco Use - screening and interventions for all women, and expanded counseling for
pregnant tobacco users
Sexually Transmitted Infections (STI) - counseling
Syphilis - screening
Well-woman visits - to obtain recommended preventive services
26 Covered Services for Children
Alcohol and Drug Use - assessments
Autism - screening for children limited to two screenings up to 24 months
Behavioral - assessments for children limited to 5 assessments up to age 17
Blood Pressure - screening
Cervical Dysplasia - screening
Congenital Hypothyroidism - screening for newborns
Depression - screening for adolescents age 12 and older
Developmental - screening for children under age 3, and surveillance throughout
childhood
Dyslipidemia - screening for children
Fluoride Chemoprevention - supplements for children without fluoride in their water
source when prescribed by a physician
Gonorrhea - preventive medication for the eyes of all newborns
Hearing - screening for all newborns
Height, Weight and Body Mass Index - measurements for children
Hematocrit or Hemoglobin - screening for children
Hemoglobinopathies - or sickle cell screening for newborns
HIV - screening for adolescents
Immunization - vaccines for children from birth to age 18 – doses, recommended ages,
and recommended populations vary (Diphtheria, Tetanus, Pertussis, Hepatitis A & B,
Human Papillomavirus, Inactivated Poliovirus, Influenza (flu shot), Measles, Mumps,
Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicells)
Iron - supplements for children up to 12 months when prescribed by a physician
Lead - screening for children
Medical History - for all children throughout development (Ages: 0 to 11 months, 1 to 4
years, 5 to 10 years, 11 to 14 years, 15-17 years)
Obesity - screening and counseling
Oral Health - risk assessment for young children up to age 10
Phenylketonuria (PKU) - screening for newborns
Sexually Transmitted Infection (STI) - prevention counseling and screening for
adolescents
Tuberculin - testing for children
Vision - screening for all children under the age of 5
Benefit Acknoweldgement
This is to acknowledge that I have been given the opportunity to enroll in the Minimum
Essential Coverage / employee only benefits from Bolder Staffing, Inc. I have been
informed and have received benefit-related materials from my employer and coverage
information.
I understand that:
Coverage is entirely voluntary;
I must complete the enrollment or decline the Minimum Essential Coverage plan. If I
do not enroll, or am late in submitting my enrollment form, I may elect to participate
during the next annual open enrollment period;
My failure to complete the enrollment process during the annual open enrollment
period will be interpreted as declining coverage;
If I decide to enroll at a later date, it must occur during a qualifying life changing event or
during the next annual open enrollment period.
If I later decide to stop coverage, I understand it must occur within 30 days of a qualifying
life changing event or during the annual open enrollment period. I further understand that I
must complete and submit my enrollment change request and supporting documentation
directly to ESC.
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), I may have
the right to continue receiving benefits even if I am no longer an employee. In that case,
however, I must pay for the total cost of coverage and the employer is permitted to cancel
the coverage in certain circumstances. I understand that if I elect to decline to
participate in the benefits, I will not have an opportunity to obtain coverage after my
employment ends.
I understand that I am NOT AUTOMATICALLY ENROLLED without going through the
enrollment process with ESC and that my failure to enroll within thirty days of my hire
date may delay my enrollment and/or participation in the benefits.
Do You Wish To Decline Benefit Enrollment? (Y or N): _______
EMPLOYEE NAME (PRINT)
LAST FOUR DIGITS OF SOCIAL SECURITY #
_____________________________________________________________
EMPLOYEE SIGNATURE _____________________________________________
DATE
______________________