The Problem

You Have To Obtain And Maintain Minimal Essential Coverage…

Every individual is required to be covered by a health plan in the United States under PPACA. If the individual is not covered under a plan, then individual penalties can be levied.

The type of coverage you’ll need to avoid the fee is called Minimum Essential Coverage (MEC). Minimum essential coverage includes all marketplace insurance, most Private Major Medical Plans sold outside the marketplace, Medicare, Medicaid, and CHIP, most employer-based coverage, grandfathered health plans, and more.

Minimum essential coverage must be obtained during that type of plan’s Open Enrollment Period, typically from November 1st through January 31st of the following year. Short term plans and other non-compliant plans purchased outside of open enrollment don’t comply with ObamaCare’s individual mandate!

In most cases, you can only obtain private insurance that counts as minimum essential coverage during each year’s open enrollment because insurers are unofficially adopting marketplace enrollment periods.

To comply, you’ll need to not only obtain minimal essential coverage, but also to maintain it throughout the year. For any month in which you do not maintain MEC coverage, you will be penalized for 1/12 of the Fee described below.

…or Face The Individual Mandate Penalty

  • Every individual is required to be covered by a health plan in the United States under PPACA. If the individual is not covered under a plan, then individual penalties can be levied.
  • For 2016 and beyond, the penalty is the greater of:
    • $695 per adult and one-half of the adult penalty or $347.50 per child under 18 years old OR
    • 2.5% of your household income above the tax return filing threshold for your filing status
  • There is a family cap on the flat dollar amount (but not the percentage of income test) of 300 percent, and the overall penalty is capped at the national average premium of a bronze level plan purchased through the 
  • Marketplace (currently up to $2,085 for a family).
  • Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.
  • This penalty is completely eliminated for an individual that is participating in a MEC plan (individually or) offered through their employer

The Solution

Xpress Health Satisfies The Mandate…

Our Xpress MEC Plans are an ACA Compliant, affordable, integrated solution that help employers and individuals avoid the penalties under PPACA.

  • Meets the Minimum Essential Coverage requirements to avoid Penalty A under PPACA (“Obamacare”)
  • Provides all of the required benefits of the Preventative Care under the Act
    • ALL 18 Preventative Services for Adults
    • ALL 26 Preventative Services for Women,
    • ALL 27 Preventative Services for Children
    • Authorized Preventative Medications are covered 100%
  • Provides individuals with basic benefits without having to satisfy a very large, unfavorable out-of-pocket cost first.

…and Goes Beyond The Mandate

Avoiding Penalties is just the beginning. Providing affordable coverage that can be tailored to meet your needs while helping combat the soaring costs of traditional health insurance is where Xpress Xcels.

Xpress APEX, SUMMIT, PINNACLE, and ZENITH

ALL include your favorite Xpress Healthcare®*** features below:

  • Prescription Discount Card with 10 to 85% off most prescriptions
  • Dental powered by Aetna Dental Access®
  • Teladoc with $0 per visit fee
  • Retail Health Clinics
  • Health Advocate™ Solutions, which includes
  • Medical Bill Saver™, Health Advocacy, NurseLine™
  • Vision
  • Alternative Medicine
  • Chiropractic
  • Lab Testing
  • Vitamins
  • Hearing Aids
  • Diabetic Supplies
  • Durable Medical Equipment

*** features below:

Xpress ZENITH

also include the enhanced features below:

  • Co-pays for:
    • Primary Care Physician Office Visits
    • Specialist Office Visits
    • Urgent Care
    • Diagnotic X-Rays & Labs
    • Cat Scan or MRI
    • Outpatient Testing
Xpress PINNACLE and ZENITH

includes:

  • Hospital, Surgical, Ambulance, Emergency Room
    • $0 Deductible
    • 50% co-insurance up to $5,000 (max benefit $2,500)

Program Overview

ApexSummitPinnacleZenith
Preventative Benefits – Covers all mandated benefits under PPACA
Note that this list will be updated from time to time and a current list of covered preventative services is available at all times by visiting  
the Marketplace
All 18 Preventive Services for Adults100% Coverage for Preventive Care Services100% Coverage for Preventive Care Services100% Coverage for Preventive Care Services100% Coverage for Preventive Care Services
All 26 Preventive Services for Women
All 27 Covered Preventive Services for Children
PPO Network Services – Multi Plan PHCS

Provider Search

Provider Search

Provider Search

Provider Search
Primary Care Physician Office Visit $0 Co-pay
(max 1 visit per calendar year)
$0 Co-pay
(max 2 visits per calendar year)
$20 Copay
(max 3 visits per calendar year)
$20 Co-pay
(max 3 visits per calendar year)
Specialist Office VisitNot CoveredNot Covered$50 Co-pay
(max 3 visits per calendar year)
$50 Co-pay
(max 3 visits per calendar year)
Urgent Care$50 Co-pay
(max 3 visits per calendar year)
$50 Co-pay
(max 3 visits per calendar year)
Diagnostic X-ray and Lab$50 Co-pay
(max 5 services per calendar year)
$50 Co-pay
(max 5 services per calendar year)
Cat-Scan/MRI or Outpatient Testing$200 Co-pay
(max 1 MRI, CT Scan per calendar year)
$200 Co-pay
(max 1 MRI, CT Scan per calendar year)
Hospital, Surgical, Ambulance, Emergency Room (Reference Based Pricing)Not Covered
$0 Deductible, 50% Coinsurance to $5,000
Max Benefit $2,500 (RBP)**
** Exclusions to the Hospital Benefit are Radiology Oncology, Chemotherapy, and SD MRI
Prescription Benefits
Tier 1 – Low Cost GenericsAuthorized Preventive Medications covered 100%

Discount Card
Save 10% to 85% off most prescriptions at over 60,000 pharmacies***

Compare RX Prices
Authorized Preventive Medications covered 100%

Discount Card
Save 10% to 85% off most prescriptions at over 60,000 pharmacies***

Compare RX Prices
$1 Copay$1 Copay
Tier 2 – Generics10% Co-insurance10% Co-insurance
Tier 3 – Preferred Brand20% Co-insurance20% Co-insurance
Tier 4 – Non-Preferred Brand40% Co-insurance40% Co-insurance
Tier 5 – Generic and Preferred Specialty10% Co-insurance
(Plan pays 90% up to max of $150 per Rx)
10% Co-insurance
(Plan pays 90% up to max of $150 per Rx)
Tier 6 –Non-Preferred Specialty20% Co-insurance
(Plan pays 80% up to max of $250 per Rx)
20% Co-insurance
(Plan pays 80% up to max of $250 per Rx)
Health, Wellness, and Lifestyle Benefits***
PREMIUM
Dental powered by Aetna Dental Access®IncludedIncludedIncludedIncluded
Vision
Lab Testing
Vitamins
Teladoc w/ NO Per Visit Fee
Hearing Aids
Diabetic Supplies
Retail Health Clinics
MRI & CT Scans
Health Advocate™ Solutions (Medical Bill Saver™, Health Advocacy, NurseLine™)
Durable Medical Equipment
Alternative Care
Chiropractic
XCLUSIVE
ID Sanctuary Enhanced Premium FamilyIncludes Premium,
Plus these Features
Add $10****
Includes Premium,
Plus these Features
Add $10****
Includes Premium,
Plus these Features
Add $10****
Includes Premium,
Plus these Features
Add $10****
Roadside Assistance
Global Travel Assistance
Pet Care
Ticket Monster
**** Add these costs the Contribution Schedule below to determine your final pricing. For example, If you are purchasing the Pinnacle Member Only, with the Xclusive Benefits above, your total cost per month would be $150.64+ $10 = $160.64
Contribution Schedule
Four (4) Year Rate Lock: Increases in years 2-4 Not to Exceed 3% per Year!
Member Only$84.50$97.83$150.64$239.09
Member + Children$105.25$139.66$221.70$390.56
Member + Spouse$105.25$149.44$238.30$390.56
Member + Family$105.25$201.55$316.17$459.04

Note: For Apex and Summit, Authorized Preventative Medications are covered 100% in accordance with the Affordable Care Act.  Xpress Healthcare®*** provides Pharmacy Discounts as part of your Xpress Healthcare® Membership Card. Show the card and receive the exclusive member pricing. Use our network to find the best RX pricing closest to you HERE.

Note: For Pinnacle and Zenith, Authorized Preventative Medications are covered 100% in accordance with the Affordable Care Act. WellDyneRX provides your remaining Pharmacy Benefits. Both plans will utilize a partially closed prescription drug formulary. This prescription drug formulary delivers substantial savings by maximizing the utilization of generics and preferred brands while reinforcing clinically-sound, yet cost-effective drug choices by members.

Note that these providers are subject to change at any time. Xpress or it’s partners will notify Members of such changes as they occur.

Why Xpress MEC

  • Don’t qualify for Subsidies? Get Affordable Coverage for the Care You Need
  • Access the 70+ ACA Mandated Preventative Care Services for Men, Women, and Children
  • Become a Member 365 days a year, not just during ACA Open Enrollment (November – January)
  • There is NO underwriting and pre-existing conditions are ok
  • No deductible, no high out-of-pocket costs
  • No Age, Gender, or state-based differences in rates
  • Grants member access to Primary Care, Specialist, Urgent Care Facilities, as well as available Diagnostic Testing, X-Ray, MRI, and CatScan’s
  • Preventive services are not subject to a copay
  • Your membership includes all of the preventative and network services above, with member Health, Wellness & Lifestyle benefits*** favorites being:
    • Teladoc with No Per Visit Fee – Talk to a doctor by phone or online video to get a diagnosis, treatment options and a prescription if medically necessary, and avoid a visit to your doctor or the ER 
    • Dental powered by Aetna Dental Access® – save 15% to 50% per visit* on dental services at over 195,000** available dental practice locations nationwide
    • Pharmacy – Save 10% to 85% (average 46%) on most prescriptions at 60,000 pharmacies nationwide including CVS, Walgreens, Walmart, Target and more
    • Medical Bill Saver™ – Skilled negotiators will attempt to negotiate discounts on medical and dental bills
    • Vision – save 10% to 60% on glasses, contacts, laser surgery, exams and even designer eyewear at 20,000 vision providers nationwide, including national chains and local retailers.
The Xpress MEC Team
The Xpress MEC TeamNotebook
Heard enough? Let’s start working together.

Heard enough? Let’s start working together.

Heard enough? Let’s start working together.