Hourly employees with access to the healthcare system stand out in a crowd. So do their employers.

EssentialCare insurance solutions expand protection for insurance companies, brokers, agents, administrators, employers, and hourly/seasonal employees. And while other insurers are trying to gain a foothold in the limited benefit marketplace, BCS Insurance has been filling this important need for years.

The EssentialCare limited benefit fixed indemnity medical insurance solution can be used as a stand-alone health plan, in conjunction with a Minimum Essential Coverage Plan (MEC) or as a Supplemental Plan to major medical coverage.

EssentialCare Highlights

  • No pre-existing condition limitations
  • Dependable administration
  • No medical underwriting
  • No deductibles within the fixed indemnity medical plan
  • Dependent coverage for all plans
  • No coordination with other plans
  • Employer contributions not required
  • Fixed indemnity medical with Rx insurance coverage
  • Ancillary lines such as dental and vision
  • Flexible plan design allows for customizable programs
  • Coverage for physician office visits, hospital services, surgical procedures, and more

Top-rated Provider Networks

  • First Health network of hospitals and physicians
  • Caremark network of pharmacies
  • EyeMed Vision Care network

Administrative Features

  • Enrollment, claim payment, ID card issuance, and customer services
  • Online web administration tools
  • Flexible enrollment option with call center, Internet, IVR, and paper submissions
  • COBRA administration

BCS Insurance Limited Benefit Markets

  • Employer/employee relationship with 100+ hourly employees
  • Young populations with average age under 45
  • High turnover and/or waiting period-based populations
  • Industries include national restaurant franchises, hotel chains, department stores, and staffing companies

EssentialCare MEC is a self-funded aggregate Minimum Essential Coverage plan that provides coverage for government mandated wellness and preventive services as outlined under the Affordable Care Act (ACA). EssentialCare MEC provides coverage for 100% in network and 40% out of network services.

Tax Advantages1

  • An employer offering a Minimum Essential Coverage (MEC) plan may be able to satisfy Part A of the employer mandate under ACA to offer coverage
  • An employee that accepts coverage may be able to mitigate the Individual Insurance Coverage Mandate
    • In 2015–A tax of greater than 2% of adjusted gross income or $325 per adult, $162.50 per child, whichever is greater
    • In 2016–A tax of greater than 2.5% of adjusted gross income or $695 per person, $347.50 per child, whichever is greater

Employer Self-Funding Advantages

  • Flexible Contribution Options – Employers have the option of contributing to the premium (a portion or the entire amount), or having employees cover the full cost
  • Lower Cost of Operation–Self-funded TPA program costs are lower than those charged for a fully insured program
  • Increased Cash Flow Benefit–Money previously held by the insurance company for unreported claims and pending claims is available for use by the employer plan sponsor
  • Flexible Plan Design–State regulations mandating costly benefits are avoided because self-funded programs are subject to (or protected by) ERISA
  • Elimination of Carrier Profit Margin and Risk Charge–The standard profit margin and risk charge of an insurance carrier are eliminated
  • Risk Management through Stop Loss Carrier–The employer may choose the amount of risk to retain and the amount of Stop Loss coverage2

1The information provided in this brochure is not intended for use as tax or accounting advice. Please consult with a qualified tax attorney or accounting professional before making decisions or taking action relating to your business situation.

2A Fixed Indemnity Medical plan underwritten by BCS must be offered in order to obtain stop loss coverage. BCS offers a brochure product with a $20,000 minimum annual aggregate deductible with a $1 Million annual aggregate benefit maximum. The employer assumes the risk between the normally anticipated claim level and the Stop Loss coverage level.

Self-Funding Process

Employer submits a complete eligible census of active employees
Once reviewed, a total monthly aggregate claims funding factor is provided (includes maximum claim
amount, stop loss premium, and administrative fees)
Employer payroll deducts the employee’s share, contributes any difference, and provides the total monthly funding factor to the administrators on a monthly basis
Monthly maximum fund amount is placed into the employer’s claim account, which is used to pay any related claims
Claims (fully-funded by the employer) are paid twice weekly

EssentialCare plus EssentialCare 5500 – A fully-insured medical plan that provides compliant coverage under ACA. For more information about EssentialCare 5500 coverage, please contact your BCS representative.

Fully-Insured Limited Medical Benefit Plan

  • Fully insured medical plan designed to meet the Affordable Care Act (ACA) requirements for large employer groups with 100+ active eligible full-time employees
  • Employer groups avoid both the A and B Tax
  • Employees will be exempt from the individual tax mandate
  • The EssentialCare 5500 Plan is designed to cover all the essential health benefits as required by ACA
  • Offered to hourly full-time employees of the staffing, retail, and hospitality industries with more than 85% non-benefitted part-time employees eligible for the limited benefit plan

For more information, please contact:

Craig Irvine
Vice President
Business Development