If your selected
program contains a MEC (all Association programs utilize the Access medical cost sharing guidelines and all programs except Self-Directed and, beginning January 1, 2019, Direct Primary Care, contain a MEC), your program includes an in-network (only) preventive care benefit.
If you’re enrolled in the MPowering Benefits Group program, your program utilizes the Select medical cost sharing guidelines and contains a MEC that provides both in- and out-of-network services for preventive care—but at a cost if you use out of network providers.
Note that preventive services include preventive services
only. Providers can charge for any “preventive” services that are considered and coded as diagnostic or treatment services (examples would be polyps removed as part of a colonoscopy) or charges performed during a preventive visit that are considered non-preventive (an example would be charges for an office visit if the doctor prescribes medications as part of a wellness visit).
Note: you are less likely to experience these problems if you choose the Provider-Directed Healthcare program, which is one of the options offered to members of the MPowering Benefits Association.
While the distinction between what is considered a preventive service (paid through the MEC) an a treatment service (considered part of the individual Unshareable Amount until a Need is established for Medical Cost Sharing) is an issue
for Health Excellence
this distinction is also an issue for all plans and programs that include preventive care, including Affordable Care Act plans.