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MEC Advantage
The MEC Advantage Schedule of Benefits Base Plan Plus Plan
Plans are designed to Inpatient Benefits
provide you with lower Hospital Inpatient Standard Care (per day) $200 $300
Number of Days Allowed per Calendar Year
30
30
cost plan to best meet your Intensive Care (per day) $400 $600
speciic needs. Both of the Number of Days Allowed per Calendar Year 15 15
plans provide you with Skilled Nursing (per day) (for stays in a skilled $100 $150
the minimum level of nursing facility after a hospital stay) 30 30
Number of Days Allowed per Calendar Year
coverage needed to avoid Surgery (per day) Not Included $1,500
Not Included
$375
the government taxation Anesthesiology (per day) All outpatient benefits are subject to the Outpatient
penalty for 2017. Outpatient Benefits maximum
Calendar Year Maximum $0 $1,500
Both of the plan options Outpatient Surgery (per day) Not Included $400
include preventive care Anesthesiology Benefit (per day) Not Included $100
$125
Diagnostic Laboratory/X-Ray (per day)
Not Included
beneits which cover 100% Ambulance (per day) Not Included $200
$50
of eligible preventive Physician Office Visit (per day) Not Included $200
Emergency Room Benefit
Not Included
service charges when Off-the-Job Accident & Sickness (per day)
performed by an in-network Accidental Loss of Life, Limb or Sight Benefit Not Included $20,000
provider. In addition to (Employee Only)
Prescription Drugs underwritten by BCS
preventive beneits, the plan Discount Plan Included on Member ID Card Caremark Discount Plan Caremark Discount Plan
includes the following. Annual Maximum N/A $400
Generic Coinsurance N/A 70%
X Critical illness Brand Coinsurance N/A 50%
X 24 hour telemedicine Critical Illness Benefit underwritten by Voya Not included $5,000 upon diagnosis
Benefits are paid at time of diagnosis for Heart
X Surgical beneits attack, Stroke, End stage renal failure, Coronary
Artery Bypass (25%), Coma, Major Organ
X Hospitalization beneits Failure, or Permanent Paralysis Minimum Essential Coverage
Preventive Services Coverage
X Physician ofice visits Network First Health
PAI
Administration: Visit www.paisc.com for Plan
X ...and more Information
In-Network Preventive Services Covered at 100%—no deductible per ACA guidelines
Out-of-Network Preventive Services Not covered
Telemedicine Services Provided by Teledoc
Telemedicine Program Covered at 100%—unlimited consultations
Monthly Employee Contributions*
Employee Only $26.70 $53.56
Employee + Spouse $60.15 $174.21
Employee + Children $99.40 $178.63
Employee + Family $122.84 $303.85
* Rates displayed include employer contribution toward the plan.
Note: Beneits are not paid unless you ile a claim for reimbursement. Employees can obtain claim forms by visiting
www.paisc.com or by contacting the plan administrator, PAI, at 866.484.0857
6
Airport Terminal Services
The MEC Advantage Schedule of Benefits Base Plan Plus Plan
Plans are designed to Inpatient Benefits
provide you with lower Hospital Inpatient Standard Care (per day) $200 $300
Number of Days Allowed per Calendar Year
30
30
cost plan to best meet your Intensive Care (per day) $400 $600
speciic needs. Both of the Number of Days Allowed per Calendar Year 15 15
plans provide you with Skilled Nursing (per day) (for stays in a skilled $100 $150
the minimum level of nursing facility after a hospital stay) 30 30
Number of Days Allowed per Calendar Year
coverage needed to avoid Surgery (per day) Not Included $1,500
Not Included
$375
the government taxation Anesthesiology (per day) All outpatient benefits are subject to the Outpatient
penalty for 2017. Outpatient Benefits maximum
Calendar Year Maximum $0 $1,500
Both of the plan options Outpatient Surgery (per day) Not Included $400
include preventive care Anesthesiology Benefit (per day) Not Included $100
$125
Diagnostic Laboratory/X-Ray (per day)
Not Included
beneits which cover 100% Ambulance (per day) Not Included $200
$50
of eligible preventive Physician Office Visit (per day) Not Included $200
Emergency Room Benefit
Not Included
service charges when Off-the-Job Accident & Sickness (per day)
performed by an in-network Accidental Loss of Life, Limb or Sight Benefit Not Included $20,000
provider. In addition to (Employee Only)
Prescription Drugs underwritten by BCS
preventive beneits, the plan Discount Plan Included on Member ID Card Caremark Discount Plan Caremark Discount Plan
includes the following. Annual Maximum N/A $400
Generic Coinsurance N/A 70%
X Critical illness Brand Coinsurance N/A 50%
X 24 hour telemedicine Critical Illness Benefit underwritten by Voya Not included $5,000 upon diagnosis
Benefits are paid at time of diagnosis for Heart
X Surgical beneits attack, Stroke, End stage renal failure, Coronary
Artery Bypass (25%), Coma, Major Organ
X Hospitalization beneits Failure, or Permanent Paralysis Minimum Essential Coverage
Preventive Services Coverage
X Physician ofice visits Network First Health
PAI
Administration: Visit www.paisc.com for Plan
X ...and more Information
In-Network Preventive Services Covered at 100%—no deductible per ACA guidelines
Out-of-Network Preventive Services Not covered
Telemedicine Services Provided by Teledoc
Telemedicine Program Covered at 100%—unlimited consultations
Monthly Employee Contributions*
Employee Only $26.70 $53.56
Employee + Spouse $60.15 $174.21
Employee + Children $99.40 $178.63
Employee + Family $122.84 $303.85
* Rates displayed include employer contribution toward the plan.
Note: Beneits are not paid unless you ile a claim for reimbursement. Employees can obtain claim forms by visiting
www.paisc.com or by contacting the plan administrator, PAI, at 866.484.0857
6
Airport Terminal Services
