Page 4 - 2022 Chartwell Hospitality - Non-Managers

Your Health

Care Coverage

Detailed information about each plan is in this section. If
you have questions, please contact Human Resources.

YOUR MEDICAL PLAN
The Affordable Care Act(ACA) requires individuals to
maintain health insurance called Minimum Essential
Coverage(MEC). To help you meet this individual insurance
mandate, you are being given the opportunity to enroll in a
MEC at work. This plan pays 100% of covered preventive
care services for all adults and children. The ACA mandates USING YOUR BENEFITS
which preventive services must be included in a MEC plan. Once you enroll in MEC-Select, you’ll receive an insurance ID card
To learn about these required services, visit that you will use to file claims for both the MEC and Select
www.healthcare.gov/preventive-care-benefits. Benefits.

You must visit a MultiPlan in-network provider to receive To use your MEC-Select coverage, follow these simple steps:
benefits under your MEC plan. If you choose to visit an out- 1. Present your ID card to your provider at the time of service. If
of-network provider, no benefits will be paid. To verify your you need to access coverage before you receive your ID card,
provider is part of the MultiPlan network or to search for contact the Select Benefit Administrators (SBA), before your
providers in your area, visit www.multiplan.com. visit and ask for the group number. Give your provider this
information along with the SBA customer service phone
This benefit package also includes fixed-payment medical number, 1-800-497-3699.
coverage called Select Benefits, insured by Symetra Life 2. Ask your provider to bill SBA and accept an assignment of
Insurance Company. The benefits in this policy can help benefits.
reduce out-of-pocket expenses for other types of services, a) For MEC services – Your provider should accept the
such as non-preventive doctor visits, hospital stays and assignment and work with SBA for payment. As long
more. There are no deductibles or co-pays, and benefits are as your provider is part of the MultiPlan network, you
paid until you reach the policy’s calendar year maximum. will not have any out-of-pocket cost. If you visit a
You will receive this full benefit amount regardless of any provider outside the network, MEC benefits will not
other coverage you may have. be paid.
b) Select Benefits Policy - Ask your provider to accept
Through Select Benefits you can visit any provider you the assignment and be paid directly by SBA. If there is
choose; in or out of network. any balance, SBA will send you a notice with the
amount due. If your provider will not accept the
These two coverages work together as one health care assignment, or if you prefer to be paid directly, you
solution called MEC-Select. will need to file your claim with SBA.
3. To File a Select Benefits claim yourself, complete a claim form
and return it to SBA. You will need a signed Authorization for
Release of Medical Information form and an itemized bill from
the provider listing dates of service, and procedure and
diagnosis codes. As a reminder, all MEC preventive service
claims must be submitted to SBA by your in-network provider.
4. Pay the Provider if there is an outstanding balance. Any
charges that remain after the Select Benefits policy’s claim has
been paid are your responsibility. If you choose to file the
claim and receive the Select Benefits payment yourself, you
will need to pay your provider the full amount due