The Essential StaffCARE 5500 (“ESC5500”) plan is a fully insured major medical plan that provides comprehensive coverage as outlined under the Affordable Care Act (“ACA”) to full-time employees working a minimum of 30 or more hours per week. The ESC5500 plan meets ACA requirements for health insurance coverage, and may satisfy your state individual health insurance mandate for those states that operate under an individual mandate requirement. For questions regarding your state individual health insurance mandate, please contact your employer.
Please note that, in accordance with ACA regulations, this offer of the ESC5500 plan disqualifies you from subsidized coverage on the Federal Marketplace. If you decline coverage under the ESC5500 plan and purchase coverage on the Federal Marketplace, you may be responsible for the full cost of coverage without any subsidy from the government or your employer.
About the ESC5500 Plan:
· This plan has an individual deductible of $5,500 in-network/$11,000 out-of-network.
· The plan has an individual/children deductible of $11,000 in-network/$22,000 out-of-network.
· The plan pays 80% for in-network services and 60% for out of network services (excluding prescription coverage) after the deductible.
· To learn more about the cost and coverage provided by the ESC5500 plan or to view the Summary of Benefits and Coverage, please visit www.essentialclient.com.
· You can also view your Summary of Benefits and Coverage (SBC) by logging into the Member Portal at www.paisc.com.
· If you wish to keep your ESC Indemnity medical and/or ancillary enrollment to supplement your ESC5500 plan you may do so. To cancel your existing ESC Indemnity medical and/or ancillary enrollment, please submit a change form or contact customer support at 866-798-0803.
· If you are currently enrolled in a Minimum Essential Coverage (MEC) plan that provides for wellness and preventive services, please note that wellness and preventive benefits are included in ESC5500 plan. If you wish to cancel your MEC enrollment, please submit a change form or contact customer support at 866-798-0803.
How to enroll in ESC5500 Plan:
Visit www.essentialclient.com. You’ll need to know your Company ID: (2991800) and your social security number. Your temporary password is new and the job class is Benefit Eligible. The date of hire is the date you were considered full-time.
Questions? Call Essential StaffCARE customer service center at 866-798-0803, Monday – Friday from 8:30 am to 8:00 pm EST. Para pedir una copia de este carta en espanol, llame al Centro de servicio al cliente, al 866-798-0803.
Acknowledgement:
I hereby acknowledge the receipt of ESC5500 plan information. I understand that if I do not go online to enroll or to decline this offer, this document is considered my declination of coverage. If I decline coverage, I will not be able to enroll until the next open enrollment or in the event of a qualifying life event.