Get a proposal in 3 steps
Use this generator to price StarMed’s Minimum Essential Coverage plans for a group, see what the employer and employees would pay, and create a StarMed proposal to send to the employer.
- Enter group info.
- See pricing.
- Create the employer proposal.
MEC Proposal Calculator
Questions? Running into issues with the proposal generator? Contact StarMed at admin@starmedadmin.com or (888) 616-2131.
The plans
Minimum Essential Coverage (MEC) is the type of health coverage the Affordable Care Act (ACA) requires employers with 50 or more full-time employees, including full-time equivalents (FTEs), to offer. An employer-sponsored health plan under ERISA can qualify as MEC. The ACA also requires these plans to cover preventive and wellness services at no cost to employees. StarMed’s Basic plan provides these wellness and preventive benefits.
The Basic plan is StarMed’s Minimum Essential Coverage plan. It covers ACA preventive services, including:
- One preventive wellness check a year at no cost
- Preventive and wellness medications, plus a prescription discount card
- Free 24/7 telehealth for the employee and dependents, even on employee-only coverage
- Access to the PHCS network
No. The Basic plan is not major medical coverage and does not include hospitalization, emergency room, or critical illness benefits. Employees may be eligible to buy supplemental or voluntary benefits to help cover major medical costs.
The Mega plan includes everything in the Basic plan, plus office visits with copays and no deductible:
- General physician, chiropractic, and prenatal/postnatal: $25 copay, $1,000 a year in covered charges
- Specialists: $40 copay, $1,000 a year
- Lab work: $25 copay, $2,000 a year
- Outpatient tests: $200 copay, $2,000 a year
- Urgent care (not ER): $50 copay, $2,000 a year
For groups of 21 or more, the Mega plan is an employee buy-up. For groups of 2–20, the Mega plan is the only plan offered. The employer pays 100% of Mega plan employee-only coverage, and every full-time employee is enrolled except those who decline with proof of other coverage.
No. However, offering the Mega plan doesn’t cost the employer any extra contribution and can give employees additional benefits.
No. Family coverage on the Basic plan and the Mega plan covers all dependents at no additional cost.
The Minimum Value Plan (MVP plan) is a major medical plan designed to meet the ACA’s minimum value standard. Employees who choose to enroll pay about 10% of their wages; the percentage changes each year.
The cost of the MVP plan isn’t calculated in this tool, so the proposal shows no cost for offering it. Actual MVP plan pricing is based on underwriting and how many employees choose the plan. Generally, 50% or more of employees need to enroll in the MVP plan to get standard underwriting pricing.
Offering the Basic plan meets the ACA requirement to offer Minimum Essential Coverage, which avoids the “A” penalty. Offering the MVP plan alongside it addresses the affordability and minimum value requirements, which avoids the “B” penalty.
The Basic plan and Mega plan include preventive and wellness medications and a prescription discount card. The MVP plan covers generic and preferred brand drugs after the deductible.
Yes. StarMed is willing to work alongside other carriers.
Pricing and commissions
The employer is billed a monthly rate for each employee who enrolls.
- Groups of 2–20: Mega plan at $150 per employee per month, paid 100% by the employer
- Groups of 21–150: Basic plan at $70 (employer pays 50%), $67.50 (75%), or $62.50 (100%) per enrolled employee per month
- Groups over 150: Basic plan at $67.50 (50%), $65 (75%), or $57.50 (100%) per enrolled employee per month
Group size counts full-time employees plus full-time equivalents (FTEs). Employees who choose a richer plan pay the difference through payroll deduction.
Group size, the employer’s share of Basic plan employee-only coverage, how many employees enroll, and, for groups of 50 or more, how many employees decline without proof of other coverage and the resulting maintenance fee. A monthly minimum may also apply.
Reach out to your StarMed representative to discuss this possibility.
The participating broker receives 10% of all collected contributions. Commissions are disclosed to the group.
Commissions are paid the month after StarMed collects the contribution from the employer.
Contribution and participation
Yes. For groups of 21 or more, the employer must pay at least 50% of Basic plan employee-only coverage; 100% is recommended, and a higher employer share lowers the Basic plan rate. For groups of 2–20, the employer must pay 100% of Mega plan employee-only coverage.
ERISA allows employers to sponsor their own health benefit plans at a lower cost than traditional commercial health insurance. StarMed requires the employer to fund at least 50% of the Basic plan to sponsor the plan.
Yes. For every group size, at least 10% of eligible employees must enroll. Employees who decline with proof of other coverage are not included in the participation calculation.
When the employer pays 100% (and for all groups of 2–20), every full-time employee is automatically enrolled except those who decline with proof of other coverage.
Groups of 21–49 have a monthly minimum of $950, and groups of 50 or more have a minimum of . If the invoice, including maintenance fees and buy-ups, is below the minimum, the minimum is billed. Groups of 2–20 have no minimum.
No. Employees who show proof of other coverage, such as through a spouse’s plan, can decline. This applies to every group size and contribution level, including 100%. The employer isn’t billed for them, and they aren’t counted in the participation calculation.
Employees with proof of other coverage can always decline. Employees without proof can decline only when the employer pays less than 100%. For groups of 50 or more, a monthly maintenance fee applies for each eligible employee who declines without proof of other coverage: for groups of 50–150 and for groups of 151 or more.
The maintenance fee covers ACA reporting (Forms 1094/1095), COBRA notices, plan documents, and Form 5500. It must be paid by the employer, not through payroll deductions.
ACA and compliance
Employers with 50 or more full-time employees, including full-time equivalents (FTEs), must offer qualifying coverage to their full-time employees.
An employer with 50 or more full-time employees, including FTEs, must offer compliant benefits to at least 95% of its full-time employees. StarMed’s quarterly census helps the employer stay in compliance.
The proposal generator estimates the Section 4980H(a) “no offer” penalty: (full-time employees − 30) × the annual penalty amount. For 2027, the 4980H(a) penalty is $3,780 per year per full-time employee.
It doesn’t calculate the Section 4980H(b) affordability penalty, which for 2027 is $5,670 per year for each impacted employee (an employee who applies for and receives a subsidy for their health insurance).
These are educational estimates, not tax or legal advice. The comparison appears only for groups of 50 or more.
Notices, offer documentation, plan documents, ACA/IRS/ERISA filings (Forms 1094, 1095, RxDC), Form 5500, the PCORI fee filing, COBRA notices, and help with IRS or DOL disputes. No additional charges are billed to the employer for these services.
Enrollment and administration
Initial enrollment is set up during onboarding (see “What happens after the final proposal?”). Throughout the plan year, the employer adds employees to and terminates employees from the plan through StarMed’s online portal or by sending updates to their account manager. StarMed can provide a walkthrough video of the portal on request. The quarterly census keeps enrollment accurate.
StarMed can work with Employee Navigator in two ways:
- StarMed receives a monthly updated census, or a list of new hires and terminations, from the employer through the Employee Navigator.
- StarMed connects with Employee Navigator through an 834 EDI file feed directly into StarMed’s system. StarMed is happy to do this and covers the initial implementation cost. Employee Navigator requires the broker who holds the Employee Navigator license to start the request. Some coordination from your team is needed, and your StarMed representative can walk you through the steps.
The employer must report new hires, rehires, and terminations promptly and pay the monthly invoice, which is drafted by ACH on the 1st of the month. StarMed also requests a census from the group every quarter to ensure every member is tracked correctly for ACA reporting and compliance.
Every quarter. StarMed requires a census from the group each quarter to ensure every member is tracked correctly for ACA reporting and compliance. A $250 fee is charged each quarter the census isn’t provided.
Working with StarMed
Yes. StarMed approves the pricing in a final proposal created by this proposal generator. The employer has 30 days from the proposal date to sign the Participation Agreement. Once it is signed with an effective date, the pricing is locked in for the first plan year until renewal. Monthly billing is based on actual enrollment.
- Complete the attached New Client Intake Form and provide an updated census of all eligible full-time employees.
- Review and sign the Participation Agreement.
- Review and sign the Plan Document and Summary Plan Description.
- Schedule an onboarding meeting with the employer team. During this meeting, we will:
- Review the open enrollment process.
- Set the two-week enrollment period.
- Choose how enrollment will be held: a virtual meeting, an in-person meeting, or another option.
- Choose the enrollment method: paper forms or the online portal.
- Discuss employee cost-sharing, if it hasn’t already been set.
- Submit all enrollment information by a mutually agreed-upon date to allow enough processing time.
- After employees are enrolled:
- ID cards are mailed to enrolled employees.
- Enrolled employees receive an email from Healthee with instructions for the mobile app, their ID cards, and telehealth.
- StarMed finalizes enrollment and distributes ID cards so the group is fully implemented and coverage is active on the group’s effective date.
- Provide StarMed with a census every quarter to ensure every member is tracked correctly for ACA reporting and compliance. A $250 fee is charged for each quarter the census isn’t provided.
When:
- The employer wants to contribute toward family coverage or buy-ups
- A group of 2–20 wants the employer to pay less than 100% or does not want every employee to enroll
- The group needs MVP plan pricing
- There are multiple locations
Questions? Running into issues with the proposal generator? Contact StarMed at admin@starmedadmin.com or (888) 616-2131.