Meritain Health Insurance offers customizable health plans for employees through self-funded employer programs.
As a third-party administrator (TPA) under Aetna, it provides flexible solutions for businesses and their workers.
This article explains how Meritain Health Insurance works, its benefits, and how to make the most of your coverage.
What Is Meritain Health Insurance?
Meritain Health Insurance is a TPA that manages self-funded health plans for employers. It’s part of Aetna, a CVS Health company, and focuses on tailored employee benefits.
Instead of offering traditional insurance, Meritain administers plans funded by employers, covering medical, dental, and vision care.
It serves over 1 million members across the U.S., providing access to Aetna’s broad network. Employers design plans, and Meritain handles claims and member support.
How Self-Funded Plans Work
In self-funded plans, employers pay for employee medical claims directly, unlike traditional insurance where insurers bear the cost.
Meritain Health Insurance processes claims, manages networks, and provides customer service. This setup allows businesses to customize coverage to fit their workforce.
Employees get benefits like doctor visits and prescriptions, similar to standard insurance. Employers save on premiums but take on financial risk for claims.
Why Choose Meritain Health Insurance?
Meritain Health Insurance offers flexibility for employers to design affordable plans. Employees benefit from access to Aetna’s Choice POS II network, with over 1.1 million providers. It’s ideal for businesses wanting control over benefits without managing claims themselves.
The plans often include wellness programs and telehealth, promoting employee health. Meritain’s focus on cost management helps keep coverage affordable.
Types of Plans Available
Meritain Health Insurance supports various plan types, depending on the employer’s design. These plans cater to different needs and budgets. Common options include:
- Medical Plans: Cover doctor visits, hospital stays, and prescriptions.
- Dental Plans: Include cleanings, fillings, and sometimes orthodontics.
- Vision Plans: Cover eye exams, glasses, and contact lenses.
- Supplemental Plans: Offer extras like critical illness or accident coverage.
Plan specifics vary by employer, so check your benefits package.
What Does Meritain Cover?
Coverage depends on the employer’s plan but typically includes essential health benefits. These include primary care, specialist visits, emergency services, and hospital stays. Most plans cover preventive care, like vaccinations, at no extra cost.
Some plans offer mental health services, prescription drugs, and telehealth through Teladoc. Always review the Summary of Benefits and Coverage (SBC) for details.
What’s Not Covered?
Meritain Health Insurance excludes services not specified in the employer’s plan. Common exclusions include cosmetic procedures, experimental treatments, and non-medically necessary services. Pre-existing conditions are covered, but some plans may have waiting periods.
Check your plan’s SBC for a full list of exclusions. Contact Meritain at 1-800-925-2272 if you’re unsure about specific services.
Benefits of Meritain Health Insurance
Meritain Health Insurance provides access to Aetna’s extensive provider network, ensuring quality care. Employees enjoy tools like the Meritain member portal for claims and provider searches. Telehealth services offer convenient doctor visits from home.
Employers benefit from cost transparency and wellness programs that reduce healthcare expenses. This flexibility supports healthier, happier workplaces.
Costs of Meritain Plans
Costs vary by employer and plan design. Employees may pay monthly premiums, deductibles, and copays, similar to traditional insurance. On average, individual deductibles range from $500-$5,000, with family plans higher.
Here’s a sample cost breakdown for a typical Meritain plan:
| Plan Component | Estimated Cost | Notes |
|---|---|---|
| Monthly Premium | $50-$200 | Varies by employer and coverage level |
| Individual Deductible | $500-$5,000 | Higher for high-deductible plans |
| Copay (Doctor Visit) | $20-$50 | Applies to in-network providers |
| Out-of-Pocket Maximum | $2,000-$8,000 | Caps annual expenses |
Costs depend on the employer’s plan structure.
Accessing the Aetna Network
Meritain uses Aetna’s Choice POS II network, with over 1.1 million doctors and 7,500 hospitals. In-network providers offer lower costs, with discounts up to 50%. You can see specialists without referrals in most plans.
Use the Meritain member portal or Aetna’s provider search to find in-network doctors. Always verify provider status before appointments to avoid extra costs.
Telehealth with Teladoc
Meritain Health Insurance includes Teladoc for virtual doctor visits. You can consult board-certified doctors 24/7 for minor issues like colds or allergies. Visits cost $0-$50, depending on your plan.
Access Teladoc via the app or website. It’s a convenient option for busy schedules or remote areas.
Wellness and Preventive Care
Meritain promotes employee health through wellness programs. These may include fitness discounts, smoking cessation support, and health screenings. Preventive care, like annual checkups and vaccines, is often fully covered.
Wellness initiatives help reduce long-term healthcare costs. Check your plan for specific programs and incentives.
How to Enroll in Meritain Plans
Enrollment is handled through your employer, typically during open enrollment periods. New employees usually have 30 days to join after hiring. You’ll receive plan details and a Summary of Benefits and Coverage.
Contact your HR department for enrollment forms or deadlines. Meritain’s customer service can clarify plan options if needed.
Filing Claims with Meritain
To file a claim, pay your medical bill upfront, then submit the invoice and claim form via the Meritain member portal. Reimbursement typically takes 1-3 weeks. Keep receipts and medical records for smooth processing.
Some services require pre-authorization, like surgeries. Call Meritain at 1-800-925-2272 to confirm requirements.
Using the Meritain Member Portal
The Meritain member portal lets you view your ID card, check claims, and find providers. Register online with your member ID, found on your insurance card. The portal is available 24/7 for easy access.
The Meritain mobile app offers similar features, including digital ID cards. It’s compatible with iOS and Android devices.
Short-Term vs. Long-Term Plans
Most Meritain plans are designed for long-term employee coverage, but some employers offer short-term options for temporary workers. Short-term plans cover essentials like doctor visits but may exclude wellness benefits. They’re not ACA-compliant, so check for gaps in coverage.
Long-term plans provide comprehensive benefits, including preventive care. Review your employer’s offerings to understand plan duration.
Dental and Vision Coverage
Meritain’s dental plans cover cleanings, fillings, and sometimes braces, depending on the employer. Vision plans include eye exams, glasses, and contacts, with annual limits around $100-$200. Waiting periods of 6-12 months may apply for major dental work.
These plans are optional add-ons. Check your benefits package for availability and costs.
Supplemental Plans
Supplemental plans cover specific needs, like critical illness or accident insurance. They pay cash benefits for events like hospital stays, helping with out-of-pocket costs. Premiums are typically $10-$50 monthly.
These plans complement medical coverage. Ask your employer if they’re included in your benefits.
Choosing the Right Meritain Plan
Selecting a Meritain plan depends on your health needs and budget. Review your employer’s options, focusing on premiums, deductibles, and covered services. Consider how often you visit doctors or need prescriptions.
Use the Meritain member portal or call customer service for plan comparisons. Your HR team can also provide guidance.
Tips for Maximizing Your Coverage
To get the most from Meritain Health Insurance, stay in-network to save on costs. Use Teladoc for minor issues to avoid copays. Keep track of claims and medical receipts for reimbursement.
Review your plan annually during open enrollment. Update coverage if your health needs change, like adding dental or vision benefits.
Health Insurance for Small Businesses
Meritain Health Insurance is popular among small businesses for its flexibility. Employers can tailor plans to fit budgets while offering robust benefits. This helps attract and retain employees.
Meritain provides tools like cost projections and wellness programs. Small businesses benefit from Aetna’s network and Meritain’s administrative support.
Summary
Meritain Health Insurance offers flexible, employer-funded health plans with access to Aetna’s vast network. As a TPA, it manages claims and provides tools like the member portal and Teladoc.
Plans cover medical, dental, and vision care, with options for supplemental benefits. By understanding your plan and using in-network providers, you can maximize coverage and stay healthy.
FAQ
What is Meritain Health Insurance?
Meritain Health Insurance is a TPA under Aetna, managing self-funded employer health plans. It covers medical, dental, and vision care, tailored to employer needs. Employees access Aetna’s Choice POS II network.
How much do Meritain plans cost?
Costs vary by employer, with premiums of $50-$200 monthly and deductibles from $500-$5,000. Copays range from $20-$50 for doctor visits. Check your plan’s SBC for specifics.
Does Meritain cover telehealth?
Yes, Meritain includes Teladoc for 24/7 virtual doctor visits. Costs are $0-$50, depending on the plan. Access it via the Teladoc app or website.
How do I file a claim with Meritain?
Pay the medical bill, then submit the invoice and claim form via the member portal. Reimbursement takes 1-3 weeks. Pre-authorization may be needed for some services.
Can I use Meritain for dental and vision care?
Yes, many plans include dental and vision coverage for cleanings, exams, and glasses. Waiting periods may apply for major services. Check your employer’s plan for details.