a quick guide to your benefits and enrollment
TRANSCRIPT
Enroll with Meritain Healthtoday to take your next steptowards a healthier, balanced tomorrow.
Meritain Health knows how important it is for healthcareconsumers like you to really understand how your planworks. In this way, you can make the changes you want inyour health and in your life.
Healthcare benefits provide the support you need to reach yourhealthy balance.Chances are, you try every day to restore a healthy balanceto your life, but time gets away from you, or other detailscome first. Meritain Health is here to help you focus, tosupport you every step of the way. Think of the benefitsand programs as an important resource in the protection of your body, mind and spirit!
Protecting your healthy balance withpreventive care. Question: Which is better? Taking an hour or two out ofyour busy day to have your annual checkup—or missinghidden symptoms and paying the price in sick days, copaysand missed events?
Answer: Nothing makes more sense in these busy timesthan preventing illness before it happens. That’s why yourplan offers excellent benefits for preventive services.
Early detection, proper nutrition, and routine exercise arethe key to living a long and healthy life, and will also helpto control long-term healthcare costs. Your employerencourages you to take the necessary steps—available toyou right now—to ensure early detection and treatment ofdiseases.
A Quick Guide to Your Benefits and EnrollmentTulsa FOP 93Group #14441
www.myMERITAIN.com
Healthcare for you and your family: When sickness or injury throw you off balance.Knowing that you’re in good hands when you’re sick is one of the most comforting feelings there is. You can be assured thatyour health plan has everything you’ll need to get the right care if something goes wrong.
Balancing healthcare costs: What you pay and what the plan pays.
The Benefits Schedule in this packet shows how much you pay for care, and how much the plan pays. It’s a listing of what isand isn’t included in your benefits plan. For more detailed information, see your summary plan description (SPD).After you pay your annual deductible and any up-front copays, the plan begins to pay a percentage of your provider’s charges,for example 80%. The remaining percentage, for example 20%, is your responsibility—your “out-of-pocket” costs. You’re protected from financial hardship by a maximum out-of-pocket amount each year—the most you’ll have to pay before the plancovers costs at 100%. (Copays do not always apply to the out-of-pocket maximum. This varies by plan).
Know your “numbers.”Are you secretly at risk for serious medical conditions?
It’s possible to be at risk for developing serious conditions such as heart disease or diabetes, but not know it because you feelfine. That’s why it’s important to have your vitals checked regularly, such as your cholesterol levels, glucose and blood pressure(as advised by your doctor) and know your “numbers.” It helps to be able to understand what the numeric results of your clinical lab tests could mean and discuss any concerns with your doctor. An ounce of prevention is worth a pound of cure!
Support for your health journey.Your employer wants you to get the best, most appropriate care, when and where you need it. That’s why your plan includesthe extra expertise of Meritain Health’s Medical Management program. The Medical Management nurses are like personalhealth consultants who can help you make decisions about certain types of care you and your doctor may be considering.Registered nurses review treatment plans, then help to assure that you get the right treatment in the right setting, when youneed it.
Some of these services include:
n Before admission to the hospital for elective or non-emergency servicesn Within 48 hours (two working days) after an emergency or urgent hospital admission.n Before elective inpatient, outpatient or ambulatory surgery. n Before inpatient substance-abuse treatment or treatment for a mental health disorder.n Before entering an extended-care, rehabilitation or skilled-nursing facility.
Consult your summary plan description for a complete listing of healthcare services that require precertification with a medicalmanagement nurse.
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Benefit Highlights
Benefits Design
3
FOP
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Benefits Design
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5
The final step toward better balance and better living.
Enroll online during open enrollment at www.tulsafoptrust.com. After you’ve completed enrollment and your employer has approved it, your benefits will be effective.
Your Meritain Health ID Card will be on its way to you soon. The card showsMeritain Health as your health plan administrator. Keep it in your wallet and carry itwith you.
Sample ID Card:
Complete your enrollment, and you’re on your way!
■ Your healthcare plan includes a network of
providers you can visit for healthcare services.
When you visit providers in this network, you
will receive the best service rate. Contact the
network or visit their website for participating
providers.
■ Your group name, medical group number,
member ID number and name are used to
identify you and your covered dependents’
benefits.
Card front
Card back
■ By visiting pharmacies who participate with
your Pharmacy Benefits Manager (PBM),
you can maximize your savings on
prescription drugs.
■ All medical claims should be submitted to
this address. Call the customer service
number with questions about your claims.
■ All other claims should be submitted to this
address. Call the customer service number
with questions.
■ You or your provider can call Meritain Health
to verify eligibility of benefits or check on
your claims status.
■ Please ensure that you precertify with
a Medical Management nurse, if required.
Visit your personalized member website, www.myMERITAIN.com, to find the benefits information you need.Once enrolled as a Meritain Health member, you will have access to www.myMERITAIN.com. When you log in, you’ll findeverything you need to know about your benefits—from eligibility, to enrollment, to what’s covered. It’s another way we’re working with you to help you get the most from your benefits—so you can live a life that’s balanced and informed.
Registration is easy!
If you’re already registered to access your online account, simply enter www.myMERITAIN.com into your browser and loginfrom the homepage.
If you’re not yet registered, it’s OK. Registration is an easy 4-step process.
1. Go to www.myMERITAIN.com. 2. Click on Create a new user account and follow the instructions. You will need to fill in:
n Your group ID (you can find this on your ID Card).n Your member ID (you can find this on your ID Card, as well. Enter with no spaces or dashes).n Date of birth.n Name.n Zip code.n Email address.
3. The system will display your username, which is your member ID. You will be asked to change your password. Enter and re-enter your new password, which you will need to create.
4. You will automatically be logged into your myMERITAIN account. The next time you login, use the same username and password from Step 3.
Important Contact Information:
Questions about... You may call... At this number:
n Medical benefits Meritain Health Customer Service 1.800.925.2272
n Prescription drug benefits Scrip World 1.866.475.7589www.caremark.com
n Participating providers Aetna 1.800.343.3140www.aetna.com/docfind/custom/mymeritain
n Precertification Meritain Health Medical Management 1.800.242.1199
n Enrollment or benefit questions Tulsa FOP 93 1.918.878.3425 orHuman Resources Representative 1.918.878.3373 or
n CareATC Clinic Customer service 1.800.993.8244
n Hospital St. Francis Medical Center 1.918.494.2200
Access convenient online tools and resources.
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