Question 1

What services and screenings are covered as preventive care?

Accepted Answer

Preventive screenings can help you take better control of your health. They are an important foundation of early detection and prevention of disease. Preventive care services are NOT subject to a copayment or deductible when using in-network providers and must be billed to insurance with proper preventive coding.

Take a look at this flyer to learn about the services and screenings that are covered as preventive care.

Please note: Coverage for these services is subject to certain conditions, age and time limits.

Question 2

What is a Qualifying Life Event (QLE)?

Accepted Answer

A Qualifying Life Event (QLE) is a specific life change that allows you to make changes to your health insurance and other benefits outside of the annual Open Enrollment period. These changes are permitted because the event significantly impacts your coverage needs.

Common QLEs include:

Marriage, divorce, or legal separation
Birth or adoption of a child
Death of a dependent
Loss or gain of other coverage (e.g., through a spouse's job)
A significant change in employment status (e.g., starting or leaving a job, changing from full-time to part-time, or retiring)
A change in residence that affects your coverage area (e.g., moving to a different state)

When a QLE occurs, you have a limited window of 30 days from the date of the event to make adjustments to your benefits through our benefits enrollment form. This could include enrolling in, changing, or canceling coverage. It's essential to act quickly and provide any necessary documentation to avoid missing this opportunity.

Here's an overview of qualifying life events from Healthcare.gov.

Please let HR or your Lacher healthcare advocate know when you have a QLE.
 
You will need to submit required documents to HR or your Lacher healthcare advocate. Click here for a checklist of required documents.

Question 3

How do I find an in-network provider?

Accepted Answer

Medical: Click here and select Aetna Choice POS II (Open Access). You can also login, or create an account, on the Meritain portal at www.meritain.com.

Dental & Vision: Visit https://www.capbluecross.com/. There will be a pop up on the side to enter your zip code and enter the plan name. The Dental plan name is BlueCross Dental PPO. The Vision plan is administered by Capital Blue Cross and uses NVA network for vision benefits.

Question 4

How do I get a new insurance ID card?

Accepted Answer

Medical: Login to www.meritain.com. Once logged in, you'll have access to print of download an ID card. You may also call Meritain at 800-566-9311 to request a new ID card. You will need to your member ID when calling.

Dental & Vision: You can register at https://www.capbluecross.com/. Once logged in, you can view, print, or request ID cards. You may also call Capital Blue Cross at 610-820-2700 to request a new ID card.

Question 5

What is a Coordination of Benefits and how often do I need to complete it?

Accepted Answer

You are required to update your Meritain Coordination of Benefits information every year so that they can properly process your claims.

Coordination of Benefits information confirms whether you and/or your enrolled dependents have insurance coverage other than your employer's and if so, what that other insurance is, so that they can determine proper payment responsibilities for claims. If your Coordination of Benefits is updated yearly or as requested, your claims will be processed.

Click here for the Coordination of Benefits form. If you’d like to complete the Coordination of Benefits online, you can do so once you are registered on the Meritain portal.

Question 6

What is Telemedicine?

Accepted Answer

With Teladoc, you can speak with a U.S. board certified doctor 24/7 by phone or video for many non-emergency illnesses.
​
Phone: 1-800-DOC-CONSULT (362-2667)
Web: www.teladoc.com
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Learn more:
​
Setup your account
 
Print an ID card
 
Download the app:

For Apple devices
For Android devices

Question 7

How do I change my plan or enroll my dependents?

Accepted Answer

You can make plan changes and enroll dependents during open enrollment, or if you have a qualifying life event, by visiting the Enroll Now page on this benefits website.

Question 8

I think a provider is billing me an incorrect amount for a service, what should I do?

Accepted Answer

First, make sure you compare the bill you received with the EOB from the insurance. If you need to locate an EOB you can find one by logging into your account at www.meritain.com.

If the bill does not match the EOB, try reaching out to the provider to see why they are billing you a different amount. If the EOB states “non-covered charges” or something else that does not seem right, contact your Lacher benefits advocate for further assistance.

Question 9

Why did I get billed for my preventive care visit?

Accepted Answer

While regular medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place by focusing on helping you maintain good health.  When you visit your doctor for a preventive care service - like a physical exam or a health screening - you should not be billed.  However, if you ask your doctor about a specific health concern while you are at your preventive care visit, it may be billed as an office visit, and not a preventive care visit.

Here’s how to be sure your preventive care visit is free for you:

Mention prevention upfront – When scheduling your appointment, confirm that you are scheduling a preventive care visit.
Know what to discuss with your doctor during the visit – During your visit, keep the conversation focused on how you can maintain a healthy lifestyle.
Ask your doctor - If you do ask questions about a specific health concern while at your visit, ask your doctor if that will be treated as an office visit or as a preventive visit. Let your doctor know you are expecting this visit to be of no charge to you.

For more information about preventive care, contact your Lacher benefits advocate.

Question 10

Where should I go for medical care?

Accepted Answer

Take a look at this flyer to learn about your choices when it comes to where you should receive care.

High level overview:
 
Primary Care Physician - This is your home base. Your doctor knows your history and is a good place to start. Cost to you:
HSA plan - Once you pay your deductible, there is no additional charge.
Copay plan - $30 copay per visit.

Emergency Room - Go to an ER when you have a life-threatening issue. Cost to you:
HSA plan - Once you pay your deductible, there is no additional charge.
Copay Plan - $150 copay per visit.

Urgent Care - Consider an urgent care center for non-life threatening condition. You'll save time and money over the ER. Cost to you:
HSA plan - Once you pay your deductible, there is no additional charge.
Copay Plan - $75 copay per visit.

Telemedicine - Consider using the Teladoc app for non-life threatening conditions, and when you need 24/7 care. Download the Teladoc app now on iPhone or Android. Cost to you:
HSA plan - Once you pay your deductible, there is no additional charge.
Copay Plan - $30 copay per visit.

Frequently Asked Questions