Frequently Asked Questions

Medical Plans

  • What does "in-network" mean? An in-network provider is a physician, facility, or other provider that has agreed to supply covered services to their members at a reduced or negotiated rate.
  • What does "out-of-network" mean? An out-of-network provider is a physician, facility, or other provider that has not contracted with the selected medical plan and may charge participants higher or non-negotiated rates.

North American Administrators PPO

  • How do I contact Meritain Health ? Meritain has established a dedicated toll free number for faculty, administrators, and staff of Notre Dame. This number is 1-888-668-6855. Customer service representatives are available Monday-Friday, 8:00 a.m. - 5:00 p.m. EST. Information regarding claims can also be obtained on their website at www.meritain.com .
  • What is Utilization Management? Utilization Management is the department that handles prior authorizations and pre-certifications.
  • Who should I contact for Utilization Management? Meritain also handles utilization management. The toll free number for utilization management is 1-800-242-1199. This number will also be listed on your identification card.
  • When should I contact Utilization Management? Utilization management should be contacted before you or a covered family member are admitted to the hospital. In the case of a life-threatening emergency, Meritain must be notified within 48 hours or the first business day following hospital admission.
  • What networks are associated with the Preferred Provider Organization Plan? The Preferred Provider Organization (PPO) will be utilizing three networks. The local network is Select Health Network, the national network is Beech Street Network, and the behavioral health network is New Avenues Midwest.
  • How do I locate a provider in the Select Health Network? You can visit their website at www.selecthealthnetwork.com or use a paper directory, which is available in the Office of Human Resources.
  • How do I locate a provider in the Beech Street Network? Beech Street can be contacted by phone at 1-800-432-1776 or online at www.beechstreet.com . You can use this contact information to verify network participation or to request doctors who currently are not affiliated.
  • How do I locate a provider in the New Avenues Midwest Behavioral Health Network? New Avenues can be contacted by phone at 1-800-223-6246, online at www.newavenuesonline.com, or use a paper directory, which is available in the Office of Human Resources.

Meritain Health Plan

  • What is Meritain Health Plan? Meritain Health Plan is the plan that has replaced Partners Health Plan.
  • How do I contact Meritain Health ? Meritain has a dedicated toll free number for faculty, administrators, and staff of Notre Dame. This number is 1-888-668-6855. Customer Service representatives are available Monday-Friday, 8:00 a.m. - 5:00 p.m. EST. Information regarding claims can also be obtained on their website at www.meritain.com .
  • What is Utilization Management? Utilization Management is the department that handles prior authorizations and pre-certifications.
  • Who should I contact for Utilization Management? You will need to contact the number on the back of your insurance card.
  • When should I contact Utilization Management? Utilization Management should be contacted before you or a covered family member are admitted to the hospital. In the case of a life-threatening emergency, Meritain must be notified within 48 hours or the first business day following hospital admission.
  • What network does the Meritain Health Plan use? North American Health Plan will be accessing Community Health Alliance (CHA) for the in-network benefit. This network is similar to the network you were using in 2003.
  • How do I locate a provider in the Community Health Alliance Network? You can visit their website at www.chanetwork.com or call 1-574-284-1025 or 1-888-689-2242. A paper directory will be available in the Office of Human Resources.
  • What health professionals are considered primary care physicians? Family and general practitioners, internists, pediatricians and Ob-Gyn physicians.
  • What is the co-payment for an office visit to a primary care physician? You will pay a $20 co-payment for an office visit to a general care physician.
  • What is the co-payment for an office visit to a specialist physician? You will pay a $30 co-payment for an office visit to a specialist.
  • What hospitals are considered in-network? The in-network hospitals are Memorial Hospital of South Bend and Elkhart General Hospital in Elkhart .

Pharmacy

  • Which pharmacies can I use? You can log onto www.medcohealth.com to find out whether a particular pharmacy is in the network.
  • How will I get started using the home delivery pharmacy? Let your doctor know that you have a home delivery prescription drug program as well as the maximum-day-supply of medication, which is usually 90 days plus refills for up to one year. You may mail your prescription(s) in the special home delivery order envelope or ask your doctor to call 1-888-EASYRX1 for instructions on how to fax your prescription(s). If your order is faxed, your doctor will need your member number.

Vision

  • Do I need to obtain a claim form prior to receiving vision services? No. When visiting an in-network EyeMed provider, you do not need to request a claim form. Simply present your EyeMed Member ID card at the time of your appointment. Taking advantage of your EyeMed benefits is easy and convenient.
  • I have an eye care professional that I already visit on a regular basis. How can I find out if he/she is an EyeMed provider? To find out whether or not your current eye care professional is an EyeMed provider, do one of the following: 1) contact your eye care professional, 2) use EyeMed's online Provider Locator at www.enrollwitheyemed.com , or 3) call 1-877-226-1115 and use the automated phone system to inquire about EyeMed providers.

Life Insurance

  • When do I need to complete an Evidence of Insurability (EOI) form? When you are electing a life insurance increase of more than a one-level change or when you request a life insurance increase more than $50,000.
  • What amount of life insurance should I carry for my family? Most Financial experts suggest that a family carry life insurance equal to five to seven times their annual household income, plus an additional one time annual salary for each child under 18.

Can't find the answer here? Try the HR Frequent Questions section.