How Do The Options Work?

PPO – Meritain Health

The Meritain PPO Plan includes:

In-Network Services Out-of-Network Services
$400 individual deductible $800 individual deductible
Once deductibles are met for eligible services:
Covered at 85% Covered at 65% of usual and customary co-pay
Nationwide coverage for both routine and emergency medical care.
Flexibility to visit physicians both in-network and out-of-network.
No requirement to choose a primary care physician.

NOTE: The in and out-of-network deductibles do not cross-accumulate.

All services are subject to contract provisions and exclusions as defined in the benefit plan document.

Click here for information on local, national and Midwest Behavioral Health networks. To request a printed copy of a directory from the Office of Human Resources, email askhr@nd.edu or call the askhr Call Center at 631-5900.

Claim information can be obtained through Meritain Health’s web site at www.meritain.com.


HMO Plans

Meritain CHA HMO and Meritain Select HMO

Both options provide plan participants with local, in-network coverage only. Life-threatening emergencies that may occur while out of the in-network area are also covered. For example, situations that require immediate medical attention would be considered life-threatening emergencies and would be covered. However, routine medical care would not be considered a life-threatening emergency and, therefore, would not be covered outside of your service area. Plan coverage is generally based on co-payments and not out-of-pocket deductibles except for inpatient hospitalization where a deductible and coinsurance is applicable.

The HMO Plans Include:

Meritain CHA HMO Meritain Select HMO
Requires designation of primary care physician No No
Requires referrals for specialist physician in the network No No
Co-payments for:
* Primary Care Physician
* Specialist Physician

30
35

30
35

Click here for information on local, national and Midwest Behavioral Health networks. To request a printed copy of a directory from the Office of Human Resources, email askhr@nd.edu or call the askhr Call Center at 631-5900.

Claim information can be obtained through Meritain Health’s web site at www.meritain.com.


High Deductible Health Plans (HDHP)

This new plan provides a lower-premium option for those who can pay a larger portion of their medical care at the time they receive it.

How it works

The High Deductible Health Plan costs less each month than the other plans, so it could save you money—as long as you don’t incur many medical claims. If you do have claims, you’ll pay a higher deductible before the plan pays. You’ll also pay “first dollar” of the care you receive, which means you’ll pay the full cost each time—not just a co-pay or co-insurance—until you’ve met the deductible. (Preventive care is an exception: it is always covered at 100% regardless of how much of your deductible you’ve met.)

HDHP includes Health Reimbursement Account

Because HDHP participants are responsible for paying a higher deductible, unexpected medical costs can be an unwelcome surprise. So if you decide the HDHP is right for you, the University will help you meet the first one-third of your deductible by setting aside $500 for you (or $1,000 for individual +1 or families) in a Health Reimbursement Account (HRA).

HDHP includes Accident Insurance and Critical Illness Insurance

Individual Accident Insurance and Critical Illness Insurance are included at no cost for all faculty and staff who participate in the HDHP; additional coverages may be purchased for an additional premium.

For more information, please see the Decision Guide (PDF)

Click here for information on local, national and Midwest Behavioral Health networks. To request a printed copy of a directory from the Office of Human Resources, email askhr@nd.edu or call the askhr Call Center at 631-5900.

Claim information can be obtained through Meritain Health’s web site at www.meritain.com.


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