Medical and Prescription Drug

The University offers benefit-eligible employees two types of medical coverage. The Preferred Provider Organization (PPO), and the Health Maintenance Organization (HMO) both managed by Meritain Health. If you are enrolled in another medical plan, you may choose to waive participation in medical coverage,  If medical coverage is waived you will only be able to elect coverage during the annual Open Enrollment period or if you have a qualifying life event.

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

 

$20

$30

 

$20

$30

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.

 

Prescription Drug Program

You are automatically enrolled in the prescription drug plan administered by Medco when you enroll in one of the medical options. Effective January 1, 2007, employees will no longer receive a separate Medco Prescription drug ID card. This prescription information will now be included on your medical health plan ID card.

The prescription drug plan provides retail and mail services.  Under the retail network service, you can visit any in-network pharmacy for your short-term prescription drug needs.  For a 30-day drug supply, the following co-payments apply:

  • $5 for generic drugs
  • $20 for preferred brands
  • $35 for non-preferred brands
  • $70 for specialty drugs (click here for a list of specialty drugs)

If you visit an out-of-network pharmacy, you must pay the prescription drug cost in full and then file a claim for reimbursement.  Medco will reimburse the cost of the prescription drug minus the applicable co-payment.

The mail service program must be used for maintenance or long-term medications.  This will save you time and money, as you will receive a 90-day supply delivered to your home for the following co-pays:

  • $12 for generic drugs
  • $45 for preferred brands
  • $75 for non-preferred brands
  • $150 for specialty drugs (when clinically appropriate)

Medco offers participants several online services such as:

  • Benefit plan information
  • Coverage comparisons on home delivery, retail brand-name, and generic medications
  • Online prescription orders, tracking prescription status, and viewing up to 18 months of prescription history.

For more information, visit Medco's web site at www.medco.com.

Generic Drug versus Brand-Name Drugs


Generic Drugs: Generic drugs are chemically identical to brand name drugs, but are sold under their chemical generic name. Generic drugs must contain the same active chemical ingredients and be equivalent in strength and dosage form to the brand-name product. The federal Food and Drug Administration regulates the quality, strength, and purity of generic drugs.

Brand-Name Drugs: Brand-name drugs are drugs that are advertised and sold under a product name chosen by the manufacturer. In general, brand-name drugs are more expensive than generic drugs.

What is a Preferred Drug List?

The Prescription Drug plan includes a formulary, which is a list of preferred drugs. This list includes a wide selection of drugs offering you choices while keeping benefit costs affordable. Each drug is approved by the Food and Drug Administration (FDA) and reviewed by an independent group of doctors and pharmacists for safety and effectiveness. For a listing of preferred drugs, please visit the Medco web site at www.medco.com or contact Medco's customer service at 1-800-711-0917.

Diabetic Coverage

Diabetic supplies along with insulin are available at the retail pharmacy or through mail service. A co-payment will only apply to the insulin. Supplies are available at no charge.

Supplies Include:

  • Lancets
  • Urine/Blood Test Strips & Tapes
  • Blood Glucose Testing Monitors
  • Insulin Syringes with/without Needles

Medical/Prescription Drug/Vision/Dental Comparison Chart

When deciding which medical option to choose, there are a number of points to consider. For instance, do you want a plan that offers access to more providers? Are you looking for a plan with lower costs? Do you want one doctor to coordinate your care? What kind of coverage is important?  Each medical option has unique features, and to help you understand the differences between the options, please review the

Medical / Prescription Drug / Vision / Dental Plan Summary (PDF).