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

How do I register on the Meritain portal, so I can print an ID card or review my claims?

Accepted Answer

When you register on the Meritain portal, you will have access to print an ID card, view your claims, or find an in-network doctor. Visit https://account.meritain.com/Portal/Registration and input your Group ID, which is 19812. You will also need your Member ID, which is located on your ID card.  If you do not have your ID card, please feel free to contact your Lacher benefits advocate to obtain your Member ID.

Question 3

How do I get a new insurance ID card?

Accepted Answer

If you misplace your ID card or simply need a new one, you can request one using the information below.

Medical  - Meritain
Register online at account.meritain.com/Portal/Registration
You can use your Social security number to register if you do not have your Member ID number available 
You will need your Group Number, which is #19812
Once registered, you can access a temporary ID card, EOBS, and any dates of service
Your Medical ID Card also has your SmithRx information

Prescription Drug - SmithRx
Login to your member portal
To access your ID card, you'll have to login to your member portal account at portal.mysmithrx.com/login
Under "Prescriptions" you can see any prescriptions you have on file
Under "Documents" you can access the formulary
Under "Find My Meds" you will be able to search prescriptions and see prices at the different pharmacies where it's available 
For more information, go to pennstainlessbenefits.com/faq

Dental – United Concordia
No ID card needed to receive services! Simply present your name and Social Security Number to your provider when you receive services

Vision - EyeMed
Register online at https://member.eyemedvisioncare.com 
New users will need to create an account using your member ID or the last four digits of your social security number. You’ll then receive a registration email in your inbox to confirm your account.
Once registered, you may download or request a new ID card.
You may also call EyeMed at 1-866-939-3633 to request a new ID card to be mailed to you.

HSA Card – Optum Bank
Once enrolled, call Optum at 1-844-326-7967

Question 4

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:
 
Telemedicine with 98point6 - Consider using 98point6 for non-life-threatening conditions, and when you need 24/7 care. Learn more and activate this benefit here. Cost to you:
QHDHP Plan - $8 copay per use.
PPO Plan - No cost.  
PPO Plus Plan - No cost.

Primary Care Physician - This is your home base. Your doctor knows your history and is a good place to start. Cost to you:
QHDHP Plan - Once you pay your deductible, there is a 10% coinsurance charge.
PPO Plan - $30 copay per visit.  
PPO Plus Plan - $20 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:
QHDHP Plan - Once you pay your deductible, there is a 10% coinsurance charge.
PPO Plan - $75 copay per visit.  
PPO Plus Plan - $50 copay per visit.

Emergency Room - Go to an ER when you have a life-threatening issue. Cost to you:
QHDHP Plan - Once you pay your deductible, there is a 10% coinsurance charge.
PPO Plan - Once you pay your deductible, there is a 10% coinsurance charge.
PPO Plus Plan - $250 copay per visit (if admitted).

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 a Qualifying Life Event (QLE)?

Accepted Answer

A QLE is a change in your situation, like a marriage, divorce, or having a baby, for example, which allows you to make changes to your health insurance. Take a look at this document for more information.

You have 30 days to submit your changes online through our benefits enrollment form.

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

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

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, please 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

How do I file a short-term or long-term disability claim?

Accepted Answer

Click here to learn more.

Frequently Asked Questions