Meritain Health medical plans

What you need to know

Meritain Health, an Aetna company, offers medical plans with their own network of doctors, hospitals, and providers that they contract with. You have two plans to choose from, and they differ in things like the annual deductible and out-of-pocket costs. No matter which plan you choose, you’ll always pay less when you see providers that are part of the Aetna network.

Transition of care

Transition of care provides new Meritain members the option to request extended coverage from your current provider at in-network rates for a limited time due to a specific medical condition until the transfer to an in-network provider can be arranged. While over 99% of United Healthcare providers are in the Aetna network, transition of care support is available through Accolade. If you have questions, call Accolade or message your Health Assistant.

Call Accolade     Learn more

Meritain Copay Plan

The Meritain Copay Plan gives you the flexibility to see any provider, anywhere, but you pay less when you see in-network providers. If you see an out-of-network provider, you're responsible for any billed charges that exceed "customary and reasonable" charges.

How it works

Free in-network preventive care. That includes services like screenings, immunizations, and exams.

Low copays for covered services and prescription drugs when you see an in-network provider or use an in-network pharmacy. You and any covered family members must meet the deductible before the plan pays its portion of covered services.

Once you meet the deductible, the plan pays 90% of most in-network covered services, and you pay the rest until you reach the out-of-pocket maximum. You’ll also pay the copay and coinsurance for prescription drugs. But you’ll always pay less when you use in-network providers.

You’re protected against big medical bills with the out-of-pocket maximum. Once your medical and prescription drug bills hit the out-of-pocket maximum, the plan pays 100% of the costs for covered services for the rest of the year.

Pharmacy benefits are provided by CVS / caremark. You pay a copay ($10–$40) for generic, brand, and non-brand prescriptions at in-network pharmacies. You pay more if you use out-of-network pharmacies.

Under the PayPal health plans, certain medications are covered at 100%. This includes prescriptions to treat diabetes, high blood pressure, and high cholesterol when you get them filled by in-network pharmacies.

Questions about the Meritain Copay Plan? Visit the Accolade member portal or download the mobile app to speak with a Health Assistant.

Health Reimbursement Account (Grades 15-19)

Grades 15–19: Health Reimbursement Account for Meritain Copay Plan Participants

If you enroll in the Meritain Copay plan, a Health Reimbursement Account (HRA) will be opened for you and completely funded by PayPal. With the HRA, you can offset your health plan expenses, such as deductibles and coinsurance. PayPal will make a one-time payment to an HRA of $500 for employee-only coverage or $1,200 if you cover dependents. For details, go to the Health Reimbursement Account page, or view the FAQs.

Question about your health benefits? Speak with an Accolade Health Assistant.

Accolade is your first place to turn to whenever you have a health benefits question, big or small. Your Accolade Health Assistant will take the time to get to know you, understand your needs, and provide support with your PayPal benefits.

Contact Accolade

Meritain CDHP with HSA

The Meritain Consumer Directed Health Plan (CDHP) with Health Savings Account (HSA) is a high-deductible health plan administered by Meritain Health. All care, including prescriptions, is subject to the deductible and coinsurance — except for preventive care and prescriptions used to manage certain medical conditions.

You also have the option to make pre-tax contributions to an HSA to pay for qualified medical expenses or save for future medical expenses. The company makes an annual contribution to the HSA ($500 for individuals/$1,000 for family) that you can use now or in the future.

How it works

Free in-network preventive care. That includes services like screenings, immunizations, and exams.

You pay a percentage of the cost for services and prescription drugs, but you pay less when you see an in-network provider or use an in-network pharmacy. You must meet the entire deductible before the plan pays coinsurance — the amount the plan pays for covered services — for any one family member.

Coinsurance — after you meet your deductible, you and the plan share the cost of medical expenses, called coinsurance. You’ll always pay less when you use in-network providers.

You’re protected against extremely high medical bills with the out-of-pocket maximum. Once your medical and prescription drug bills hit the out-of-pocket maximum, the plan pays 100% of the costs for covered services for the rest of the year.

You can also use your HSA as protection against high medical bills. Or you can save the money in your HSA for expenses in the future.

Contributions to the HSA are pre-tax. Your contributions to an HSA are pre-tax, and you can use the money in your account to pay for qualified medical expenses, or you can save it for future medical expenses. Plus, PayPal contributes to your HSA — $500 for employee coverage and $1,000 if you cover dependents!

Pharmacy benefits are provided by CVS / caremark.  After you have satisfied the entire plan deductible, you typically pay 10% of the cost for generic, brand, and non-brand prescriptions at in-network pharmacies. You pay more if you use out-of-network pharmacies. Prescription drug costs count toward your deductible.

Under the PayPal health plans, certain medications are covered at 100%. This includes prescriptions to treat diabetes, high blood pressure, and high cholesterol when you get them filled by in-network pharmacies.

Questions about the Meritain CDHP with HSA? Review the FAQs or visit the Accolade member portal.

How you pay for care under the CDHP

  • You see the doctor or fill a prescription.
  • Your provider sends a claim to Meritain Health.
  • You are responsible for 100% of the cost until you reach the deductible.
  • Meritain Health sends an Explanation of Benefits to you showing the full cost and the amount you’re responsible for paying. (In-network providers charge lower rates.) These expenses count toward the deductible.
  • Your doctor sends you a bill.
  • You pay the doctor using the money in your HSA or pay out of pocket.
  • At the pharmacy, you can pay with your HSA debit card (if a member of the CDHP) or pay out of pocket.

Locate a provider

The Meritain plans use the Aetna Choice POS II (Open Access) network. Visit member.accolade.com or download the Accolade mobile app on the App Store or Google Play to search for providers. Or, call Accolade at 866-406-1338 to confirm if your provider is in-network. You can also contact your provider directly.

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Need help deciding?

Use the Medical Plan Cost Estimator to compare your medical plan options and decide which plan is right for you. Or contact Accolade to talk to an Accolade Health Assistant.

Medical Plan Cost Estimator     Call an Accolade Health Assistant

Provider contact information

Meritain Health plans at a glance

The charts below give a brief comparison of the two plans. Both Meritain Health plans also provide you with out-of-network coverage. View the plan comparison chart for details.

Meritain Health plans

  Meritain Copay Plan Meritain CDHP with HSA
Network Aetna Choice POS II (Open Access) Aetna Choice POS II (Open Access)
Annual physical exams 100% covered 100% covered1
HSA eligible? No Yes
Annual HSA contribution by PayPal? None $500 employee only coverage
$1,000 if you cover dependents
Eligible for Health Reimbursement Account? Yes, for employees in grades 15–19, PayPal will make a one-time payment of $500 for employee-only coverage or $1,200 if you cover dependents. No; however, you may participate in an HSA.

1 Deductible applies.

  Meritain Copay Plan
In-network
Meritain CDHP with HSA
In-network
Annual deductible $500 Individual
$1,200 Family
$1,500 Individual
$3,000 Family
Out-of-pocket maximum $3,000 Individual
$6,000 Family
$3,500 Individual
$7,000 Family
Coinsurance Plan pays 90% Plan pays 90%
Emergency room2 (copay waived if admitted) $250 copay; then 90% covered after deductible 90% covered after deductible
Doctor office visits $20 copay3 90% covered after deductible3
Accolade Care virtual visit $10 copay
No deductible
90% after deductible
Specialist office visits $35 copay 90% covered after deductible
Diagnostic X-ray/lab 90% covered after deductible 90% covered after deductible

2 If services are not a true emergency, you'll pay more for the cost of the visit.
3 In-network doctor office visits for care relating to diabetes maintenance are provided at no cost to you.

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