What you need to know
Meritain Health offers medical plans through the Aetna national network of doctors and hospitals. 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 UnitedHealthcare 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.
Meritain Copay (PPO) Plan
The Meritain Copay (PPO) 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 (PPO) 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 (PPO) Plan Participants
If you enroll in the Meritain Copay (PPO) 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 FAQ.
Meritain CDHP with HSA
The Meritain Consumer Driven 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 pretax 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 employee coverage or $1,000 for family coverage) 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 pretax. Your contributions to an HSA are pretax, 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 FAQ, 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.
How Meritain Health and Accolade work together
Accolade works in partnership with Meritain Health, making Accolade your personalized health care assistant to help you navigate your Meritain health plan. Accolade can help you with:
- Benefits guidance: Health Assistants can help you learn more about your Meritain Health benefits available to you and your family
- Understanding coverage and costs: Health Assistants can help you understand your Meritain Health plan coverage, make sense of your Explanation of Benefits (EOB), or estimate out-of-pocket costs for a test or procedure
- Finding in-person care: Health Assistants can help you find a great in-network doctor, specialist, or health care facility nearby; schedule an appointment; and better understand your options for care
In this partnership, Meritain Health is your health insurance provider. When you need medical care, Meritain will pay their portion of your medical claim and will provide you with an Explanation of Benefits (EOB).
You do not need to contact Meritain. Any questions that would normally go to your health insurance provider should be directed to Accolade.
Question about your health benefits? Speak with an Accolade Health Assistant.
Locate a provider
Meritain Health uses the Aetna national network of doctors, behavioral health providers, urgent care centers, hospitals, and other medical facilities.
To locate an in-network provider, visit member.accolade.com, or download the Accolade mobile app on the App Store or Google Play to search for providers. You can also call Accolade at 866-406-1338 to confirm whether your provider is in-network or contact your provider directly.
Aetna Network Name: Aetna Choice POS II – Open Access
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
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 (PPO) 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 (PPO) Plan In-Network | Meritain CDHP with HSA In-Network | |
---|---|---|
Annual deductible | $500 Individual $1,200 Family | $1,700 Individual $3,400 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 or 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.
Precertification
To help you get the right care at the right time, you should work with your provider and Accolade to obtain precertification for certain medical procedures, such as MRIs or CAT scans. If this step is not completed, your coverage could be affected.