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

What is a Qualifying Life Event?

Accepted Answer

A Qualifying Life Event (QLE) is a specific life change that allows you to make changes to your health insurance and other benefits outside of the annual Open Enrollment period. These changes are permitted because the event significantly impacts your coverage needs. Common QLEs include:

Marriage, divorce, or legal separation
Birth or adoption of a child
Death of a dependent
Loss or gain of other coverage (e.g., through a spouse's job)
A significant change in employment status (e.g., starting or leaving a job, changing from full-time to part-time, or retiring)
A change in residence that affects your coverage area (e.g., moving to a different state)

When a QLE occurs, you have a limited window of 30 days from the date of the event to make adjustments to your benefits. This could include enrolling in, changing, or canceling coverage. It's essential to act quickly and provide any necessary documentation to avoid missing this opportunity.

For more information or to report a QLE, contact your Lacher Healthcare Advocate.

Question 3

When can I make changes to my benefit elections?

Accepted Answer

You can make changes to your benefit elections during your healthcare and benefits open enrollment OR if you have a qualifying life event (QLE).

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 a this document for more information.

As a new hire, you have 30 days to submit your changes online through our benefits enrollment system.

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

Question 4

How do I change my plan or enroll my dependents?

Accepted Answer

You can make plan changes and enroll dependents during open enrollment by visiting the Enroll Now page.

Question 5

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 6

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 healthcare advocate.

Question 7

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:

Primary Care Physician - This is your home base. Your doctor knows your history and is a good place to start. 
Cost to you: $40 copay after deductible

Emergency Room - Go to an ER when you have a life-threatening issue. 
Cost to you: $300 copay after deductible

Urgent Care - Consider an urgent care center for non-life threatening condition. You'll save time and money over the ER. 
Cost to you: $100 copay after deductible

Telemedicine - Consider using Teladoc for non-life threatening conditions, and when you need 24/7 care. 
Cost to you: $0

Question 8

What is precertification?

Accepted Answer

Precertification is a process where certain medical services or procedures must be reviewed and approved by Meritain Health before they are provided. This ensures that the proposed care is medically necessary and follows established clinical guidelines.

What Types of Services Require Precertification?
Precertification typically applies to:

Hospital stays – Both planned and emergency admissions.
Outpatient surgeries – Procedures performed outside of a hospital setting.
Diagnostic tests – Such as MRIs, CT scans, and other advanced imaging.
Specialized treatments – Including therapies or procedures that require additional evaluation.

Always review your specific plan details to know which services are included.

Please note: if you use the Valenz program for your outpatient surgery or procedure, you will not be required to submit preauthorization.

Frequently Asked Questions