What Is Meritain Health

What Is Meritain Health

You’ve likely heard of Meritain Health, a healthcare benefits administrator with a reputation for tailoring network and benefit plans to bolster member health and affordability. Offering medical plans through the massive Aetna network, and pharmacy benefits via CVS Caremark, they’re making considerable strides. But the intrigue doesn’t stop there; they’re also championing mental health with a focus on evidence-based treatment methods. Now, wouldn’t you want to uncover more about this organization and its unique approach to healthcare?

Understanding Meritain Health

Meritain Health is a health insurance provider that offers custom network and benefit plans with a focus on enhancing member health and affordability. The company strives to build robust relationships within the industry and assists in the development of employee benefits programs. Moreover, they conduct comprehensive research on member benefits and supply patient support.

Meritain Health adopts a customer-oriented approach, tailoring network, plans, and communications according to specific client needs. Their approach to health care stresses the importance of improving member health through detailed plan designs and active member involvement. They also pay close attention to copay and coinsurance, connecting members with in-network providers to facilitate cost-effective care.

Furthermore, Meritain Health is committed to providing economical health care solutions. Their strategies are aimed at managing costs, generating savings, and making health care affordable.

Meritain Health Medical Plans

Meritain Health’s medical plans provide coverage through the Aetna network, which includes a wide variety of doctors and hospitals.

The company offers two main plans: the Meritain Copay Plan and the Meritain CDHP with HSA. These plans feature different deductible structures and strategies for managing costs to accommodate your requirements.

The health insurance plans include pharmacy benefits via CVS Caremark for prescriptions. The plans also offer cost savings for in-network services and options for out-of-network coverage.

Additionally, health reimbursement accounts and out-of-pocket maximum protection are part of these plans. Coverage for mental health conditions is also included, underscoring the comprehensive nature of these plans.

Meritain Health’s plans aim to provide a balanced, cost-effective health insurance solution.

Therapy Coverage by Meritain Health

Meritain Health offers therapy coverage for mental health conditions, including depression, anxiety, PTSD, and eating disorders. The level of coverage varies depending on your specific plan, employer offerings, and location.

Out-of-pocket costs for therapy typically range between $50 and $150, with the possibility of additional copays or coinsurance. It’s crucial to utilize a licensed in-network provider for therapy coverage. Meritain Health may cap the number of therapy sessions per year, but they support evidence-based treatment methods.

Costs could increase if an out-of-network therapist is chosen. It’s vital to understand your plan’s specifics to effectively manage healthcare costs and maximize benefits.

Mental Health Conditions and Meritain Health

Meritain Health offers coverage for a wide range of mental health conditions, including depression, anxiety, PTSD, and eating disorders among others. The insurance plan is structured to cater to individual behavioral health needs.

Here are some important aspects of the Meritain health plan:

  • Coverage for therapy services may vary depending on location, plan, and employer.

  • The Meritain health plan includes a variety of therapy types such as ACT, CBT, DBT, EMDR, mindfulness practices, and child-parent psychotherapy.

  • Services from unlicensed practitioners and modalities such as life coaching or yoga therapy are typically not included in the coverage.

  • Therapists are required to be credentialed and trained to provide therapy services eligible for coverage.

Substance Abuse Treatment With Meritain Health

If you’re considering treatment for substance abuse, Meritain Health offers coverage for a range of addiction treatments and mental health programs. Depending on your specific insurance plan and location, you may have coverage for residential treatment, partial hospitalization, intensive outpatient, and outpatient care.

It is, however, essential to confirm what treatments your insurance will cover. Meritain Health is part of Aetna’s network, providing access to various care levels. Generally, using in-network providers can result in lower out-of-pocket costs for substance abuse treatment. Choosing out-of-network providers might lead to higher costs.

It’s important to understand your choices and what your insurance covers when seeking substance abuse treatment.

In-Network Vs Out-Of-Network Providers

Understanding the distinction between in-network and out-of-network providers is essential as it directly influences your out-of-pocket costs with Meritain Health. With Meritain, you have access to a broad selection of providers via the Aetna Choice POS network, which can noticeably reduce your healthcare costs.

Note these important factors:

  • In-network providers generally present lower out-of-pocket costs.

  • Out-of-network providers may necessitate pre-authorization, introducing an additional step before treatment can be received.

  • The Aetna network under Meritain encompasses a wide array of treatment options, including addiction and mental health services.

  • Various levels of care, such as residential and outpatient programs, are available to accommodate individual needs.

Making an informed choice between in-network and out-of-network providers can have a substantial impact on your financial expenditures.

Navigating Insurance With Meritain Health

When dealing with insurance, selecting between in-network and out-of-network providers can be a significant decision. With Meritain Health, this decision-making process is facilitated by their substantive support and tailored solutions.

Meritain Health is a third-party administrator (TPA) and a subsidiary of Aetna, bringing a high level of credibility to their operations. Their approach emphasizes health and wellness, which is integrated into their assistance with employee benefits programs and member benefits exploration.

They address self-funding challenges with their strategic programs, and provide solutions that can be customized to unique individual requirements. Options such as Directed Health are available for those seeking cost-effective solutions that control expenses and potentially generate savings.

In essence, navigating health care with Meritain Health involves working with a versatile and adaptable insurance provider.


So, when it comes to your health, Meritain Health’s got you covered. They offer custom plans, mental health support, and substance abuse treatment.

Whether you’re using in-network or out-of-network providers, they’ll help you navigate your benefits. With Meritain, you’re not just getting insurance—you’re getting a partner in your health journey.

Remember, your wellbeing is their priority, and they’re committed to providing quality care tailored to your needs.