Medical

With our medical plan you can access care in-network or out-of-network. We recommend accessing in-network care whenever possible, as it will be less expensive. The medical plans are administered by Meritain through the Aetna Network. Your prescription drug plan is administered by SmithRx and is included for employees enrolled in a medical plan.

Medical Plan Overview

What medications are covered?

Click here to determine which medications are covered under your plan and any applicable limitations.
How do I fill a specialty prescription?

A specialty prescription is for special medicines that may cost more and need extra care, often used for serious health conditions. Follow these required steps to fill a specialty prescription: Initiate the Prescription: Request your doctor to send your prescription to one of the SmithRx specialty pharmacies. Choose between Kroger Specialty Pharmacy or Senderra. Click here for more information and contact details. Kroger Specialty Pharmacy: 888-355-4191 Senderra: 888-777-5547 Prior Authorization: Your physician must complete and submit a prior authorization to SmithRx to obtain approval for your medication under your plan. Connect with Support: Reach out to the SmithRx Connect Team at 1-844-385-7612. They'll assess if you're eligible for any patient assistance programs to help you save on the cost of your medication. If not, they'll guide you through applying for any available manufacturer coupons. This step is required before you can fill your specialty medication.
I'm looking to use mail order. Where does my doctor send my script?

Your doctor will send your mail order script to either Amazon Pharmacy, Walmart Pharmacy, or Cost Plus Drugs. You must first be enrolled in mail order: Amazon Pharmacy - click here for enrollment instructions Walmart Pharmacy - click here for enrollment instructions Cost Plus Drugs - click here for enrollment instructions
What information can I access when I register on the SmithRx website?

When you register for a free account on https://member.mysmithrx.com/, you can look up covered medications new or past-filled medications. You can also find in-network pharmacies from their national network of over 68,000 participating locations. Click here to learn more.
Where can I get my prescription filled?

Many standard prescriptions can be filled at your local retail pharmacy. You can review the national chain options here. Specialty medications are generally filled at Kroger Specialty pharmacy or Senderra Rx. Click here for more information. Do you prefer the convenience and potential cost savings of mail order? You have three options for mail order: Amazon Pharmacy - click here for enrollment instructions Walmart Pharmacy - click here for enrollment instructions Cost Plus Drugs - click here for enrollment instructions
What should I tell my doctor if they need to submit a script?

If you are not using mail order pharmacy, tell your doctor to send the scripts to your preferred pharmacy, like CVS or Walgreens, for example.
What is the SmithRx Connect program?

Did you know your local retail pharmacy may not always be the lowest cost option? SmithRx Connect can help you navigate alternative sources and hold your hand through the process. Click here to learn more.
How can I find the best price on my medication?

Use the Find My Meds tool, found at https://member.mysmithrx.com/. Click here to learn more.
What is a qualifying life event?

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. 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. If you have a QLE, contact our Lacher benefits advocate, Stephanie Cassel at 267-498-0600 or stephanie@lacherinsurance.com.
I think a provider is billing me an incorrect amount for a service, what should I do?

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.
Where should I go for medical care?

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 (Your doctor's office) - This is your home base. Your doctor knows your history and is a good place to start. Once you pay your annual deductible, there is no additional cost. Urgent Care - Consider an urgent care center for non-life threatening condition. You'll save time and money over the ER. Once you pay your annual deductible, there is no additional cost. Emergency Room - Go to an ER when you have a life-threatening issue. Once you pay your annual deductible, there is no additional cost.
How do I change my plan or enroll my dependents?

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.
Why did I get billed for my preventive care visit?

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.
Why is the insurance sending me a statement that says, “this is not a bill”?

After submitting a claim for medical treatment, you may receive an Explanation of Benefits (EOB) from your insurance company. The EOB is a form that insurance companies send to their members to explain what part of a claim was paid by insurance, what part was not paid, and why. It is important to understand what this statement means.
Who do I talk to if I have a problem with a claim or questions about my benefits?

You may contact our Lacher Benefits Advocate, Stephanie Cassel at 267-498-0600 or stephanie@lacherinsurance.com.
Prescription medicine information through SmithRx

Covered prescriptions: Click here to determine which medications are covered under your plan and any applicable limitations. Mail order pharmacy information: Click here for enrollment instructions. Other helpful resources from SmithRx, your Prescription provider: Understanding your SmithRx prescription benefits (in English and Spanish) National chain pharmacy listing How to use the SmithRx portal
Insurance carrier contact information

Medical: Meritain 1-800-925-2272 www.meritain.com Prescription: SmithRx 1-844-454-5201 www.smithrx.com Mail order prescription: Amazon Pharmacy (through SmithRx) 1-855-206-3605 www.amazon.com/smithrx
Meritain Health portal user guide

Click here to learn how to register, print an ID card, view your claims, and much more!
Estimate the cost of a service or procedure

Click here to learn more about the Meritain Cost Estimator Tool.
What is the KISx Program?

KISx (pronounced "Kiss") is a new program that allows you to pay $0 out of pocket for over 400 procedures. So rather than paying your normal copay or deductible on a knee replacement, for example, you could now receive it for free! Click here to learn more.
Search for a Medical provider

Click here and select Aetna Choice POS II (Open Access).
Dental insurance carrier contact information

MetLife 1-800-821-6400 www.metlife.com
Search for a Dental provider

Visit https://www.metlife.com/insurance/dental-insurance/ Click on the Find a Dentist button Click on the PDP button Enter your zip code to search for in-network Dental providers
Search for a Vision provider

Click here
Vision insurance carrier contact information

Guardian 1-888-278-4542 www.guardianlife.com
What is a Coordination of Benefits and how often do I need to complete it?

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.
How do I get a copy of my ID cards?

Medical: Login to www.meritain.com. Once logged in, you'll have access to print of download an ID card. You may also call Meritain at 800-566-9311 to request a new ID card. Dental: Login to www.metlife.com/mybenefits. Once logged in, you can view, print, or request ID cards. You may also call MetLife at 1-877-638-2862 to request a new ID card.
How do I find an in-network provider?

Medical: 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 15772. 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 benefits advocate at 215-660-0334 or benefits@lacherinsurance.com to obtain your Member ID. Dental: To locate in-network dental providers, visit www.metlife.com/insurance/dental-insurance and then click the "Find a Dentist" button.
Can I set up home delivery for my prescriptions?

Yes. You can access the Amazon Pharmacy (through SmithRx) to set up your mail order prescriptions: 1-855-206-3605 www.amazon.com/smithrx
How do I register on the Meritain portal, so I can print an ID card or review my claims?

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 15772. 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.
What are Health Savings Account (HSA) eligible expenses?

See this document from the IRS for information. Scroll to page 5.
How does the Health Savings Account (HSA) work?

HSAs are a great way to save money and efficiently pay for medical expenses because they are tax-advantaged savings accounts that accompany high deductible health plans, or HDHPs. HSA money can be used tax-free when paying for qualified medical expenses. At the end of the year, you keep any unspent money in your HSA. This rolled over money can grow tax-free. Your HSA and the money in it belongs to you—not your employer or insurance company. Learn more:
How do I get a new HSA debit card or check my balance?

Login to your Health Equity account or contact them by phone: Health Equity 1-866-346-5800 www.healthequity.com
How can I change my HSA contribution?

You can change your contribution amount any time throughout the year. Visit the Enroll Now page to do so.
Medical

Medical Plan Summary Special Enrollments Rights, Marketplace information, Women's Health & Cancer Rights, and CHIP Notices HIPAA Privacy Notice Your Rights and Protections Against Surprise Medical Bills Summary Plan Document
Medicare

Medicare creditable coverage disclosure notice
Dental

Click here
Vision

Click here