Meridian Health Plan of Illinois is rated 3.5 out of 5 by the NCQA among Medicaid plans in the US for 2016-2017.

Contact

Call

Member

Services at

866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.

with any questions. You can also use our Live Chat for fast and friendly service (on the left side of the page).

 

Email support is available at Memberservices.IL@mhplan.com

Health Library

The Health Library is a free resource exclusively for Meridian members where you can get tips to help you manage your health.


ACCESS HEALTH LIBRARY

FAQS


 

You’ve got questions, we’ve got answers. If there’s a question you can’t find the answer to on our website, call

Member

Services at

866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.
General

What kind of health plan is

MeridianHealth

?


Meridian Health Plan is a Medicaid managed care plan that partners with the State of

Illinois

to provide services for beneficiaries of the State of

Illinois

 

Medicaid program, Integrated Care Program (ICP), Family Health Plan (FHP), and Affordable Care Act (ACA). 


What is the phone number and hours of operation for

MeridianHealth

?


You can reach

MeridianHealth

Member Services at

866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.

Am I eligible to enroll in

MeridianHealth

?


You can become a Meridian Health Plan member if you are enrolled in the Illinois Medicaid program, Integrated Care Program (ICP), Family Health Plan (FHP), or Affordable Care Act (ACA). You must also live in our service area.


How do I enroll?


To join Meridian Health Plan, please call the Illinois Client Enrollment Services (ICES) at 877-912-8880 or visit their website. You will be asked to choose an in-network Primary Care Physician (PCP) with Meridian Health Plan. To see if your PCP participates with Meridian, call Member Services at

866-606-3700


How do I replace my Member ID card?


You can call our Member Services Department at

866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.

Do you offer interpreter services for non-English speakers?


Yes, we offer interpreter services for over 140 different languages. For more information, call Member Services at

866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.

 

Multi-Language Insert


What is a PCP?


A Primary Care Provider (PCP) is a person who practices medicine. A provider can be a doctor, a nurse practitioner, a physician assistant, or other health care professional.


How do I find a PCP in my area?


Use our Find a Doctor tool to locate a provider near you. You can also call our Member Services Department at

866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.

How do I change my PCP?


Use our Member Portal or

Call Member Services at

866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.

Do I need a referral to see a specialist?


No, you do not need a referral from your PCP to see a specialist. You do not need a referral for routine vision care, chiropractic services, or mental health/counseling services.


Does

MeridianHealth

have copays?


No,

MeridianHealth

does not charge co-pays for any covered services.


Does Meridian cover dental services?


Preventive dental check-ups are covered with our contracted vendor, Liberty Dental. Please call 888-401-1128 to find a dentist.

 

You can also refer to your Member Handbook for details or call Member Services at

866-606-3700

.


Does

MeridianHealth

cover routine eye care (vision services)?


Yes. Check your Member Handbook or call Member Services if you have questions at 866-606-3700 (TTY 711), Monday - Friday from 8 a.m. – 8 p.m.

Does

MeridianHealth

help with transportation?


Yes, Meridian does offer help with transportation. Please refer to your Member Handbook for more information.  You can schedule your gas reimbursement up to 30 days BEFORE your appointment date. The earlier you let us know about your transportation needs, the better we can help you.  We may also be able to provide alternative methods of transportation based on needs or medical necessity."


Does Meridian cover chiropractic services?


Chiropractic services for members under 21 years old are covered and do not require authorization for in-network providers.


BEHAVIORAL HEALTH

What is behavioral health?


Behavioral health is a type of health care that offers mental health and substance abuse counseling.


How do I find behavioral health services?


Call our Behavioral Health Department at 888-222-8041 if you need help finding a behavioral health provider in your area.


Do I need a referral from my PCP for behavioral health services?


No, you do not need a referral from your PCP (Primary Care Provider).

 

 

 

 

Meridian Health Plan can help you find a provider in your area. Please call our Behavioral Health department at 866-796-1167 if you have questions about whether your service is covered.


What is Prior Authorization? Do I need it for behavioral health services?


Prior Authorization means that a service must be approved before you get that service. Prior Authorization is not needed for outpatient behavioral health services from Meridian Health Plan.

 

You can reach Meridian Health Plan's Behavioral Health department Monday through Friday from 7 a.m. to 5 p.m. at 866-796-1167.

 

If you are having a Behavioral Health crisis or emergency please call 911.


How can I make sure that I have an authorization for inpatient, day program or alcohol and substance abuse services?


You can ask your behavioral health provider to call Meridian Health Plan's Behavioral Health Department at 866-796-1167 to obtain or verify an authorization is on file.


Can I continue to see the same behavioral health provider that I am currently seeing?


Yes, as long as your behavioral health provider is part of the Meridian Health Plan network. To find out if your provider is part of our network, please call 866-796-1167.

 

If you are currently using an out-of-network behavioral health provider, please call Meridian Health Plan's Behavioral Health Department.


PHARMACY

I need to fill a prescription. What should I take to the pharmacy?


Take your

MeridianHealth

Member ID Card to the pharmacy. You should also take personal identification, like a driver's license or state issued identification card, with your picture on it.

 

 

 

Ex:

 

 

Healthy Michigan ID Card     Michigan Health Medicaid ID Card

 

 

 

 Meridian does not charge a co-pay for covered medications.


If I paid cash for a medication, how do I receive reimbursement?


If you have paid cash for a medication, please fill out the form below and attach the medication label name, pharmacy receipt and a note describing the reasons for paying cash. 

 

Member Request for Reimbursement Form


What is a Drug Formulary?


A drug formulary is a list of prescription drugs approved by your plan. The

MeridianHealth

Formulary uses the clinical advice of doctors, pharmacists and other medical experts to come up with this drug list.


What is a Pharmacy Benefit Manager (PBM)?


 A PBM is a business that works with insurance companies to fill member prescriptions. MeridianRx is the PBM for

MeridianHealth.

  

MeridianRx also takes care of drug prior authorization (PA) requests.


What is Prior Authorization (PA)?


There may be times when your doctor prescribes a drug for you that is not approved in your plan. Your doctor can fill out a PA request form, giving facts about your medical history and why you need the drug. Note: We must approve the drug before you can fill the prescription.


What happens if the Prior Authorization (PA) is not approved?


Meridian and the MeridianRx Formulary Team may deny a drug request for medical reasons. If your doctor's PA request is not approved, you and your doctor will get a letter explaining why. The letter will also explain the appeal process if you and your doctor disagree with the denial.


What is a quantity limit (QL)?


For some drugs, there are limits to how much you can take safely. This limit is based on research from the drug maker and the FDA. The QL is the amount of drug that can be filled safely each month. If your doctor feels that you need more of a medication, he/she must fill out a PA request.


What is Step Therapy?


Sometimes more than one medication can be used to treat your condition. Step therapy means that one medication must be tried first before another medication can be tried. Your healthcare provider or pharmacist can explain which medication must be tried first.


I have a question about my drug. What is the MeridianRx phone number?


You can call MeridianRx toll-free at

855-580-1688.



Page Last Modified: 12/19/2016 8:20:49 AM