Contact

Call

Member

Services at

855-580-1689 (TTY 711), Monday - Sunday 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

Our office is located at:

333 South Wabash Avenue – Suite 2900

Chicago, Illinois 60604

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

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.
General

What is Meridian Complete?


Meridian Complete is a Medicare-Medicaid Plan (MMP) for beneficiaries eligible for both Medicaid and Medicare.


What is the phone number and hours of operation for

MeridianComplete

?


Call our

Member

Services Department with any questions or concerns, or to file a grievance (complaint), at

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

 

You should call your Primary Care Provider (PCP) with any medical concerns that you have.


Am I eligible to enroll in

MeridianComplete

?


MeridianComplete is a Medicare-Medicaid Plan (MMP).

You are eligible for MeridianComplete if you:

  • Live in our service area, and
  • Have both Medicare Part A and Medicare Part B, and
  • Are eligible for Medicaid, and
  • Are age 21 and older at the time of enrollment, and
  • Are enrolled in the Medicaid Aid to the Aged, Blind and Disabled category of assistance, and
  • Meet all other Demonstration criteria and are in one of the following Medicaid 1915(c) waivers:
    • Persons who are Elderly;
    • Persons with Disabilities;
    • Persons with HIV/AIDS;
    • Persons with Brain Injury; or
    • Persons residing in Supportive Living Facilities.


For other questions about MeridianComplete, please contact MeridianComplete Member Services at

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

How do I enroll?


You can enroll in Meridian Complete by contacting Client Enrollment Services for the Illinois Department of Healthcare and Family Services at 877-912-8880 (TTY 866-565-8576), Monday - Friday from 8 a.m. to 7 p.m. The call is free. You can also visit the Illinois Client Enrollment Services website at http://enrollhfs.illinois.gov/

 

For other questions about Meridian Complete, please contact Meridian Complete Member Services at

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

 

Multi-Language Insert


What are the costs (e.g., copays, deductibles, premiums, etc.) associated with enrollment in Meridian Complete?


Meridian Complete has no premiums, deductibles, or coinsurance for medical services.

 

2017

In 2017 for generic drugs covered by Medicare (including brand drugs treated as generic) you will pay either a $0 copay, a $1.20 copay, or a $3.30 copay. In 2017, for brand drugs covered by Medicare, you will pay either a $0 copay, a $3.70 copay, or a $8.25 copay. 

 

If you have any questions or concerns about premiums and/or cost-sharing associated with enrollment in Meridian Complete, or you receive a bill for medical or prescription services, please call Member Services at

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

How do I replace my Member ID card?


You can call our Member Services Department at

855-580-1689 (TTY 711), Monday - Sunday 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

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

 

Multi-Language Insert

Inserto de Multi-Lenguaje


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

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

How do I change my PCP?


Call Member Services at

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

Do I need a referral or authorization to have services performed?


Some healthcare services require a "prior-authorization" before they are performed. Before you visit the doctor, these services need to be approved by

MeridianComplete

. Your PCP or specialist can inform you if you need a prior-authorization and will take care of submitting the necessary information to coordinate these services.


What if I need emergency care?


Emergency care within the United States is a benefit covered by

MeridianComplete

.

You do not need to contact

MeridianComplete

for approval before receiving emergency services. If your situation is urgent but not life threatening, you should call your Primary Care Provider's (PCP's) office or Meridian Complete at

855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

for help with finding an urgent care center.


What if I travel out of town and need health care services?


When you travel out of

MeridianComplete

's service area, you may go to an emergency room (ER) or go to an urgent care clinic. Make sure you tell the provider you are a

MeridianComplete

member and show them your

MeridianComplete

Member ID card.

MeridianComplete

will pay for your out-of-area emergency care, but routine care is not covered out of

MeridianComplete

's service area (even if it is provided in an ER).


Does Meridian cover dental services?


Meridian does cover some dental services.

 

Please review your Member Handbook for more information.

PHARMACY

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


Take your

MeridianComplete

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.

 

 

 

 

 

2017 Member ID Card


What is a List of Covered Drugs?


List of Covered Drugs (Drug List) is a list of prescription drugs covered by Meridian Complete. The plan chooses the drugs on this list with the help of doctors and pharmacists. The Drug List tells you if there are any rules you need to follow to get your drugs. The Drug List is sometimes called a “formulary.” For more information on how to fill your prescriptions, please review your Member Handbook.


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

MeridianComplete.

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

855-898-1480.


MEDICARE DISCLAIMER

Meridian Complete is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.

 

ATTENTION:  If you speak English, language assistance services, free of charge, are available to you.  Call 1-855-580-1689 (TTY: 711).

Meridian Health Plan of Illinois (Medicare-Medicaid Plan) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 

 

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-855-580-1689 (TTY: 711).

Meridian Health Plan of Illinois (Medicare-Medicaid Plan) cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

 

UWAGA:  Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.  Zadzwoń pod numer 1-855-580-1689 (TTY: 711).

Meridian Health Plan of Illinois (Medicare-Medicaid Plan) postępuje zgodnie z obowiązującymi federalnymi prawami obywatelskimi i nie dopuszcza się dyskryminacji ze względu na rasę, kolor skóry, pochodzenie, wiek, niepełnosprawność bądź płeć.  

 

Limitations, copays, and restrictions may apply. For more information, call Meridian Complete Member Services or read the Meridian Complete Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

 

Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.

 

For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at

855-580-1689 (TTY users should call 711)

.

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