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What kind of health plan is MeridianHealth?
MeridianHealth is a Medicaid managed care plan that partners with the State of Illinois to provide services for Illinois Medicaid beneficiaries through the HealthChoice Illinois program.
If you are eligible for Medicare, you may be eligible in MeridianCare. For more information on our dual-eligible program, please visit MyMeridianCare.com.
What is the phone number and hours of operation for MeridianHealth?
You can reach
Member Services at
Am I eligible to enroll in MeridianHealth?
You can become a MeridianHealth member if you are enrolled in the Illinois Medicaid program and eligible for services under HealthChoice Illinois. For more information click here.
How do I enroll?
To join MeridianHealth, 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 MeridianHealth. To see if your PCP participates with Meridian, call Member Services at
How do I replace my Member ID card?
You can call our Member Services Department at:
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
A Primary Care Provider (PCP) is a licensed physician, nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides and manages your health care services. This can also be called a Primary Care Physician.
Your primary care provider is the person you see first for most health problems. They make sure that you get the care you need to keep you healthy. They also may talk with other doctors and healthcare providers about your care and refer you to them.
How do I find a PCP in my area?
Use our Provider Search tool to locate a provider near you. You can also call our Member Services Department at
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 not charge co-pays for any covered services.
Does MeridianHealth cover dental services?
Preventative dental check-ups are covered with our contracted vendor, Dentaquest. Please call 866-245-2770 to find a dentist
You can also refer to your Member Handbook for details or call Member Services at
cover routine eye care (vision services)?
Yes. Check your Member Handbook or call Member Services if you have questions at
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 MeridianHealth cover chiropractic services?
Chiropractic services for members under 21 years old are covered and do not require authorization for in-network providers.
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). MeridianHealth 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 Preauthorization? Do I need it for behavioral health services?
Preauthorization is approval from a plan that is required before the plan pays for certain:
Medical equipment or
This is also called prior authorization, prior approval or precertification. Your plan may require preauthorization for certain services before you receive them. This excludes an emergency.
Prior Authorization is not needed for outpatient behavioral health services from MeridianHealth.
You can reach MeridianHealth'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 MeridianHealth 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 MeridianHealth 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 MeridianHealth Behavioral Health Department.
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.
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.
A drug formulary is a list of prescription drugs approved by your plan. The
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
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?
MeridianHealth 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?