The Health Insurance Marketplace (the Marketplace) was established as part of the Affordable Care Act (ACA) and Health Insurance Reform. The Marketplace is where individuals, families and businesses can shop for affordable insurance coverage to meet the requirements of the ACA. Individuals, families and small employers can compare, choose and buy affordable health plans. You only need to fill out one application to see your options and to enroll in a health plan. People are also directed to Medicaid, the government health insurance program, if they are eligible.

You can reach

Member Services at

Whether looking for an individual or a family, MeridianChoice has a plan that fits your patient’s needs and budget. Our unique plan options, unsurpassed quality care and personalized service to members make MeridianChoice the best CHOICE for your health. To see how much a MeridianChoice plan would cost, click here or call us at

learn more about our benefits and pricing.

We’re glad you’re interested in a MeridianChoice plan! Our online enrollment tool is an easy way for you to buy one of our plans directly through us. With the same great health benefits and coverage, including all mandated 10 essential health benefits and free preventive care services, enrolling with a MeridianChoice plan is quick and simple.

Open enrollment for 2017 coverage starts November 1, 2016 and ends January 31, 2017. If you want coverage to start on January 1, 2017, you must enroll by December 15, 2016. After the open enrollment period ends, you can only enroll in a MeridianChoice plan under special circumstances (qualifying events), like marriage, divorce, birth, loss of minimum essential coverage, a change in eligibility or your enrollment in another qualified health plan or an eligibility change for a premium tax credit.

Members can start getting the best care possible from MeridianChoice as soon as January 1, 2017. Members should sign up for a MeridianChoice plan by December 15, 2016 to have health coverage at the beginning of the year.

Open enrollment for 2017 coverage starts November 1, 2016 and ends January 31, 2017. If members want coverage to start on January 1, 2017, they must enroll by December 15, 2016.  After the open enrollment period ends, members can only enroll in a MeridianChoice plan under special circumstances (qualifying events), like marriage, divorce, birth, loss of minimum essential coverage, a change in eligibility or your enrollment in another qualified health plan or an eligibility change for a premium tax credit.

Yes! Whether looking for you or your family, MeridianChoice has a plan that fits your needs and your budget. We offer both family and individual plans for all of our offerings and, with the addition of the “Healthy” plans, one is sure to meet your family’s needs and budget. Our unique plan options, unsurpassed quality care and personalized service to members make MeridianChoice the best CHOICE for your health.

It’s good to think about what type of coverage you need and have a budget in mind when shopping for health insurance. Whether looking for you or your family, MeridianChoice has a plan that fits your needs and your budget. Review the different plan options available through the Marketplace and the specific MeridianChoice offerings to get an idea of what you need and want. Need more information? Call us at

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All of our health plans have comprehensive provider networks, allowing our members to get the right care at the right time by the right provider. Most importantly, MeridianChoice plans meet the minimum essential benefits (outpatient, emergency, hospitalization, mental health, maternity and newborn care, labs, prescriptions, rehabilitation, preventive and wellness, pediatric vision and dental) and FREE preventive health care (physicals, screenings, vaccines and immunizations).

All of our health plans have comprehensive provider networks, allowing our members to get the right care at the right time by the right provider. But it’s good to double check. Here are two ways to check if your doctor is covered:

1. Visit our online Find a Doctor tool to see if your doctor and/or hospital is in the MeridianChoice network
2. Call us toll-free at

1. Outpatient care (the kind you get without being admitted to a hospital)
2. Emergency room care
3. Hospital inpatient care
4. Care before and after your baby is born
5. Mental health and substance use disorder services, including behavioral health, counseling and psychotherapy
6. Prescription drugs
7. Rehabilitative and habilitative devices and services. These devices and services help you recover from injuries, disabilities or chronic conditions and help you gain or recover mental and/or physical skills. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation and more
8. Lab tests
9. Preventive and wellness services including counseling, screenings and vaccines to keep you healthy and help you manage a chronic disease
10. Pediatric services, including dental care and vision care for kids

States and plans may have differences in other covered benefits. Visit www.healthcare.gov for more information.

You can call our Member Services Department at

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

Multi-Language Insert

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.

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

Call Member Services at

Consult the SBC for your selected plan option for more information.

Previous Balance: The final total amount owed as of the last billing date

Payments Received: The total payments received during the last billing cycle

Outstanding Balance: The total amount left over after figuring out (Previous Balance – Payments Received)

Premium Amount: The agreed upon monthly fee for health care coverage for a defined benefit period

Additional Fee: Any fee added to the Premium Amount

APTC Amount: Advanced Premium Tax Credits help bear the cost of coverage purchased through the Marketplace for qualifying members

Subsidy Amount: Any aid which lowers the monthly premium or out-of-pocket costs to help bear the cost of coverage purchased through the Marketplace for qualifying members

New Balance: The final total owed before the next billing period. This is figured out by (Outstanding Balance + Premium Amount + Additional Fees) – (APTC Amount + Subsidy Amount)

Knowing your billing cycle can help you pay on time and keep your account in Good Standing.

MeridianChoice sends you a billing statement shortly after you join. You get one each month after you pay your first premium and become an active member.

Key Billing Tips

• Premiums are billed a month early to make sure you have health coverage
• Balances must be paid in full by the 25th of each month to stay in Good Standing

Members who fail to pay on time will get a delinquency notice and their accounts are “Delinquent.” If your account status says “Delinquent,” it may be followed by a 30, 60 or 90 to show the number of days the account has been “Delinquent.”

A delinquency notice means you did not pay your premium and are not in Good Standing with MeridianChoice. You are given a grace period to pay this late amount in full to change your account status from “Delinquent.” Here are some other things you should know about delinquency:

• Members that purchased their plan on the Health Insurance Marketplace and get a tax credit (APTC members) are given a 90-day grace period
• Members who do NOT get a tax credit are given a 30-day grace period
• All premiums must be paid in full for a “Delinquent” status to be removed. The amount owed keeps growing from month-to-month until it is paid in full or the grace period ends
• If all premiums are not paid in full by the end of the delinquency period, the member will be terminated from the plan due to non-payment. The termination date will show the end of the first month the member was delinquent

NOTE: If you are terminated due to non-payment, you cannot re-enter the Marketplace during the plan year unless you have a Special Enrollment Period (SEP) qualifying event. Failure to have minimum essential health coverage may result in tax penalties and you may have to pay for healthcare services during that time.

We are proud to offer different options to pay:

• Online bill pay! Online bill pay lets you pay your premium online and is available through our secure Member Portal, saving you time and money
• By check or money order. Send the bottom portion of your billing statement along with a check or money order to the address indicated. We do not accept cash payments
• Over the phone. You can make a payment by calling 877-852-4294 and enter your account number in the first prompt

Log in to the secure Member Portal to set up online auto-payments. If you prefer to pay be check, you can set up automatic monthly payments through your bank. Your bank can draft and send monthly checks upon your request to make sure you never miss a payment and stay covered.

A credit will be noted on your future statement(s) and deducted from your premium.

You must change your billing address with both MeridianChoice and the Marketplace. Call us at

to change your address with MeridianChoice. Visit www.healthcare.gov to change your address on the Marketplace.

Advanced Premium Tax Credits (APTCs) help bear the cost of coverage purchased through the Marketplace for qualifying members. The desired APTC amount you choose during enrollment will be deducted from your monthly premium.

Take your

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.

A formulary is a list of safe and covered drugs used to treat sick people and improve health. We use clinical advice from doctors, pharmacists and other medical experts to come up with this drug list. The formulary lists prescription drugs and also some over-the-counter medicines. Some drugs are not part of the formulary. We do not cover these drugs.

Your doctor needs to write you a prescription if you need a drug. You can view the current formulary here. Or you can call

if you want a printed copy.

 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.

Some drugs in the formulary need prior authorization (PA). This means one of our pharmacists reviews the requested drug to make sure it is the best choice for you. Your doctor needs to fill out a Prior Authorization Request Form and send it to us. Note: We must approve the PA before you can fill the prescription.

We do not pay for drugs not in the formulary unless there is an exception. Your doctor can ask for a different drug for you if a formulary drug does not work for you or the drug makes you sick. Your doctor needs to fill out a Formulary Exception Form if a drug is not in the formulary. Note: We must approve the formulary exception before you can fill the prescription.

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.

You can call MeridianRx toll-free at

855-323-4583.