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.
What is the phone number and hours of operation for MeridianChoice?
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.
How do I get insurance through MeridianChoice?
We’re glad you’re interested in a MeridianChoice plan! Our online enrollment tool is an easy way for you to locate and buy one of our plans that fit your health care needs. 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.
When will health coverage begin?
Members can start getting the best care possible from MeridianChoice as soon as January 1, 2020. Members should sign up for a MeridianChoice plan by December 15, 2019 to have health coverage at the beginning of the year.
Open enrollment for 2020 coverage starts November 1, 2019 and ends December 15, 2019. If members want coverage to start on January 1, 2020, they must enroll by December 15, 2019. 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.
I want my family to all be on my plan. Is that possible with MeridianChoice?
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.
What plan is best for me or my family?
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
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).
Yes. Your copay, deductible, coinsurance and out-of-pocket limits vary based on the plan option you choose. Go to our Plan Options page for more information.
Is my doctor covered?
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
What are the 10 essential health benefits covered through Marketplace plans?
Outpatient care (the kind you get without being admitted to a hospital)
Emergency room care
Hospital inpatient care
Care before and after your baby is born
Mental health and substance use disorder services, including behavioral health, counseling and psychotherapy
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
Preventive and wellness services including counseling, screenings and vaccines to keep you healthy and help you manage a chronic disease
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.
How do I replace my Member ID card?
You can call our Member Services Department at 855-537-9746 (TTY 711), Monday - Friday from 8 a.m. - 8 p.m. You can also log in to your member portal to order a replacement Member ID card.
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
Yes. A prior authorization is required before seeing a specialist.
Does MeridianChoice cover dental services?
View the SBC for your selected plan option for more information.
cover routine eye care (vision services)?
View the SBC for your selected plan option for more information.
What do the terms under “Account Summary” mean?
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)
What is my billing cycle?
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.”
I got a delinquency notice. What does this mean?
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.
How can I pay?
We proudly offer several payment options for your convenience:
Phone: You can make a payment by calling 877-852-4294 and entering your account number
Online: Our member portal allows you to pay your premium online. Click here to login
Mail: Send a check or money order with the coupon attached to your billing statement to the address indicated. We do not accept cash
How can I set up auto-payments?
You can set up automatic 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.
What happens if my account has a credit?
A credit will be noted on your future statement(s) and deducted from your premium.
How do I change my billing address?
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.
How does APTC affect my balance?
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.
I need to fill a prescription. What should I take to the pharmacy?
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.
What is a Formulary?
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.
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)?
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.
What happens if the Prior Authorization (PA) is not approved?
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.
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?