PPO Providers

When you are in the US, claims are paid at a significantly higher level if you use in-network providers.

 

How to Find a PPO Provider
  • Call Aetna's provider line through Meritain Health at 800-343-3140, or online www.aetna.com/docfind/custom/mymeritain
  • Call your provider’s billing office and ask if the provider still an Aetna network provider

 

What If I Use a Non-PPO Provider?

You may prefer a particular provider for many reasons. If you choose a non-PPO provider, it is important to understand the additional costs to you and the Plan.

  • Non-PPO claims are typically paid at 70% of usual and customary
  • Non-PPO claims may have little or no discount
  • If your non-PPO provider charges more than usual and customary as defined by Meritain, you will be charged any difference, plus your percentage
  • The 30% you pay on Non-PPO claims will accumulate toward a non-PPO Out of Pocket Maximum of $1,000. This calculates separately from the $1,000 Out of Pocket Maximum for PPO claims
  • The Plan may pay significantly higher amounts on non-PPO claims, particularly larger claims like hospitalizations. Since your health plan is self-funded, this impacts all international workers in the long run

 

What if there are no PPO providers in my area?

If there are no PPO providers of a needed specialty within a 50-mile radius of your US residence, there is a Plan provision to pay claims at the higher network level. You may still incur additional costs if the provider’s charge is above what Meritain defines as usual and customary.

 

 

What about Dental providers?

We have no PPO network for dental providers; you may use any licensed provider. If your dentist charges more than Usual and Customary you will be charged any difference.

 

What about Vision providers?

You may find optometrists or ophthalmologists in the Aetna network.

  • Call Aetna's provider line through Meritain Health at 800-343-3140, or online www.aetna.com/docfind/custom/mymeritain/
  • Call your provider’s billing office and ask if the provider is still a Aetna PPO provider

For glasses or contacts, any provider may be used.

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Please Note: The information contained in this site is intended as a summary of benefits. It does not guarantee coverage. The Health Plan pays benefits for medically necessary services resulting from illnesses or injuries that are not work related, up to reasonable and customary limits. Even though a doctor recommends or performs a service for you or your covered dependent, this does not automatically mean the service is covered by the Plan. If you have any doubt about whether a proposed treatment or service is covered under the Health Plan, please contact the number shown on your ID card.