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2022 MEDICAL PLANS FAQS

This page addresses a variety of questions related to BRI’s 2022 Medical Plans, including inquiries about new ID Cards, medical provider networks, 2021 medical claims, and more. Use these quicklinks to navigate to a specific question:

GENERAL QUESTIONS:
1. Will I be receiving a new ID Card?
2. What if I didn’t receive my new ID Card?
3. Can I get an ID card for my spouse and dependents?
4. Have the EPC Medical Plan Benefits changed in 2022?
5. What has changed with the EPC Medical Benefit program for 2022?
6. What happens if I use my Highmark ID Card after December 31, 2021?
7. I still have unresolved claim issues from 2021 with Highmark, who will handle that?
8. You say that our Plan is not changing for 2022 but we are moving to Meritain Health and will be no longer be using Highmark. This is confusing. Doesn’t this mean we are changing Plans?
9. Where can I access information about Meritain Health?
10. The Provider Network is changing from the BC/BS network to the Aetna Choice POS II network. What does this mean and how will it impact me?
11. How do I know if my current doctor is in the Aetna Choice POS II network?
12. What if my doctor is not in the Aetna Choice POS II network?
13. Why is the EPC changing from Highmark to Meritain Health to administer our medical benefit program?
14. My doctor was not in network with BC/BS and is not in-network in the Aetna Choice POS II network either? Is there a way that I can reduce my out-of-pocket expenses?
15. Are there any changes to the Prescription drug program administrator or coverages for 2022?
16. Many new member care programs are becoming available in 2022, when will I hear more about these? How do I sign up?
17. Do the EPC plans include 24/7 availability for virtual primary care visits?
2021 CLAIMS QUESTIONS:
18. Who will be processing and paying medical claims for my doctor’s visits occurring late in 2021?
19. What if I paid cash for a doctor’s visit or medical procedure in 2021 and need to file a paper claim?
20. What if I have questions about a claim from 2021 or wish to make an appeal?
DEFINITIONS:
21. What is the difference between a Provider Network, Plan Administrator and Plan Sponsor?
22. What is a Provider Network?
23. What is a Plan Administrator?
24. What is a Plan Sponsor?

1

Will I be receiving a new ID Card?

Yes, all plan participants will receive new ID cards. It will arrive in an envelope from Meritain Health. The same card can now be used for both medical visits and prescription orders at your pharmacy.

2

What if I didn’t receive my new ID Card?

You can contact CDS Administrators (who manages our enrollment records) at 877-578-8707. They can confirm your eligibility, give you your Member ID number, and email you a copy of your ID card while you await arrival of your new card. Your ID Card will have your Member ID on it that enables you to log into your Meritain Health account. Once registered, you can use the Meritain Health app to upload a virtual ID Card to your smart phone.

3

Can I get an ID card for my spouse and dependents?

When sent, ID Cards are automatically included for the employee, spouse, and dependents 18 and older. If you need an extra card you can request one through Meritain Health. There is also an App through which you can download a virtual ID Card.

4

Have the EPC Medical Plan Benefits changed in 2022?

No, the coverages, co-pays, and all other plan features remain the same in 2022 as they were in 2021.

5

What has changed with the EPC Medical Benefit program for 2022?

While our medical plans and coverages were not changed from 2021 levels, the EPC has changed our medical administrator from Highmark to Meritain Health. This means all customer service matters formerly handled by Highmark will be handled by Meritain Health in 2022. Meritain Health can be contacted at 800-925-2272 or at www.Meritain.com.

We also are using a different medical network provider. Instead of the Blue Cross network we are using the Aetna Choice POS II network. You will need to show your new ID Card at your first visit to any doctor or medical services provider in 2022 so your claim can be properly processed. Your prior Highmark card will not work for 2022 claims.

6

What happens if I use my Highmark ID Card after December 31, 2021?

If your doctor or other medical services provider submits a claim to Highmark in 2022, they will receive a message that you are ineligible. You will need to show your medical service provider your new ID Card that shows your member ID number and the Aetna Choice POS II network. Then they can confirm your eligibility, receive your co-pay information, and submit their service invoice to be paid.

7

I still have unresolved claim issues from 2021 with Highmark. Who will handle that?

Highmark will continue to process medical claims and paper claims submitted for dates of service in 2021. They will continue to answer your calls and resolve any outstanding issues with EPC members until December 31, 2022.

8

You say that our Plan is not changing for 2022 but we are moving to Meritain Health and will be no longer be using Highmark. This is confusing. Doesn’t this mean we are changing Plans? 

The EPC has established its own custom medical plans, though we hire a medical benefit plan administrator to process claims in accordance with our plan design specifications. Our 2021 plan specifications were transferred to Meritain Health and they will administer the 2022 program duplicating those same specifications. What is changing is the Provider Network, so you will need to show your new ID Card at your first doctors’ visits in 2022 so that the doctor will submit claims through Meritain Health rather than Highmark.

9

Where can I access information about Meritain Health?

You can log onto Meritain Health at www.Meritain.com to get access to valuable information. Once on the site, you can register to gain access to your member portal where you can download an ID Card, view your benefit coverages, and access information on wellness, care management, and other special EPC programs available to plan participants—such as the Healthcare Bluebook. You will need your Member ID number to log on the first time. If you don’t have your card with the Member ID, contact Meritain at 800-925-2272 or CDS Administrators at 877-578-8707. Either can provide you with your Meritain Member ID.

10

The Provider Network is changing from the BC/BS network to the Aetna Choice POS II network. What does this mean and how will it impact me?

You will need to show your new ID Card on your first visit to any doctor or medical facility in 2022 so that your eligibility can be confirmed and your doctor will submit the claim through Meritain Health rather than through Highmark. The Aetna Choice POS II network is one of the nation’s largest, so you have a high probability that all of your healthcare providers and facilities are already in the network. If you would like to check in advance, call your healthcare providers and ask if they are in the Aetna Choice POS II network. You also can also check online at www.aetna.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=mymeritain.

11

How do I know if my current doctor is in the Aetna Choice POS II network?

You can start by simply asking your doctor’s office if they participate in the Aetna Choice POS II network. If they ask you which Aetna Plan you are in, you are not in an “Aetna Plan.” You are in the EPC Plan. Just tell them the Aetna network name: “Aetna Choice POS II network.” You also can search the Doctor Find search tool at www.aetna.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=mymeritain.

12

What if my doctor is not in the Aetna Choice POS II network? 

First, confirm with your doctor that they are not in-network. Sometimes doctors elect not to be listed on the search tool but are in-network. If they are not, you can encourage them to join or you can submit a provider nomination form at http://www.aetna.com/form_assets/docfind/provider_nomination_form.html and your doctor will be invited to join. If your doctor is not in-network and you are pregnant or undergoing care for a serious medical condition or post-surgery acute care, contact Meritain Health at 800-925-2272 and inquiry about the “Transition of Care” program that enables qualifying individuals to continue in coverage with their current doctor.

13

Why is the EPC changing from Highmark to Meritain Health to administer our medical benefit program?

The delivery of healthcare and preventative care is evolving quickly, and it has been accelerated by the COVID-19 pandemic. Now more than ever, Wellness and Preventative Care, Personalized Care Management for those with Chronic Diseases, and those undergoing treatment for serious medical conditions all need to be a foundational part of a healthcare benefit. To achieve this objective at the direction of the EPC Benefit Resources, Inc. (BRI) Board of Directors, the EPC conducted a national search to find a medical benefit administrator that could provide all of these added-value services to our members and effectively administer our custom benefit plans. We identified Meritain Health as the best at all of these services. Soon you will be learning about many new programs and health resources that will be available.

14

My doctor was not in network with BC/BS and is not in-network in the Aetna Choice POS II network either? Is there a way that I can reduce my out-of-pocket expenses?

Unfortunately, out-of-network co-pay levels are higher than in-network. Some healthcare professionals choose not to participate in any provider networks because those networks negotiate for reduced fees. Often these providers have enough business without being in a network, or are limiting the acceptance of new patients. Meritain Health does have a program to negotiate for fee reductions with non-network doctors when such claims are received. The savings they can negotiate will be used to reduce the patient’s out-of-pocket costs. This was not available through Highmark.

15

Are there any changes to the Prescription Drug program administrator or coverages for 2022?

No changes; the 2022 prescription drug coverages, deductibles, and co-pays are the same as 2021. Express Scripts remains your Plan Administrator. You may continue to use your Express Scripts ID Card in 2022, but you also can use your new Meritain Health joint ID card when filling a prescription. Either card will work, and all Rx claims will continue to be processed by Express Scripts regardless of which card you use. Feel free to start using the convenience of a single card for both medical and prescription claims.

16

Many new member care programs are becoming available in 2022. When will I hear more about these? How do I sign up?

Among the new programs being offered are:

My Active Health wellness.
Disease Management programs with Nurse Health Coaches for seven common chronic conditions such as kidney, lung and heart disease, chronic pain, and asthma.
Livongo Whole Person Health, a program that focuses on management of diabetes, pre-diabetes and high blood pressure.
Maternity Management and Healthcare Bluebook.

Some of these programs are already up and running for your use today. Stay tuned for more information on others.

17

Do the EPC plans include 24/7 availability for virtual primary care visits?

Yes, all EPC plan participants can access 24/7 virtual primary care visits through telemedicine. The co-pay is only $5 (or $0) depending on which plan you are in. The coverage is offered through 98point6. You already are enrolled, but need to register to be visit-ready when a need arises. For information on downloading the mobile app and registering, go to www.98point6.com/members-homebase/?utm_source=EPC&utm_medium=newsletter&utm_campaign=intro_letter.

18

Who will be processing and paying medical claims for my doctor’s visits occurring late in 2021?

Highmark will continue to process and pay claims for all medical services you received in 2021, even if the claims are submitted by your provider in 2022. Highmark customer service will remain open for all of 2022 and continue receiving customer service calls, handling appeals, and processing 2021 paper claims until December 31, 2022.

If an EPC Plan participant calls Highmark about a 2022 claim, the Highmark operator will transfer the caller to Meritain Health.

Note that is the same answer for questions 19 and 20.

19

What if I paid cash for a doctor’s visit or medical procedure in 2021 and need to file a paper claim?

Highmark will continue to process and pay claims for all medical services you received in 2021, even if the claims are submitted by your provider in 2022. Highmark customer service will remain open for all of 2022 and continue receiving customer service calls, handling appeals, and processing 2021 paper claims until December 31, 2022.

If an EPC Plan participant calls Highmark about a 2022 claim, the Highmark operator will transfer the caller to Meritain Health.

Note that is the same answer for questions 18 and 20.

20

What if I have questions about a claim from 2021 or wish to make an appeal?

Highmark will continue to process and pay claims for all medical services you received in 2021, even if the claims are submitted by your provider in 2022. Highmark customer service will remain open for all of 2022 and continue receiving customer service calls, handling appeals, and processing 2021 paper claims until December 31, 2022.

If an EPC Plan participant calls Highmark about a 2022 claim, the Highmark operator will transfer the caller to Meritain Health.

Note that is the same answer for questions 18 and 19.

21

What is the difference between a Provider Network, Plan Administrator, and Plan Sponsor?

There are several major national “Provider Networks” that medical plan administrators utilize to allow doctors and medical facilities to submit claims for participants in their plans. Doctors and medical facilities that are properly licensed and credentialed join these networks so they can submit their patient’s bills to the Plan Administrator for payment. The information on your ID Card tells your doctor who is providing your benefit and which Provider Network administrator to submit your claim to. The Aetna Choice POS II network used for the EPC medical plan is one of the largest in the country, and is utilized by many public, private, and Medicare plan providers. For resources to find out which doctors and medical facilities are in our network, see the “Find an In-Network Doctor” material available here.

Note that is the same answer for question 22.

22

What is a Provider Network?

There are several major national “Provider Networks” that medical plan administrators utilize to allow doctors and medical facilities to submit claims for participants in their plans. Doctors and medical facilities that are properly licensed and credentialed join these networks so they can submit their patient’s bills to the Plan Administrator for payment. The information on your ID Card tells your doctor who is providing your benefit and which Provider Network administrator to submit your claim to. The Aetna Choice POS II network used for the EPC medical plan is one of the largest in the country, and is utilized by many public, private, and Medicare plan providers. For resources to find out which doctors and medical facilities are in our network, see the “Find an In-Network Doctor” material available here.

Note that is the same answer for question 21.

23

What is a Plan Administrator?

The Plan Administrator is contracted by a Plan Sponsor (like the EPC) to administer their Medical Benefit Plan. The Plan Administrator is responsible for contracting with the Provider Network, processing claims in accordance with the Plan Sponsor’s specifications, and providing customer service to plan participants. Plan participants contact the Plan Administrator with coverage questions, claims issues, to be pre-certified for surgery, appeal coverage decisions, etc. The Administrator provides a website where plan participants can log into their personal account to see claims history and tap into a multitude of Plan and health management resources. Meritain Health is our Plan Administrator.

24

What is a Plan Sponsor?

EPC Benefit Resources, Inc. (BRI) is your Plan’s Sponsor. At the direction of the EPC General Assembly, BRI has established benefit programs that provide your medical, prescription drug, dental, vision, life and long-term disability benefits, and our Retirement Plan. BRI is responsible for operating all of these plans and contracting with vendors to deliver those benefits in accordance with EPC specifications. BRI also supports church administrators by answering their benefit-related questions and assisting them with setting-up the plans, enrolling staff, and managing the church’s benefit program.

Information provided in this web site does not constitute legally binding advice. EPC benefits are subject to the provisions of the Medical Plan and Retirement Plan documents available on this web site or in print from EPC Benefit Resources, Inc. (BRI), 5850 T.G. Lee Blvd., Suite 510, Orlando FL 32822. For more information, contact BRI at benefits@epc.org or 407-930-4492 (voice and fax).

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