For employees
We’re revolutionizing healthcare – come and join us.
Our solution puts you at the heart of your medical plan, by giving you 100% coverage and $0 out of pocket (yes, you read that right). We’ve created a smarter plan, known as MERP, that lets you and your family thrive and save money at the same time. Because that’s how it should be.
Who qualifies
You’re eligible if
- You (and/or a member of your family) are currently enrolled in your employer’s medical plan, and
- Your spouse has access to coverage through his or her employer’s plan.
The plan is not available if
- You are not enrolled in your employer’s medical plan.
- Your spouse’s plan is an HDHP with active HSA contributions; Medicare, Tricare or Medicaid; an individual Marketplace plan; a stand-alone HRA; short-term coverage; or a limited benefit plan under IRS rules.
- Your spouse is self-employed.
Protecting what’s important.
The MERP is the technical name for the plan we provide. Your employer may call it something different though, but rest assured it’s the same plan Catilize has administered for nearly two decades. The MERP is unique in that it requires that you and your dependents be enrolled in your spouse’s employer-sponsored medical plan as well.
Simplicity.
We’ve untangled healthcare by removing deductibles, premiums and out-of-pocket expenses from the equation. All you have to focus on is staying healthy and getting care when you need it.
Peace of mind.
Go to the doctor without worrying about how much it will cost, and feel confident knowing that you’re 100% covered. No hidden fees or outrageous medical bills.
Financial freedom.
Take back the thousands of dollars you might normally spend a year in a standard health plan and put it towards something that matters – like your future, or a boat.
How does it typically work?
In a typical plan, there are two types of costs:
Out-of-pocket
The expenses you pay.
Out-of-pocket costs are things like your premium, deductible and out-of-pocket charges (up to your plan maximum). These costs can really add up and insurance companies are expecting people to pay more and more each year.
The big bill
The expenses the insurer pays.
The big bill is anything beyond the out-of-pocket maximum and is picked up by the insurance providers. This is important as it protects you from catastrophic debt if you get really sick or injured.
How Catilize is different.
The MERP pays all of your out-of-pocket expenses for you, and leaves the big bill to your spouse’s insurance provider.
You effectively pay $0. Nothing.
How to use the MERP.
Simply select the MERP plan during your next benefit enrollment window, follow the sign-up steps and enjoy the benefits. Using the plan is easy. Just follow these steps:
Join
Start by enrolling in your spouse’s healthcare plan. If you have dependents, make sure you all enroll in your spouse’s healthcare plan.
Select
When your own Open Enrollment comes around, select the MERP Plan and waive any other medical plan offered by your employer.
Submit
To complete your enrollment, you will have to submit proof of alternate coverage (your spouse’s coverage) and premiums paid.
Use
When seeking care with a medical provider, just show your spouse’s healthcare plan ID card and the MERP ID card after receiving care and the MERP pays for your out-of-pocket cost.*
* If the provider doesn’t accept the MERP card, you simply pay the cost up front and submit it to Catilize for your tax-free reimbursement.
Why people are loving it.
This program is amazing!
“It covers all my out of pocket cost. I have been using the MERP program for 2 years now and since going on it I have not had to pay out anything. My husband had shoulder surgery in February and we did not pay a penny for anything. It was great. Occasionally you may have to pick up a copay for a prescription because the pharmacy gets confused but all you have to do is submit for reimbursement.”
“The only impact it has had on my family is it has left more money in our pockets to do more things as a family.”
Saved us thousands
“At first, the program seemed too good to be true. We are so grateful that it really is true! It has saved us thousands of dollars over the past two years. My husband had to have physical therapy not long after we joined the program, so we saw immediate results – the total bill almost met our deductible, less than a month into the new year, and MERP covered every penny.”
“Thanks to MERP, we have saved thousands of dollars in out of pocket costs over the past two years for my family of four. Most of our practitioners accept it, but if not, filing a claim for reimbursement is easy.”
Such a relief
“I have a large family with some significant health issues. We spend a lot of money on healthcare each year. It has been such a relief to have the MERP program cover these extra costs that my husband's insurance company does not cover! We have received over $600 back in just 4 months' time! That's amazing!”
Frequently asked questions
Who is eligible?
If you and/or any member of your family is currently enrolled in your employer's medical plan, and your spouse has access to coverage through his/her employer's plan, you may take advantage of the MERP by transitioning to your spouse's plan.
Who is not eligible?
If you are not enrolled in your employer's medical plan, you're not eligible to enroll in the MERP plan. The plan is also not available if your spouse's plan is a High Deductible Health Plan (HDHP) with active contributions to a health savings account (HSA); Medicare, Tricare or Medicaid; an individual plan purchased on or off the Health Insurance Exchange (the Marketplace); a stand-alone health reimbursement account (HRA) not paired with a medical plan; short-term individual coverage; or a Limited Benefit Health Plan under IRS rules. You would also not be eligible if your spouse is self-employed, because your spouse does not have access to medical coverage through an alternate plan with his/her employer.
What constitutes proof of alternate coverage?
A paystub showing the premium contribution amount, pre-tax or post-tax, and frequency (other pay information may be blacked out). If the employee's spouse does not have a paystub at the time of enrollment, the spouse may submit a letter on their employer's letterhead or a Benefit Confirmation outlining the information; a paystub must be submitted once one becomes available. If the entire family is not enrolling in the MERP, the employee must provide the tiers of coverage, indicating the cost for each tier.
How does the plan work?
If your spouse and/or dependents are currently enrolled in your company's medical plan, you may all be eligible to participate in the MERP plan if you and/or your dependents join the medical plan offered by your spouse's employer.
What does the MERP plan cover?
Covered services are determined by your spouse's employer plan. MERP enrollees are reimbursed for all eligible copayments, coinsurance and deductibles incurred using in-network providers under your spouse's medical plan, up to the maximum out-of-pocket limits established by the Affordable Care Act. Reimbursed claims are not taxable income to the MERP enrollees.
Which ID card do I show when I receive medical services?
MERP plan enrollees should show the ID card for their spouse's plan first. Upon enrollment in the MERP plan, our administrator will send you a welcome letter with a plan ID card. That card may be shown second. Your welcome letter will explain this.
How do I receive my reimbursement?
If you pay your provider at the time of service (for example, your office visit copayment), obtain a receipt and send it along with the Explanation of Benefits (EOB) you received. EOBs are verified for an eligible service and in-network provider, then processed, and a reimbursement is sent to you from the plan's administrator. If you don't pay at the time of service, send your EOB and the bill from your provider together; once verified, payment is sent to your provider. You may get another bill from your provider while your payment is being processed. Processing should take no longer than 30 days from the date our plan administrator receives your documentation.
How long will it take to be reimbursed for claims?
Reimbursements are processed within 30 days of submission, but typically within two weeks.
The best zero dollars you’ve ever spent.
If you have any questions, check the FAQ above, or if you would like to chat to a member of the Catilize team, get in touch.