Member portal and plan resources

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.

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.

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.

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.

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.

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.

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.

Reimbursements are processed within 30 days of submission, but typically within two weeks.