MedicalMedical Plan
Your medical plan is administered by Meritain Health on the Aetna Choice POS II network. Two plan options are offered for 2027.
- Network
- Aetna Choice® POS II (Open Access)
- Member site
- www.mymeritain.com
- Member services
- (800) 343-3140
- Plan year
- 2027 — begins January 1
- New ID cards
- Issued for 2027
- Choosing a PCP
- Encouraged, not required
What changed for 2027
- Base plan deductible goes from $1,000/$2,000 to $1,500/$3,000.
- High plan deductible goes from $250/$500 to $750/$1,500.
- You will receive new ID cards for 2027.
Base plan — POS $1,500 80/60
A $1,500 individual deductible. After that you pay 20% of the cost of covered care in network, until you reach the out-of-pocket maximum.
| What you pay | In network | Out of network |
|---|---|---|
| Deductible — individual / family | $1,500 / $3,000 | $3,000 / $6,000 |
| Coinsurance — your share after the deductible | 20% | 40% |
| Preventive care | No charge | 40% after deductible |
| Primary care physician | $10 copay | 40% after deductible |
| Specialist | $40 copay | 40% after deductible |
| Teladoc virtual visit | $5 copay | — |
| Urgent care | $30 copay | 40% after deductible |
| Emergency room | $125 copay | $125 copay |
| Labs, x-rays, advanced imaging | 20% after deductible | 40% after deductible |
| Hospital — inpatient | 20% after deductible | 40% after deductible |
| Hospital — outpatient | 20% after deductible | 40% after deductible |
| Out-of-pocket maximum | $8,550 / $17,100 | $8,000 / $16,000 |
High plan — POS $750 100/80
A lower deductible with richer coverage: $750 individual. After that you pay nothing for covered care in network.
| What you pay | In network | Out of network |
|---|---|---|
| Deductible — individual / family | $750 / $1,500 | $1,500 / $3,000 |
| Coinsurance — your share after the deductible | 0% | 20% |
| Preventive care | No charge | 20% after deductible |
| Primary care physician | $10 copay | 20% after deductible |
| Specialist | $25 copay | 20% after deductible |
| Teladoc virtual visit | $5 copay | — |
| Urgent care | $15 copay | 20% after deductible |
| Emergency room | $75 copay | $75 copay |
| Labs, x-rays, advanced imaging | 0% after deductible | 20% after deductible |
| Hospital — inpatient | 0% after deductible | 20% after deductible |
| Hospital — outpatient | 0% after deductible | 20% after deductible |
| Out-of-pocket maximum | $8,550 / $17,100 | $4,000 / $8,000 |
Staying in network is worth a good deal on this plan: the deductible is half what it is out of network, and after it you pay nothing in network, against 20% out.
Prescription coverage
| Prescriptions | Base plan | High plan |
|---|---|---|
| Retail — generic (30 day) | $20 | $10 |
| Retail — brand formulary | $40 | $30 |
| Retail — non-formulary | $65 | $55 |
| Retail — specialty | $105 | $95 |
| Mail order — generic (90 day) | $40 | $20 |
| Mail order — brand formulary | $80 | $60 |
| Mail order — non-formulary | $130 | $110 |
| Mail order — specialty | $0 | $0 |
Prescriptions are not covered out of network on either plan. A 90-day mail order supply costs two copays rather than three — see the SmithRx page.
Plan documents
The Summary of Benefits and Coverage (SBC) is the official side-by-side document for each plan option. It is the one to read before you choose, and the one to keep.
| Document | Covers | Download |
|---|---|---|
| SBC — Base Plan | POS $1,500 80/60 | PDF, 9 pages |
| SBC — High Plan | POS $750 100/80 | PDF, 9 pages |
| 2027 Employee Benefit Guide | Every benefit, not only medical | PDF, 75 pages |
Both SBCs cover the plan year January 1 to December 31, 2027 and are issued for the Markovitz Enterprises, Inc. Employee Benefit Plan. The Benefit Guide is the full booklet for every benefit, medical included.
For the complete terms of coverage, or a paper copy, go to meritain.com or call (800) 925-2272. Definitions of terms such as allowed amount, balance billing, coinsurance and deductible are in the SBC glossary.
Finding a doctor
Both plans use the Aetna Choice POS II (Open Access) network.
- Go to aetna.com/dsepublic/#/mymeritain.
- Click Find a Doctor, then Find Care if you're registered. If not registered, choose plan through employer.
- Enter your ZIP code or city and state, and the type of plan you need. Click Search.
- Select network Aetna Choice POS II (Open Access) and click Continue.
Should you pick a PCP?
Meritain doesn't require you to choose a primary care physician, but they encourage it — a PCP who knows your history can coordinate your care.
Included with your plan
MinuteClinic — $0 virtual care
Eligible services at participating CVS MinuteClinic locations, including 24/7 virtual telemedicine at a zero-dollar copay. MinuteClinic providers diagnose non-emergency conditions such as sinus infections, sore throat, cold, flu and rashes. Call 1-866-389-ASAP (866) 389-2727 or visit cvs.com/minuteclinic/virtual-care. Availability is limited by location.
Or use AllyHealth instead
MinuteClinic is not your only option for virtual care. AllyHealth also costs you $0, covers your whole family, and is not limited by location — it is available 24/7/365 from anywhere.
- Virtual urgent care — a licensed physician on demand, who can send a prescription to your local pharmacy. (877) 283-3777 ext 1.
- Mental health — counseling, scheduled therapy and psychiatry, which MinuteClinic does not offer. (888) 388-0397.
- Everyday support — a concierge for eldercare and childcare research, legal and financial guidance, and life coaching.
Use whichever suits the moment. See the AllyHealth page for the full list of services and how to register.
Case Management
A free, confidential service. If you face a serious illness or injury, a dedicated case manager — a registered nurse or licensed social worker — works with you, your family and your providers to build a treatment plan and explain your benefits. You, a family member or your provider can request it.
Diabetes Management by Teladoc Health (formerly Livongo)
Free for you and your dependents with diabetes. Includes a connected blood glucose meter that uploads readings automatically, unlimited test strips at no cost, coaching support, 24/7 remote monitoring and optional family alerts. Register at teladoc.com or call 1-800-TELADOC (800) 835-2362.
LifeMart employee discounts
A discount program covering gyms, diet plans, groceries, travel, tickets, car rentals, electronics, childcare and more. Reach it from the LifeMart link under Tools and Resources on your Meritain member website, or through the LifeMart mobile app.
Your ID card, claims and app
- Log in at mymeritain.com for your ID card, claims and Explanation of Benefits.
- The Meritain Health mobile app is available for Android and iPhone.
- Your EOB is not a bill. It shows what was billed, what the plan paid, and what you may owe.
- New ID cards are being issued for 2027 — watch for them before January 1.
Who's eligible
Full-time employees working 30 or more hours a week who have met the new-hire waiting period, plus their spouse and dependent children to age 26.
For payroll costs by coverage tier, contact Badger HR.
Questions
- Phone(800) 343-3140
- Websitewww.mymeritain.com
- Badger HR(724) 631-1119 · hr@badgerind.com