Realize 100% medical coverage while eliminating all out-of-pocket expenses.
Working families typically have two working spouses and each are eligible for their own union or employer-funded health insurance plan. Still, it is often the case that they will elect to both be on the same plan, sometimes with children as dependents as well.
But did you know that by moving off of your spouse’s group health plan and onto the other one that you have access to, you can eliminate what you pay now for medical expenses?
By engaging in a Medical Expense Reimbursement Plan (MERP), the financial responsibility of your healthcare can be split between the original insurance plan you were on, which will now only pay for your out-of-pocket expenses, and the alternative group plan you move to, which will now cover medical claims.
If you're a spouse that is on your partner's employer or union-funded group health plan, know that they are happy to accommodate this transition because it saves them money too. Medical claims are collectively more expensive than out-of-pocket costs, and they won't have to pay them anymore. As a thank you for shifting this responsibility to your own employer plan, they will reimburse your out-of-pocket expenses.
What’s Covered:
• Deductibles
• Co-pays
• Coinsurance
• Office Visits
• Prescription Costs
• Reimbursement for any difference in Premium costs between plans
Please note that adding a MERP will not require you to change your healthcare plan carrier or plan design. It may also be the case that the original employee's Premium amount will be reduced once their spouse switches off of their plan.
We can help you understand what's possible for your situation and explain how any combination of family members can experience the benefits of employing a MERP.
Example of Annual Healthcare Spending
Without a MERP
$2,500 Deductible
$1,000 Co-insurance
$250 Primary Care Visits
$750 Specialist Care Visits
$500 Prescriptions
= $5,000 Total Spent
With a MERP
$0 Deductible
$0 Co-insurance
$0 Primary Care Visits
$0 Specialist Care Visits
$0 Prescriptions
= $0 Total Spent
Real Reviews from MERP Participants
“This program is amazing! It covers all my out-of-pocket costs. 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.”
- Shannon G.“I feel like we have had a pay raise for our family because we have not had any medical expenses this year. We are definitely signing up again this year!!”
- Carrie F.“My family is receiving many financial benefits from using the MERP. Not having to worry about paying co-pays, coinsurances, and deductibles really has helped our wallet. For the pharmacy side of MERP, I simply keep my insurance ERB’s to submit to the MERP and am reimbursed for those costs.”
- Sarah P
“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.”
– Joanna L.20+ yrs
saving people money
$5,000
average annual increase to household income due to out-of-pocket savings
100%
coverage for claims and co-pays
Eligibility for the MERP
1. Current enrollment in an employer or union's group health insurance plan.
2. Access to another group health insurance plan (for example, you're a wife on your husband's employer or union-funded group plan but your employer or union offers a group health plan that you could elect to enroll in).
3. The alternative group health plan must not be under Medicare or Tricare, and is not on the ACA exchange as a private individual plan.
4. In most cases, you must not have a Health Savings Account (HSA), as the two have overlapping purposes.
How Reimbursement Works
First, you will enroll in the other group health insurance plan that you have access to and receive an ID card for that plan. Fill out the MERP enrollment and attestation forms. You will receive a MERP ID card as well.
Present both ID cards at your medical appointments (preventive screenings, surgeries, doctor's visits, etc) and at the pharmacy.
Let the provider know that the MERP will pay the provider directly for covered co-pays, deductibles, and co-insurance. Typically, the provider will receive an EOB (Explanation of Benefits) from your group plan, and then the provider can use the EOB to file the MERP Claim.
You pay nothing. Your provider will file the claim with both plans.
Most claims will be paid directly to the provider through use of the ID card. In some cases, such as at select pharmacies, you will need to pay first and file a paper claim yourself. A check reimbursing you for your out-of-pocket expenses will come in the mail in about two weeks.
The Result: Increased household discretionary income.
With most Americans living paycheck to paycheck and nearly half of them carrying medical debt, here is a program that allows participants to dramatically lessen their financial stress.
As a result of eliminating out-of-pocket expenses, they are able to pay off other bills and debts, receive needed medical care, and improve the quality of their lives. Typical average annual savings amount to about $5,000. This helps to ensure that union members and their families have high quality, affordable healthcare.
Have more questions? Visit our FAQ page or call us at 714-858-1157.