KEY TERMS
In-network physicians and facilities (providers) are those contracted with Meritain under Aetna Open Choice PPO. The contract holds these providers to negotiated rates for services and the responsibility to file all claims to Meritain. You will receive the highest level of benefit by utilizing in-network providers. In-Network
Out-of-Network
Out-of-network physicians and facilities (providers) are those not contracted with Meritain. Your PPO plan offers you in and out-of-network benefits. These providers may not file claims on your behalf. Meritain will processed claims based on the amount considered reasonable and customary. As these providers are not contracted, they may balance bill you.
What’s balance billing?
The provider can bill you the difference between the total amount billed and the reasonable and customary amount.
Claims forms can be found on the PAR network at the Intranet under Resources Company Information Forms Library
Coinsurance
The percent of the cost for the claim you are responsible for. The amounts you pay in coinsurance apply to your out of pocket maximum.
Copays
The set cost for services that are pre-negotiated with in-network provider. These cost are typically collected at the time of service.
Out-of-Pocket
This amount is the maximum amount you will pay towards services on the plan for the calendar year. This amount includes the amounts you pay in coinsurance, copays, and prescription copays.
Preventive Care
PAR strongly believes in the importance of health and wellness. PAR’s medical and dental plans provide your and your covered dependents annual access to preventive services at NO COST. Preventive service include, but are not limited to, the following: Adult and child screening (such as blood pressure, cholesterol, type 2 diabetes, obesity, HIV, breast cancer, cervival cancer, etc)
Adult and child immunization (such as Hepatitis A and B, Herpes zoster, Influenza, Pneumococcal , Meningococcal, etc)
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