Meritain Health is a third party administrator of self-funded health insurance plans for companies nationwide. It is a subsidiary of Aetna Insurance and its parent company CVS. A self-funded plan refers to insurance that an employer fully pays for as a benefit to company employees. The employer doesn’t pay a premium to an insurance company, instead they cover the cost of employee medical care themselves.

A third-party administrator sets up and manages the healthcare benefits for the employees, processes insurance claims and manages billing and payments for services to providers. They can also connect a self funded plan with a provider network if they need one.

Meritain Health has been in business since 1983 and has more than 1.5 million members. Most company employers purchase the Aetna Choice POS 11 plan to offer their employees because it gives them access to Aetna’s national network of 1.6 million healthcare providers and more than 350,000 behavioral health providers.

Meritain Health is the only third party administrator that can offer access to this Aetna network.

Does Meritain Health Cover Addiction Treatment?

Self funded employer plans are not required to cover addiction or mental healthcare, but if they do, they must follow the Mental Health Parity Act and cover it at the same level as other medically necessary services.

Your employer’s plan may include mental health and rehab coverage, but it may not, so it’s very important to check with your company’s benefits manager before you commit to a treatment program. You may also need to stay within a specific provider network in order to use your employer coverage.