Meritus Provider Networks Building better health in communities through our Provider Networks. 2015MER0009v2 meritusaz.com TTY/TDD users call 7.1.1. Meritus Provider Networks 1
We believe in developing long-term partnerships with providers by working together to improve health outcomes and better control healthcare costs for our members and the people of Arizona. It s this friendly approach to achieving real change that we believe creates a positive payer/provider dynamic one we believe will change healthcare as we know it, for the good. Meritus Provider Network Design Building better health in communities through our Provider Networks. PPO 10,941 physicians and mid-level providers 45 Acute Hospitals and 12 Behavioral Health Hospitals Source: Arizona Foundation HMO 4,148 physicians 30 Acute Hospitals and 3 Behavioral Health Hospitals Source: Meritus Contracted Network Meritus has new plans for 2015: We designed HMO and PPO products structured around copays for most services, no hidden fees and predictable out-of-pocket costs. We created plans with a range of deductibles and copays. We designed plans with pharmacy benefits that provide generic maintenance medications with lower copays. 1 We structured our plans with lower copays for primary care visits, sick visits or well visits, to help promote preventive care and wellness. We included complementary and alternative medicine benefits such as Acupuncture, Therapeutic Massage, Naturopathy and rewards for staying healthy, including up to $25 per month gym membership reimbursement. These benefits are included on all of our PPO plans and on Gold and Platinum HMO plans. 4 MOHAVE COUNTY Meritus HMO Mohave Network 2 Western Arizona Regional Medical Valley Health System, Las Vegas - Centennial Hills Hospital Medical - Desert Springs Hospital Medical - Spring Valley Hospital Medical - Summerlin Hospital Medical - Valley Hospital Medical PIMA AND SANTA CRUZ COUNTIES Meritus Complete HMO Network 2 Contracted Hospitals Carondelet Health Network - St. Mary s Hosptial - St. Joseph s Hospital - Tucson - Carondelet Heart and Vascular Institute - Carondelet Neurological Institute - Holy Cross Hospital Tucson Medical Meritus HMO Pima Network 2 St. Mary s Hosptial St. Joseph s Hospital - Tucson Carondelet Heart and Vascular Institute Carondelet Neurological Institute Holy Cross Hospital MARICOPA COUNTY Meritus Complete HMO Network 2 Contracted Hospitals Scottsdale/Lincoln Health Network Banner Health Abrazo Health Maricopa Medical Meritus HMO Abrazo Network 2 Arizona Heart Hospital Arizona Heart Institute Arrowhead Hospital Maryvale Hospital Paradise Valley Hospital Phoenix Baptist Hospital West Valley Hospital Meritus HMO Banner Network 2 All of the Banner hospitals MD Anderson Cancer Cardon Children s Medical Banner Heart Hospital Meritus HMO MIHS Network 2 Maricopa Medical Phoenix Cancer Arizona Burn McDowell Health Care 11 MIHS Family Health and Community s 2015MER0009v2 Meritus Provider Networks 1.855.755.2700 602.957.2113
Meritus Statewide PPO Network 3 The Arizona Foundation for Medical Care Network is the backbone of the Meritus PPO Network. We contract directly with additional providers to make up our entire PPO network. We have a provider search tool on our website at meritusaz.com where you can find a complete list of doctors and facilities that are part of the Meritus PPO network. PPO Network 3 Contracted Hospitals COUNTY CITY FACILITY NAME Apache Ganado Sage Memorial Hospital Springerville White Mountain Regional Medical Cochise Bisbee Copper Queen Community Hospital Douglas Southeast Arizona Medical Sierra Vista Sierra Vista Regional Health Willcox Northern Cochise Community Hospital Coconino Flagstaff Flagstaff Medical Page Page Hospital Tuba City Tuba City Regional Healthcare Gila Globe Cobre Valley Regional Medical Payson Payson Regional Medical Safford Mt Graham Regional Medical La Paz Bouse La Paz Regional Hospital Parker La Paz Regional Hospital Parker La Paz Regional Hospital Quartzsite La Paz Regional Hospital Salome La Paz Regional Hospital Maricopa Chandler Arizona Orthopedic & Surgical Specialty Chandler Regional Medical Gilbert Banner Gateway Medical Banner MD Anderson Cancer Mercy Gilbert Medical Glendale Arrowhead Hospital Banner Thunderbird Medical St. Joseph s Westgate Medical Goodyear West Valley Hospital Medical Mesa Arizona Spine & Joint Hospital Banner Baywood Medical Banner Desert Medical Banner Heart Hospital Cardon Children s Medical Phoenix Arizona Heart Hospital Banner Estrella Medical Banner Good Samaritan Medical John C. Lincoln Hospital - Deer Valley John C. Lincoln Hospital - North Mtn Maricopa Medical Maryvale Hospital Medical Oasis Hospital Paradise Valley Hospital Phoenix Baptist Hospital Phoenix Children s Hospital Select Specialty Hospital - Phoenix St. Joseph s Hospital & Medical San Tan Valley Banner Ironwood Medical Scottsdale Scottsdale Healthcare Osborn Scottsdale Healthcare Shea Scottsdale Healthcare Thompson Peak Sun City Banner Boswell Medical Sun City West Banner Del E Webb Medical Continued on page 5 2015MER0009v2 meritusaz.com TTY/TDD users call 7.1.1. Meritus Provider Networks 3
PPO Network 3 Contracted Hospitals in Maricopa Maricopa County Scottsdale Lincoln Health Network Banner Health Abrazo Health Maricopa Medical Dignity Health Phoenix Children s Hospital PPO Network 3 Contracted Hospitals in Pima and Santa Cruz Counties Pima and Santa Cruz Counties Carondelet Health Network Tucson Medical Northwest Medical / Oro Valley Nogales Holy Cross Hospital 2015MER0009v2 Meritus Provider Networks 1.855.755.2700 602.957.2113
PPO Network 3 Contracted Hospitals Continued from page 3 COUNTY CITY FACILITY NAME Mohave Bullhead City Western Arizona Regional Medical Kingman Kingman Regional Medical Lake Havasu City Havasu Regional Medical Navajo Show Low Summit Healthcare Regional Medical Winslow Little Colorado Medical Pima Tucson Carondelet St. Joseph s Hospital Carondelet St. Mary s Hospital Northwest Medical Tucson Medical Oro Valley Oro Valley Hospital Pinal Apache Junction Banner Goldfield Medical Casa Grande Casa Grande Medical Florence Florence Hospital at Anthem Sacaton Hu Hu Kam Memorial Hospital Santa Cruz Nogales Carondelet Holy Cross Hospital Yavapai Cottonwood Verde Valley Medical Prescott Yavapai Regional Medical Prescott Valley Mountain Valley Regional Rehab Hospital Yavapai Regional Medical -East Yuma Yuma Yuma Regional Medical Let us help you find the right doctor. It is very important for us to help our members find doctors that are in their network. We want to help them avoid unnecessary medical bills and any confusion that could result from using doctors that are not contracted in their Meritus plan. When someone signs up for a Meritus plan, it is very important that the member understands where they are able to receive care and the importance of using doctors in their network. Steps to View Providers Please visit meritusaz.com for a complete listing of doctors and facilities by plan. 1. Visit meritusaz.com 2. Click on the Providers tab on the top of the Meritus homepage 3. Click the Find a Provider link 2015MER0009v2 meritusaz.com TTY/TDD users call 7.1.1. Meritus Provider Networks 5
Meritus Complete HMO Network 2 Meritus built our Complete HMO network of doctors with the help from our primary care physicians. Working in partnership with these PCPs, we reached out to other physicians, specialists and hospitals to create a broad and complimentary HMO network for our members. Meritus Community Networks 2 In order to offer low premiums and quality benefits to our members, Meritus also created community HMO network options in partnership with some of the best hospital based healthcare systems in Arizona. Meritus HMO MIHS Network - Maricopa Integrated Healthcare Systems Meritus HMO Banner Network - Banner Health System Meritus HMO Pima Network - Carondelet Health Network Meritus HMO Abrazo Network - Abrazo Health System Meritus HMO Mohave Network - Western Arizona Regional Medical A complete listing of the participating Meritus HMO community networks of doctors can be found on our website at meritusazcom. Due to the popularity of our three community network plans from 2014, we will continue to offer these plans in 2015 under new plan names: Meritus Neighborhood Network Maricopa is a plan in partnership with Maricopa Integrated Health System 2015 PLAN NAME Meritus Neighborhood Network Silver HMO MIHS Meritus Community Network Phoenix is a plan in partnership with Banner Health 2015 PLAN NAME Meritus Community Network Silver HMO Banner Meritus Community network Pima is a plan in partnership with Carondelet Health Network 2015 PLAN NAME Meritus Community Network Silver HMO Pima These are the only three plans which include Pediatric Dental. Complementary and Alternative Medicine Network 4 At Meritus, we know that health isn t something that you only fix when it s broken. Acupuncture Naturopathy Therapeutic massage Gym membership reimbursement 5 These benefits are available to members in a number of individual and group plans and are designed to support overall health and well-being. 2015MER0009v2 Meritus Provider Networks 1.855.755.2700 602.957.2113
Meritus Complete HMO Network 2 Contracted Hospitals in Maricopa County Maricopa County Scottsdale/ Lincoln Health Network Banner Health Abrazo Health Maricopa Medical Meritus Complete HMO Network 2 Contracted Hospitals in Pima and Santa Cruz Counties Pima and Santa Cruz Counties Carondelet Health Network Tucson Medical Nogales Holy Cross Hospital 2015MER0009v2 meritusaz.com TTY/TDD users call 7.1.1. Meritus Provider Networks 7
Meritus HMO MIHS Network 2 Maricopa County Maricopa Medical Phoenix Cancer Arizona Burn McDowell Health Care 11 MIHS Family Health and Community s Meritus HMO Banner Network 2 Maricopa County All of the Banner hospitals MD Anderson Cancer Cardon Children s Medical Banner Heart Hospital 2015MER0009v2 Meritus Provider Networks 1.855.755.2700 602.957.2113
Meritus HMO Abrazo Network 2 Maricopa County Arizona Heart Hospital Arizona Heart Institute Arrowhead Hospital Maryvale Hospital Paradise Valley Hospital Phoenix Baptist Hospital West Valley Hospital Meritus HMO Pima and Santa Cruz Network 2 Pima and Santa Cruz Counties St. Mary s Hosptial St. Joseph s Hospital - Tucson Carondelet Heart & Vascular Institute Carondelet Neurological Institute Holy Cross Hospital Nogales Holy Cross Hospital 2015MER0009v2 meritusaz.com TTY/TDD users call 7.1.1. Meritus Provider Networks 9
Colorado City Meritus HMO Mohave Network 2 Western Arizona Regional Medical Valley Health System, Las Vegas - Centennial Hills Hospital Medical - Desert Springs Hospital Medical - Spring Valley Hospital Medical - Summerlin Hospital Medical - Valley Hospital Medical Dolan Springs Kingman Bullhead City Mohave Valley Lake Havasu City Peach Springs If you have any questions about Meritus provider networks or need additional information, please call us at 602.957.2113 or toll free at 855.755.2700. Hearing Impaired? Call the Arizona Relay Service at 711. Please have the Meritus phone number available for the relay operator. 2015 Meritus. Meritus products and services are provided through Meritus Mutual Health Partners PPO and Meritus Health Partners HMO. 1 $0 Rx Generic Maintenance Drugs Copays are only available for certain plan options. Copays may range between $0-$10 for a 30 day retail supply and $0-$30 co-pay for 90-day mail order supply depending upon the plan selected. 2 HMO Networks ONLY: There are no out of network benefits for an HMO. The only out of network services are for emergencies or for services that are arranged for the member due to provider network coverage. 3 PPO Networks ONLY: You are not required to go to a Preferred Provider. At the time of services, you may obtain Treatment from a Preferred Provider or a Non-Preferred Provider. However, to maximize the benefit reimbursement level under a policy, a preferred Provider must be used. The insured will incur higher out-of-pocket costs if you choose to receive services from an out-of-network provider, and will be responsible for the difference between billed charges and the amount paid by Meritus, other than copayments, co-insurance, or any amounts that my remain on your annual deductible. If you plan to use a non-network provider, you should inquire about the fees you can expect to be charged before you receive services. 4 Complimentary and Alternative Therapies (CAM) are not a covered benefit in all plans. CAM therapies include therapeutic Massage Therapy, Acupuncture and Naturopathy. CAM Therapies are limited to 12 visits per year. 5 The $25/Month Gym Reimbursement is only available for certain plan options. In order to obtain a gym membership reimbursement, you must submit a claim. Meritus will pay up to $25 per month for each covered person, age 18 and above, who has a gym membership. Gym means a business licensed by the state or +local government to conduct business as: (1) a gym; (2) fitness center; or (3) health club. The gym must have exercise/ fitness equipment and have personnel to assist gym members. For a complete listing of benefits available for all plans as well as limitations and exclusions, please contact Meritus. This is an advertisement/informational flyer. A licensed insurance producer may contact you to discuss enrollment in a Meritus health plan. Meritus Mutual Health Partners PPO and Meritus Health Partners HMO are licensed only in Arizona and are Qualified Health Plan issuers in the Health Insurance Marketplace. 2015MER0009v2 Meritus Provider Networks 1.855.755.2700 602.957.2113
More Healthcare Options Available to Members! Introducing MeMD, one of our benefits! Meritus has teamed up with MeMD to deliver online telehealth services to you. It s simple! Visit www.memd.me/meritus, login using your Meritus ID. You will be connected to a medical provider over the phone or by webcam to discuss minor conditions, medication refills, or even a second opinion. MeMD is the fastest, most convenient way to see a medical provider online or by phone for common conditions like: Sinus Infections Seasonal Allergies Sprains & Strains Medication Refills Cold & Flu Symptoms Pink Eye Urinary Tract Infections Sore Throats Skin Infections And more! Receive treatment from home, the office or even when you re on vacation! Adding the benefit of the Minute Clinic, brings care to your client s neighborhood Your clients want to make the best choice for their family. You may already know how convenient Minute Clinics are: Open 7 days a week, including evenings and weekends No appointment necessary Located in select CVS/pharmacy stores nationwide Adding new clinics and services all the time Plus, the Minute Clinics accept Meritus plans You might not know that CVS Minute Clinics offer a broad range of services. In addition to diagnosing and treating illnesses, injuries and skin conditions, they also provide all kinds of wellness services, including vaccinations, physicals, screenings and monitoring for chronic conditions. The Minute Clinics family of nurse practitioners and physician assistants provide services for both adults and children, 18 months and older. And they can send a summary of your visit to your primary care provider, with your permission. We hope you choose Minute Clinic to help with your family s health care needs. MeMD.me/meritus 844.399.5341 cvs.com/minuteclinic/clinics/arizona Pharmacy Partners CVS Safeway Fry s Basha s Walmart Target Costco Albertsons Food City K-Mart Osco Sam s Club Sav-on 2015MER0009v2 meritusaz.com TTY/TDD users call 7.1.1. Meritus Provider Networks 11
address 2005 West 14th Street Suite 113 Tempe, Arizona 85281 website meritusaz.com email sales@meritusaz.com groupquotes@meritusaz.com phone 602-957-2113 toll free 855-755-2700 tty 7.1.1 hours of operation 8 am to 5 pm (M-F) 2015 Meritus. Meritus products and services are provided through Meritus Mutual Health Partners - PPO and Meritus Health Partner - HMO. Meritus Mutual Health Partners and Meritus Health Partners are licensed only in Arizona, and are Qualified Health Plan issuers in the Health Insurance Marketplace. 2015MER0009v2 MKG12.12.14