Claims

Medical cla​​ims  

Whenever you receive healthcare, you must present your Meritain Health ID card to your medical provider. The medical provider will then bill Meritain Health for the cost of your care, who will process the claim and pay the medical provider directly. You should not have any out of pocket costs for medical treatment, as long as your medical provider is in the Aetna Choice POS II network and you receive approval for treatment where necessary. Provided you produce your Meritain Health ID card, your medical provider should not charge you any fee at the time of your care.  
 
If you receive any bills showing a patient responsibility other than $0 please contact the Healthcare and Education Department for assistance. Do not pay anything to the medical provider.  
 
If you receive any non-emergency care from an out-of-network provider without prior authorisation from the Healthcare and Education Department, the cost of your treatment will be a personal expense. 
 
Likewise, if you have any treatment that is not automatically covered before receiving approval, the cost of your care will be a personal expense.  
 
It is your responsibility to familiarise yourself with those procedures/treatments/appointments that require authorisation before you receive any treatment.  
 

Prescription claims  

The MOD will fund your prescriptions provided the drug (or an equivalent) is available on the NHS.   
 
You must present your Meritain Health ID card to the pharmacist when filling a prescription. You will only be charged a co-pay, which is the portion of a charge for prescriptions that is the patient’s personal responsibility to pay. It is equivalent to an NHS contribution in the UK, and is currently $12 per item. You must pay this direct to the pharmacist.   
 
Please note that the cost of the drug (ingredient cost plus dispensing fee) may be less than $12. If this is the case, you will only be charged for the actual cost of the drug.   
 
If you are charged more than the co-pay amount at the pharmacy, please contact the Healthcare and Education Department for assistance.   
 
You should not be charged anything for prescribed contraceptive drugs. 
 
If you are exempt NHS charges, please inform the Healthcare and Education Department, providing proof of your exemption (e.g. exemption certificate) where necessary. Your exemption will be noted in Meritain Health’s prescription management system, and you will not be charged a co-pay whenever you fill a prescription for the duration of your exemption.
 

Optical claims  

If you’re not eligible for NHS-funded sight tests, all costs including co-pays are a personal expense.

The following individuals are exempt charges for a routine sight test: 
 
  • Are under 16
  • Are age 16, 17 or 18 and in full time education
  • Are age 60 or over
  • Are registered partially sighted or blind
  • Have been diagnosed with glaucoma or diabetes
  • Are age 40 or over and your mother, father, sibling or child has been diagnosed with glaucoma
  • Have been advised by an eye doctor (ophthalmologist) that you’re at risk of glaucoma
  • Are eligible for an NHS complex lens voucher
  • Have a valid NHS certificate for full help with health costs (HC2)
  • People named on an NHS certificate for partial help with health costs (HC3) may also get help with the cost of a private sight test.
  • For more info visit: Free NHS Sight Tests

Eyeglasses and contact lenses 

You are not entitled to claim for the cost of eyeglasses or contact lenses. 
 

Please note that the optician that conducts your eye exam may not have the most affordable glasses or contact lenses. You may wish to take your prescription and shop around to reduce your out of pocket expenses. Chain retailers such as Costco and Wal-Mart often have the most competitive prices. 

​​Dental claims  

Provided you have used an in-network provider and have only had pre-authorised treatment, Meritain Health will pay any charges incurred for treatment directly to your dental provider. This is with the exception of co-payments (or co-pays) for adults (see Dental Care for details of co-pays).    
 
You will pay your co-pay direct to the dental provider. Payment policies vary between providers; you may be asked to pay at the time of your treatment, or the provider may send you a bill in the post after your appointment. Please note that the provider has every right to charge you at the time of your treatment. They can contact Meritain Health (the contact details are on your ID card) to find out what your co-pay should be.    
 
If you are exempt from NHS co-pays (e.g. if you are pregnant or you’ve had a baby in the 12 months before treatment starts), you may claim your co-pays for treatment.   


To support the changes the majority of people will be facing in light of COVID-19, the Central Processing Centre (CPC) have invoked a Temporary Claims Process to ensure payments to both personnel and suppliers continue to be made. This process will temporarily replace the need to send wet signatures via post to CPC for claims, thereby making it easier for personnel to submit claims while working remotely and/or without leaving their house and enabling the CPC to continue to process claims remotely at reduced staffing.

Please click on this link for instructions on how to submit an electronic claim.

All dental claims should be made on a Form 200. You must attach:   
 
  • An itemised receipt from the dental provider attached (a credit card slip will not be accepted) 
  • The corresponding Meritain Health Explanation of Benefits 
If you do not attach the receipt the claim will be returned to you unpaid.  
 
Multiple co-pays made to the dental provider   
Please note that if you are charged multiple co-pays for a course of treatment (you are only responsible for one co-pay per course of treatment, however a provider may charge you for each service at the time your receive treatment – see Dental Care for details), any overpayments cannot be claimed through the Claims Processing Centre at the British Embassy. Instead, your dental provider will need to refund you any overpayments once they have received payment from Meritain Health.   
 

Traffic accident claims  

If you require medical treatment as a result of a traffic accident all bills will go through Meritain Health initially. If a flagged treatment code appears on the bill for your medical treatment, Meritain Health will send you a Third Party Liability form in the post. You will need to fill this out and submit it to Meritain Health along with the relevant auto insurance information.    
 
Meritain Health will then contact the auto insurance company directly for payment. If Meritain Health cannot acquire payment from the auto insurance the MOD will fund your treatment. 
 
If for any reason you receive a settlement for the injuries sustained during a traffic accident, the costs of your medical bills are part of this settlement.  
Last Updated: Aug 3, 2021 @ 6:41 pm

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