UKBC Healthcare FAQ
Meritain Health is the administrator of the MOD’s healthcare plan. They process all claims received from healthcare providers, and pay them on the MOD’s behalf. They are not an insurance provider, and the MOD’s plan is not a commercial insurance plan whereby a monthly premium is paid for a set package of benefits. Instead, the MOD has a self-insured healthcare plan. The Department pays for all healthcare obtained through the plan directly from its own funds.
Aetna Choice POS II is a network of medical providers, whilst Aetna Dental Access is a network of dental providers. When the holder of a healthcare plan (in this case the MOD) has signed up to use a particular network, all providers that are part of that network must offer considerable discounts on their fees to any members of that plan who use them.
No. For all non-emergency medical care, you must see a doctor that is in the Aetna Choice POS II network of providers. All of your medical providers (GPs, specialists, surgeons, hospitals, diagnostic centres etc), including any specialists you are referred to, must be ‘in-network’ with Aetna. Any dentist you see must be part of the Aetna Dental Access network. You can locate an ‘in-network’ provider near you by calling (+1) http://www.aetna.com/docfind/custom/mymeritain. Please ensure you check a provider’s network status using the number/website above, not with the provider themselves. The MOD will not fund ‘out-of-network’ care.or by using this website:
No. When you arrive in the US, you do not have to register with a GP as you would in the UK. If you try to register, the doctor will want to schedule you for a ‘Wellness Check’, which is not covered by our healthcare plan. Rather, you should not visit a doctor until you have a clinical cause to do so (i.e. to diagnose and treat an illness or for monitoring of a pre-existing condition).
You are entitled to all medically necessary treatment that would be available to you on the NHS in England. Some appointments/procedures/treatments are automatically covered and require no authorisation; however others require approval before you receive treatment. It is important that you familiarise yourself with these before you receive any care, by reading through the guidance. If you have any treatment that is not automatically covered before receiving approval, it will be a personal expense.
For details on the benefit entitlements including what is covered and what is not covered, click on this LINK.
If your doctor recommends a non-urgent medical procedure (e.g. an operation) or a course of treatment for a specific problem, you need approval for your treatment before you receive care. You should contact the Healthcare Coordinators at the British Embassy, providing details of the treatment required. This information will be anonymised and sent to a UK doctor in the Defence Medical Services, who will determine if the treatment is appropriate and would be available on the NHS, and therefore approved at public (UK taxpayer) expense.
No. A Wellness Check is a medical examination that is aimed at preventing health problems in an apparently healthy person. It can include routine testing (e.g. blood tests), and is in contrast to a medical examination that would be carried out to diagnose a problem where there are specific symptoms. Wellness testing is routine for most Americans, however it is not funded by the MOD as it is not available on the NHS.
A co-payment, or co-pay, is the portion of a charge for dental treatment, sight tests and prescriptions that is your personal responsibility to pay (adults only). It is equivalent to an NHS contribution in England.
Whenever you receive care, you must present your Meritain Health ID card to the healthcare provider. The provider will then bill Meritain for the cost of your care, who will pay the provider directly. You should not receive any bills showing a patient responsibility (the portion of the charge for care that must be paid by the patient) other than your co-pay, provided you have used an ‘in network’ provider and have only had authorised treatment. If you do receive a bill, you should contact the Healthcare Coordinators for guidance.
Your doctor may give you a paper prescription, or they may send your prescription electronically to a pharmacy of your choice. You can use/choose any pharmacy you like. You must present your Meritain Health ID card to the pharmacist when collecting your prescription. You will only be charged a co-pay (adults only), which you should pay directly to the pharmacist.
If you are within the USA and you require emergency medical care you can visit any ER to obtain treatment. Please see the guidance under ‘Emergency care’ for further information. If you require emergency prescription drugs while travelling, you can take your prescription to any pharmacy.
If you require emergency dental care while travelling, you can seek emergency treatment from a dentist that is in the Aetna Dental Access network. Please see the guidance under Dental Care for further information on emergency dental treatment.
When travelling outside of the US (including Puerto Vico and Virgin Islands) and the UK for pleasure you are not covered by the MOD for medical and dental treatment and you are strongly advised to take out private medical insurance. If you are an MOD employee travelling outside of the US or UK on business, please obtain an Emergency Medical Treatment Authorisation letter prior to travelling.