Financial Disclaimer: This article is for informational purposes only and does not constitute financial, tax, or legal advice. Consult a qualified financial advisor or tax professional for advice specific to your situation.
Yes, Meritain Health covers birth control at no charge to plan members when it's part of a preventive care benefit under the Affordable Care Act.
What is Aetna meritain?
Aetna Meritain is a third-party administrator (TPA) and health benefits subsidiary of CVS Health that designs and administers self-funded employer health plans using Aetna's provider networks and CVS pharmacy resources.
By 2026, Meritain operates independently within the CVS Health ecosystem, delivering customized health plans for employers. These plans combine carrier-level discounts with in-house products and vendor partnerships, giving companies more flexibility than traditional insurance models.
Does meritain require referral?
No, Meritain plans generally don't require referrals for most services, so members can usually see specialists without getting approval from a primary care doctor first.
That said, some high-cost services or out-of-network care might still need authorization. When in doubt, call customer service at 1-800-566-9311 before scheduling anything—it'll save you from surprise bills.
Is meritain health a TPA?
Yes, Meritain Health is a third-party administrator (TPA) that processes claims, manages provider networks, and supports self-funded employer health plans.
As a TPA, Meritain doesn't take on insurance risk itself. Instead, it partners with Aetna and CVS to deliver medical, pharmacy, and wellness benefits. Honestly, this setup often gives employers more control over their health plan designs than traditional insurance would.
Does CVS own Aetna?
Yes, CVS Health owns Aetna after completing a $69 billion acquisition back in 2018.
The merger created one of the biggest healthcare conglomerates in the U.S., blending pharmacy services, insurance, and care delivery under one corporate umbrella. Five years later, the integration still drives most of CVS's growth strategy. To learn more about how this impacts health coverage, see our article on Meritain Health's coverage policies.
Who is Aetna owned by?
Aetna has been owned by CVS Health since 2018 and operates as a subsidiary within its larger healthcare ecosystem.
Type
Products
Revenue (2018)
Employees (2018)
Parent
Subsidiary
Health insurance
$60.6 billion
47,950
CVS Health (2018–present)
How long does meritain take to process claims?
Meritain typically processes 95.6% of claims within 10 business days and maintains over 99% payment accuracy.
These metrics have stayed consistent since 2026, though complex claims or out-of-network services might take a bit longer. The company prides itself on keeping payment cycles short—something employers and providers both appreciate.
What is meritain payer ID?
The Meritain Health payer ID is 64158, used for electronic claims submission on CMS-1500 (professional) and UB-04 (institutional) forms.
Double-check this ID with your billing team or on your patient ID card before submitting any claims. Using the wrong payer ID can delay processing or even result in denials.
How do I find my meritain claims?
Check your Meritain claims online through your member portal or call 1-800-566-9311 for 24-hour automated support.
Once logged in, you can view real-time claim statuses, explanation of benefits (EOBs), and payment details. The portal updates daily, so you'll always have the latest information at your fingertips.
What is coinsurance health plan?
Coinsurance is the percentage you pay for covered services after meeting your deductible—for instance, 20% of a $100 office visit after your deductible is met.
Unlike a flat copay, coinsurance means your out-of-pocket cost changes based on the service's total allowed amount. In 2026, most plans range from 10% to 40% coinsurance, so check your specific plan details.
How do I submit a claim to meritain?
Log in to your Meritain Health account and click “Submit a Claim” to upload documentation for any covered member.
Choose the right claim type—like General Medicine—attach any supporting documents, and submit electronically. Electronic submissions process faster, so avoid mailing paper forms whenever possible.
How do you pronounce meritain?
What is Mer healthcare?
“MER” in healthcare usually means Medical Expense Ratio (also called Medical Loss Ratio), which measures how much of premium revenue goes toward medical benefits.
Regulators use this ratio to check insurer efficiency and financial stability. As of 2026, the Affordable Care Act requires large group plans to maintain an MLR of at least 80%.
What is insurance deductible in the USA?
A deductible is what you pay out-of-pocket before your insurance kicks in—for example, a $2,000 deductible means you cover the first $2,000 of care yourself.
After hitting that deductible, you typically only pay copays or coinsurance. In 2026, deductibles vary widely—from $500 for some high-deductible plans to $8,000 for others. Always check your specific plan details.
Why did CVS and Aetna merger?
CVS and Aetna merged to build a vertically integrated healthcare giant aiming to cut costs, improve care coordination, and capture value across pharmacy, insurance, and clinical services.
Not everyone was thrilled about the deal. The American Medical Association and other critics warned it could reduce competition and push premiums higher in some markets. Regulators eventually approved it with certain conditions.
Did CVS overpay for Aetna?
Analysts and CVS executives have called the $69 billion price tag steep, especially compared to earlier big acquisitions like Omnicare ($12.7 billion).
But CVS argued the deal made long-term sense for integrating care delivery and pharmacy benefits. By 2026, the company claims the acquisition has paid off through cross-selling and operational efficiencies.
Can Aetna force you to use CVS?
No, Aetna and CVS can't force patients to fill prescriptions at CVS pharmacies thanks to anti-steering and transparency rules.
CVS still has to publicly disclose drug rebates and how much it keeps from those rebates. Members can use any in-network pharmacy unless their employer plan specifically restricts pharmacy choice.
What is Bertolini salary?
Mark Bertolini earned $320,667 as an Independent Director at Verizon in 2026, according to SEC filings.
That's standard pay for corporate directors at large companies. It's worth noting this isn't related to his former role as Aetna CEO, where his compensation was significantly higher.
What is Aetna known for?
Aetna is one of the largest diversified healthcare benefits companies in the U.S., offering medical, pharmacy, dental, and behavioral health insurance nationwide.
With over 22 million members, Aetna stands out for its broad provider network, digital tools, and employer-focused health solutions. It's particularly strong in Medicare Advantage and employer group plans.
How does Aetna make money?
As of 2026, most of Aetna's revenue comes from government programs like Medicare Advantage and Medicaid, followed by employer group plans and individual exchange plans.
The company also earns significant income from pharmacy benefit management (PBM) and administrative services. Diversifying across payment models helps stabilize revenue, especially when employer plans fluctuate.
Edited and fact-checked by the FixAnswer editorial team.
