Frequently Asked Questions: Medical Expense Reimbursement Plan (MERP)

What is a MERP?

MERP is an abbreviation for Medical Expense Reimbursement Plan. This type of plan is established by your employer to reimburse covered employees (and their covered dependents if applicable) for expenses not normally covered under the group health plan sponsored by the employer. The following are examples of expenses commonly reimbursable under a MERP, dental or vision expenses or deductible and coinsurance (often referred to as out-of- pocket expenses). The plan document controls what is actually covered under your MERP. Please refer to EGA’s website www.ega-inc.com to view plan information online or contact your employer for a copy of the plan document.

How do I submit a claim?

Claim procedures are unique to each MERP. Generally, after the group health plan has paid or denied the expense, you submit a claim form, Explanation of Benefit (EOB) provided by the group health plan and a copy of the medical invoice to EGA for processing. (See below for procedures that apply to Significa Insurance Group.) Please note, a copy of the medical invoice is not always required; refer to your plan document for specific instructions.

Claim forms are available on EGA’s web site at www.ega-inc.com. Click on “Member” and then “Forms.” In addition, you can obtain a claim form from your employer or by contacting EGA’s customer service department at 717-581-1300 or 800-433-3746.

Please attach the required information to the MERP claim form and forward to EGA as follows:

Address:	EGA, Inc. P.O. Box 7777 Lancaster, PA 17601-7777
Email:	customerservice@ega-inc.com Please note, you should encrypt email that includes protected health information to assure your privacy.
Fax:	(717) 581-8379

How long does it take to process a claim?

EGA is committed to a claim turn around time of 5 business days. After processing, claim funding information is presented to your employer. Checks are generally issued the week following processing. When your claims are processed, they can be viewed on EGA’s secure member web site.

As part of EGA’s quality assurance program, a claim you submit may be randomly selected for a pre-check audit. Audited claims will be released for check processing as quickly as possible but no later than 3 days from the selection date.

What is a member ID?

This is the unique alpha-numeric member identification number that is assigned by EGA at enrollment. The first three characters are alpha, followed by six numbers. The member ID can be located on EOBs and other correspondence generated by EGA. When you contact our customer service department you will be asked for this information. If you do not have it available you can also provide your Social Security Number. If your spouse is contacting us, he or she will need to provide your Social Security Number. This verification process is necessary to assure we protect the privacy of our members.

MERP with Significa Insurance

Please note, if you are covered under a Significa Insurance Group policy, and your employer has contracted with EGA to administer the MERP, EGA will automatically process claims under the group health plan and MERP. Therefore, you will not be required to submit claims separately to the MERP for reimbursement. However, if your MERP covers expenses not normally covered under the group health plan, please follow the claim procedures described in your plan document (see above).

Your Significa group health plan EOB will be issued prior to your MERP EOB. Please read the messages on the first EOB carefully to determine whether charges will be considered under the MERP.

Payment can be issued directly to the provider.