Frequently Asked Questions – Benefits Change
Below are answers about SOMSD’s transition to Meritain effective January 2026.
What is changing and when?
Effective January 1, 2026, the District’s medical administrator will change to Meritain, an Aetna company. Meritain uses the Aetna Choice POS II network. Prescription coverage will move to CVS Caremark, Aetna’s parent company.
Why is the District changing plans?
To help control rising healthcare costs while maintaining benefit levels. Switching to Meritain allows the District to manage expenses with no change in your current benefit structure.
What do I need to do?
Enrollment is passive. Current enrolled employees will automatically move to equivalent Meritain plans. Contact Human Resources only if you wish to change your plan.
Will I get new benefit cards?
Yes. Meritain will mail new ID cards with a Coordination of Benefits form. Complete and return the form as instructed. You can also access digital ID cards on the Meritain or CVS Caremark websites once your plan is active.
How does the Aetna provider network compare to Horizon’s?
The networks are similar in size, with over 94% of members’ current providers participating in both. You can confirm your provider using the Aetna Choice POS II (Open Access) search.
Are medical or prescription benefits changing?
No. Copays, deductibles, coinsurance, and other benefit levels remain identical to current coverage.
When does dependent coverage end?
Dependent coverage will continue through the end of the calendar year in which the dependent turns 26.
Is out-of-state coverage available?
Yes. The Aetna Choice POS II network is national.
Which labs and imaging facilities are in-network?
Most labs are in-network. The major ones include LabCorp and Quest. Verify at Aetna’s provider search.
Do pre-existing conditions apply?
No. Under the ACA, pre-existing conditions are covered. Your enrollment rolls into an equivalent Aetna plan.
What if I have an appointment or surgery near January 1?
Notify your provider of the carrier change so they can obtain new authorizations. Prior approvals under NJ SEHBP will not carry over to Meritain.
What if I’m being treated by a provider not in the Aetna network?
Submit a Transition of Care form to Meritain. They will review your case and inform you of eligibility for transition coverage.
How do I get prior authorizations or continue case management?
Meritain follows the same prior authorization and case management process as Horizon for in-network services.
Are there any new benefits with Meritain?
Yes. Members gain access to CVS MinuteClinic services—virtual or in-person at over 900 locations nationwide, seven days a week.
Will my prescription coverage change?
No, but formularies update every six months. Review the CVS Caremark Formulary. If you use mail-order or specialty medications, submit new prescriptions to CVS Caremark or ask your physician to e-prescribe.
Will GLP-1 medications be covered?
Yes. GLP-1s remain covered for diabetes and weight loss. Wegovy is the preferred medication for weight-loss prescriptions.
Is there a gym reimbursement?
Yes. Meritain offers a $20 monthly gym reimbursement once you submit the required form.
Are there incentives with the new plan?
Meritain members can access LifeMart, an exclusive discount marketplace offering savings on travel, groceries, entertainment, and more through the LifeMart app.
Where can I learn more about health plan basics?
Need Support?
For help with existing plans, please contact the Administration Building.
School:
(973) 762-5600 ext. 1821
For the broker support line, please email SOMSDHelpline@fairviewinsurance.com
Responses are provided within 24 hours.