Kelsey Care Medical Plan Explained

Kelsey Care Medical Plan Explained from HISD Benefits on Vimeo.

There are three Kelsey ACO plan options

The Basic plan offers lower premiums than Plus options but has higher deductible and coinsurance amounts. This means you will pay more when you need health care. If you don’t visit the doctor often and use the plan mostly for preventive care, the Basic option may be right for you.

The Plus plan has higher premiums than the Basic plan, and the deductible and coinsurance amounts are lower. This means more of your expenses will be covered when you need care. If you think you will visit the doctor often and need more care, the Plus option may be right for you.

The Select plan has the lowest deductible and out-of-pocket maximum, but this option is only available to employees who make $29,120 or less in annual base salary.

Important: the Kelsey-Seybold ACO plan pays benefits ONLY when you receive care from Kelsey Seybold ACO network providers. If you seek care outside the network, you will pay the full cost of care out of your own pocket.

All plan options include prescription drug benefits administered by Express Scripts. You must meet a separate prescription drug deductible each year and then pay the appropriate copay for your prescriptions.

The Kelsey-Seybold ACO network

The Kelsey-Seybold ACO network is a provider group that includes:

• More than 400 doctors at 20 Houston-area Kelsey-Seybold Clinic locations:
• More than 150 primary care doctors and 180 specialists
• accredited ambulatory surgery centers
• 2 cancer center locations
• 1 sleep center

If you need hospital care, your Kelsey-Seybold doctor will determine the most appropriate hospital for your care. Kelsey has onsite pharmacies located at 15 of their clinics. Kelsey is also approved by Express Scripts as a Smart 90 pharmacy, so you can even get your 90-day maintenance medications filled at a Kelsey-Seybold pharmacy.

1. Kelsey ACO PCP and specialist copays do not count toward the annual deductible but do apply toward the annual out-of-pocket maximum
2. Free if you are enrolled in an HISD medical plan
3. Pre-certification may be required
4. OBGYN Specialists are tiered.
5. Copay applies after pharmacy deductible has been met
6. Preventive services are not subject to the deductible
7. The copays in the Kelsey plans are not subject to the deductible

How to Find a Provider 2021

How to Find a Provider 2021 from HISD Benefits on Vimeo.

To find a Kelsey Provider, click here
 > 

To view a map of Kelsey Clinics locations, click here >



PCP/Specialists Referrals
Kelsey Seybold Medical Group will be your assigned PCP; however, you can see any Kelsey Seybold PCP or Specialist at any of their locations without a referral

Telemedicine
Kelsey plans have a telemedicine program

Programs

• Aetna Community Care
• Aetna Simple Steps (Health Assessment/Online Wellness Journeys)
• 24 hour/7 day per week Informed Nurse line

What you get with Kelsey ACO
 Predictable Costs

• $30 for Primary Care - Office Visit.
• $65 for Specialist - Office Visit
• Lab tests and X-ray - subject to deductible and coinsurance.

 Virtual Health Video Visits

• $20 for Primary Care
• $55 for Specialist

Easy-to-Use Coordinated Network

KelseyCare Aetna offers quality and convenience

• See any Kelsey-Seybold doctor at any location, any specialty - no referral needed
• See a Doctor Today! Go to kelsey-seybold.com, enter your zip code, and schedule the next available appointment
• 24-hour appointment scheduling at 713-442-0000 or kelsey-seybold.com
• MyKelseyOnline - Email your doctor, get most test results, and schedule appointments online
• Virtual Health Services
  E-visits available 365 - days, evenings, and weekends; Video Visits available days, evenings, and weekends - for more than 50 medical conditions/symptoms, using your camera-enabled smartphone, tablet, or computer. Visit kelsey-seyboldvirtualhealth.com for more information.
• Access to world-class hospitals including CHI St. Luke’s Health, Texas Children’s Hospital, Memorial Hermann, Houston Methodist, and select HCA Hospitals
• After-Hours Kelsey Nurse Hotline at 713-442-0000
• Saturday appointments for sick and well care, 9 a.m. to 2 p.m. at four locations
• Pediatric appointments until 6 p.m. at specified locations. Free Get Acquainted visits with pediatricians.
• KelseyCare Aetna Concierge at 713-442-9593 helps you choose a doctor, find the most convenient clinic location, and resolve any questions or concerns

Kelsey-Seybold doctors admit to hospitals in the Texas Medical Center and in the community
Texas Children’s Hospital - Texas Medical Center, The Woodlands, West Campus
Houston Methodist - Baytown, Katy, Sugar Land, Texas Medical Center, The Woodlands, Willowbrook
CHI St. Luke’s Health - Texas Medical Center, Sugar Land, The Woodlands, The Vintage
Memorial Hermann - Katy, Memorial City, Pearland
HCA Houston - The Woman’s Hospital of Texas, Clear Lake Regional Medical Center

Why is this important for you and your family?
Your Electronic Medical Record - Kelsey-Seybold Clinic’s collaborative approach, and the electronic medical record system, allows seamless coordination between Kelsey-Seybold primary care, specialty care, pharmacy and nursing.

• Latest clinical information
• Lab results
• X-rays and advanced imaging
• Medications
• Preventive exams

Ambulatory Surgery Center

• 30 pre-op and 30 recovery beds
• 20,000 procedures a year
• 100 employees, 45+ surgeons
• Outpatient-based fee structure

The Kelsey-Seybold Cancer Center
Nationally Accredited Cancer Treatment, With A Personal Touch
As a nationally accredited cancer program, Kelsey-Seybold Cancer Center stays current with best practices and the nation’s rapidly advancing treatment guidelines. This means our patients receive the same nationally established treatment protocols for common cancers as they would at any leading cancer center in the country. With state-of-the-art radiation therapy and a newly-expanded Infusion Center at our Berthelsen Main Campus Clinic, our patients are able to see their doctors, get radiation preparation and treatment, chemotherapy, biopsies, scans, and other services in one location. MD Anderson Cancer Center is part of the Kelsey-Seybold referral network, when appropriate.

View KelseyCare Aetna FAQ. here and Kelsey-Seybold Care provider guide here