Kelsey Care Medical Plan Explained

• 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.

New rates for 2023

For additional information, view The 2023 Benefits Guide.

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 the pharmacy deductible
6. Preventive services are not subject to the deductible
7. The copays in the Kelsey plans are not subject to deductible
   

CVS HealthHUBs and MinuteClinics are now in-network for Kelsey-Seybold ACO
The CVS HealthHUBs and MinuteClinics are now in-network facilities for the Kelsey-Seybold ACO network. This includes the Kelsey-Seybold Select Plan, Basic Plan, and Basic Plus plans.

Kelsey ACO members may access these facilities for a variety of services for an office visit copay of $30 per visit and $65 for each visit with a licensed behavioral health counselor.

As a reminder, Texas Medical Neighborhood and Memorial Hermann ACO members will continue to have access to the CVS HealthHUBs and must satisfy their deductibles and coinsurance in order to use the service. To learn more about CVS HealthHUBs and MinuteClinics, including plan benefits, locations, and services, please contact Aetna customer service at 877-224-6857.

How to Find a Provider from HISD Benefits on Vimeo.

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.

What you get with Kelsey ACO

Predictable Costs:

• $30 for Primary Care office visit
• $65 for Specialist office visit
• Lab tests and X-rays are subject to deductible and coinsurance.

Virtual Health Video Visits

• $20 for Primary Care
• $55 for a 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 among 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 FAQs here and see the Kelsey-Seybold Care provider guide here.