With an ACO plan, you have a care team working together to coordinate services, provide quality care, and keep you healthy. They share information such as medical history, current medications, and test results.

This means everyone is familiar with your treatment, needs, and goals, and gaps in care are easier to spot and address. This plan encourages you to find a Primary Care Physician (PCP) who can help manage your care and make referrals as necessary, but you don’t need a referral if you choose to see a Kelsey specialist.

Through Aetna, you will have access to the Informed Health® Line, a 24/7 nurse line. The nurses can help guide you to care and answer your medical questions. The Kelsey Plan also has telemedicine available for a flat fee dependent on if you want to speak with a Primary Care Physician or a specialist. Please see the chart in this brochure for detailed plan information and costs.

You and your dependents ages 5 and up who are enrolled in the Kelsey Select Plan pay nothing for your care at HISD Employee Health & Wellness Centers, which are located at Hattie Mae White Educational Support Center and Attucks Middle School.

The centers provide non-emergency services, including routine immunizations and care for minor illnesses. They can also help you with getting your chronic conditions under control while you find a Primary Care Physician (PCP). NOTE: No Worker’s Compensation injuries are treated at the clinics.

For Select Plan members and your covered dependents, only Next Level Urgent Care Centers offer you and your family medical services for any urgent care needs. These services are provided at any of the Next Level clinics, currently at specific locations around the Houston area. The best part is, these services are provided at no cost to you and your covered dependents, as long as you and your covered dependents are enrolled in the Kelsey Select ACO plan.

You can set aside pre-tax money from your paycheck in a healthcare FSA to help pay for eligible medical expenses, including dental and vision. For details, visit HISDbenefits.org.

With the Kelsey Select ACO, you are not limited to referrals from your Primary Care Physician. As long as your specialist is in the Kelsey network, you are covered. What’s more, you can go to Kelsey-Seybold.com to find a provider, make an appointment, email your doctor, and much more.

Your copay for a trip to the ER is $300 plus 30% after meeting your deductible. Save money by using the Next Level Urgent Care Centers or the HISD Employee Health and Wellness Centers. There are 14 Next Level Urgent Care locations throughout the Houston area and two HISD clinics. The Next Level Urgent Care Centers are free to members enrolled in the Kelsey Select ACO.

• The Select Plan includes generics and, when a generic isn’t available, some brand-name drug benefits on Express Scripts’ High Performance Formulary. These are available through mail order or at Express Scripts’ retail pharmacy partners, including Costco, HEB, Kroger, Randalls, and Walmart.
• The prescription plan features generic prescriptions for $20 or less.
• You pay $0 for generics to treat high blood pressure, high cholesterol, and diabetes with a 90 day supply.
• You can get long-term maintenance medications through mail order or by going to any Express Scripts retail partner. No matter which option you choose, your copay remains the same. You can get two 30-day supplies of newly prescribed maintenance medications at any network pharmacy. After that, you can save money by ordering a 90-day supply through Express Scripts, delivered either by mail or to one of their retail partner locations. Be sure to ask for a 90-day prescription from your physician to qualify for the lower cost.
• When a generic isn’t available, brand-name drugs on the High Performance Formulary may be covered.
• There’s no separate deductible for prescriptions.
• Prior authorizations, quantity limits, and step therapy may apply.
• Please note that the Kelsey clinic pharmacies are now part of Express Scripts’ Smart 90 network.