Memorial Hermann
MEMORIAL HERMANN MEDICAL PLAN COMPARISON
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2024 coverage cost comparison
For additional information, view the 2024 Benefits Guide.
- Kelsey ACO PCP and specialist copays do not count toward the annual deductible but do apply toward the annual out-of-pocket maximum.
- Free if you are enrolled in an HISD medical plan
- Pre-certification may be required
- OBGYN specialists are tiered
- Copay applies after the pharmacy deductible
- Preventive services are not subject to the deductible
- The copays in the Kelsey plans are not subject to deductible
- If a footnote is not shown on this chart, it does not apply to this plan option.
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Memorial Hermann ACO Medical Plan Explained
Memorial Hermann ACO Medical Plan Explained from HISD Benefits on Vimeo.
There are two Memorial Hermann plan options
The Basic plan offers lower premiums each month but has higher deductible and co–insurance 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 maybe right for you.
The Plus plan has higher premiums than the Basic plan, but 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.
Important: The Memorial Hermann ACO plan pays benefits ONLY when you receive care from the Memorial Hermann ACO network providers. If you seek care outside the network, you will pay the full cost of care out of your own pocket.
Both plan options include prescription drug benefits administered by Express Scripts. You meet a separate prescription drug deductible each year and then pay the appropriate copay for your prescriptions.The Memorial Hermann ACO network is a healthcare system with:
- More than 700 primary care doctors
- More than 3,000 specialists
- 12 acute care hospitals
- 62 walk-in clinics
- 86 urgent care centers
Memorial Hermann physician groups and hospitals are located in and around Houston and surrounding areas. Follow this link to search for providers.
How to Find an In-Network Provider in the Memorial Hermann ACO Medical Plan
How to Find an In-Network Provider in the Memorial Hermann ACO Medical Plan from HISD Benefits on YouTube.
Who is Memorial Hermann?
- 110-year-old, not-for-profit, community-owned health system
- 320+ unique sites of care
- 2.3 million annual patient encounters
- 3,200 clinically integrated providers through Memorial Hermann Accountable Care Organization
- Largest PCP network in Houston
- Over 26,000 employees
- Donates more to the United Way than all other healthcare providers in Houston area combined
Memorial Hermann Accountable Care Network coverage area map
Everyday Well
Focus on providing convenient physical and virtual care options. Different levels and types of care to promote appropriate usage based on individual needs. Everyday Well delivers secure access to your health care anytime, anywhere. Easily access Everyday Well on your computer, tablet, and smart phone with the Everyday Well app or by visiting EverydayWell.com.
Experience Everyday Well online or download the app on Google Play and App Store
Everyday Well offerings:- Primary Care
- Convenient Care Center
- Urgent Care
- 24-hour ER
- Virtual Care
- House Calls
- Nurse Health Line
Everyday Well FAQ's
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How can I join Everyday Well?
- If you already had a MyMemorialHermann patient portal account, visit Everydaywell.com. Click the SECURE LOGIN button and sign in using your email address and password from your MyMemorialHermann account. We will automatically link your patient account to Everyday Well.
- If you did not have a MyMemorialHermann patient portal account, but shared your email address at registration, you should have received an email invitation from Memorial Hermann inviting you to join and create an Everyday Well account. The email invitation will expire after 90 days, but you will receive a reminder before it expires. If you forget to accept the invitation before the expiration, please call our support center at (713) 222-CARE (2273) and we will resend your email invitation.
- If you did not have a MyMemorialHermann patient portal account and did not share your email address at registration, visit Everydaywell.com to sign up. Click the SIGN UP button, enter your personal information and click CREATE ACCOUNT. Once you validate your email by clicking on the activation email, you will have access to Everyday Well.
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Do I have to be a Memorial Hermann patient to use Everyday Well?
Anyone interested in managing his or her health may sign up to use the Everyday Well website. If you are a Memorial Hermann patient, you will have access to patient information such as medical records, bill pay and appointment scheduling. If you are a Memorial Hermann Health Plan member, you will have access to patient information, benefits, claims and ID cards.
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How do I log in to the Everyday Well site?
Download the Everyday Well app or access Everyday Well by visiting EverydayWell.com. Click on Secure Login and enter the email address and password associated with your account. If you have forgotten your password, click “Forgot your password?” and enter the necessary information.
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Who do I call for help with Everyday Well?
If you have an issue signing into Everyday Well or experience other technical issues, please call patient support at (713) 222-CARE (2273).
To get answers to Frequently Asked Questions or to log in once you have enrolled, visit EverydayWell.com
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Memorial Hermann Care Management Team
Multidisciplinary care team provides personalized care plans – including care coordination, navigation, social work, and health coaching – for patients in the ACO identified as at high risk for experiencing adverse health outcomes by our risk stratification tools, including those with:- Complex chronic conditions
- Multiple hospital admissions or re-admissions
- Multiple ER visits
- Increased utilization of healthcare services
- Referrals from primary care providers
- Complex pharmacy needs
- High risk transitions between care sites
Aetna Whole Health - Memorial Hermann Accountable Care Network plans
Memorial Hermann Accountable Care Network plans are a new way of looking at health care. We’ve designed these health benefits and insurance plans to improve the quality of your care, provide a better experience for you and your family, and save you money. You’ll have access to a special network of primary care doctors, specialists and hospitals focused on you. Led by a primary care doctor you choose, your care team will work with you to:- Help keep you healthy or improve your health, not just treating you when you’re sick or injured
- Better coordinate your care and keep tabs on your prescriptions, lab results, health history, and more
- Spot problems and build personalized care plans to treat you
- Encourage you to play an active and informed role in your health and health care decisions
Aetna Whole Health FAQ's
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How are the Aetna Whole Health — Memorial Hermann Accountable Care Network plans different from other plans?
First, you’ll have access to a special network of primary care doctors, specialists, and hospitals focused on you. Led by a primary care doctor you select, your Aetna Whole Health — Memorial Hermann Accountable Care Network care team will work with you to help keep you healthy or improve your health.
Second, like other health plans, your Aetna Whole Health — Memorial Hermann Accountable Care Network doctors and hospitals get a fee for their services. Under the Aetna Whole Health plan, they can also earn more when they deliver higher quality care. So when they meet certain goals, they’re rewarded. But if they fall short on those goals, they’ll make less. Third, we may share some of your health information with your Aetna Whole Health — Memorial Hermann Accountable Care Network providers in a secure manner in compliance with applicable law. That extra data can help them make parts of your care work better and cut down on duplicate tests or doctor visits that can add to your costs. However, providers who aren’t part of the integrated network might not coordinate your care and the data may not be shared the way we described above. -
How does it work?
To start off on the right foot, it is recommended that you choose a primary care doctor to lead your Aetna Whole Health — Memorial Hermann Accountable Care Network care team. Your doctor and other health care providers will generally refer you to specialists and hospitals in the Memorial Hermann Accountable Care Network. Then, electronic health records help keep you and your care team on the same page. That’s because they can keep track of your prescriptions, lab results, health history and more. Having this big-picture view of your health can also help them spot gaps in your care. And if they find that you’re at risk for certain conditions, they can build a personalized care plan to treat you.
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Why should I choose a primary care doctor when I enroll?
The doctor you pick will lead your care team. That’s important because you should see your doctor not only when you’re sick, but also for your annual wellness exam, including preventive screenings. Your doctor can also help you find care programs tailored to your needs. They can guide you on important health decisions. And coordinate your care across other specialties and facilities in your network.
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How do I find a primary care doctor?
Visit aetna.com/docfind and:
- Type “primary care doctor” in the search field
- Enter your ZIP code or city and state
- Choose (TX) Aetna Whole Health — Memorial Hermann Accountable Care Network from the “Select a Plan” drop-down menu
- Pick a doctor from your search results
The name of your plan is located on your enrollment forms ID card.
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Do I need to see my primary care doctor for referrals?
Your plan doesn’t require a referral to see a specialist, but it’s always a good idea to consult with your primary care doctor on your care plan. They can then better coordinate your care across all facilities and specialists in your Aetna Whole Health plan network.
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How can I manage my health care on the go?
After you register for your secure member website, you can download our free Aetna® Mobile app to:
- Find network doctors, urgent care centers, pharmacies and more
- View your member ID card, claims history and disability benefits
- Check your benefits and coverage information
- See how much tests, procedures and appointments could cost you with the Member Payment Estimator tool
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How can I get the Aetna Mobile app?
Text “Apps” to 23862 to download the free Aetna Mobile app now. To learn more, visit us at aetna.com/mobile. After you download the app:
- Tap on “Aetna Mobile” and then if you haven’t already created an account on Aetna Navigator, you can do so on the app. If you already have a user name and password, you can log in via the app right away.
- Once you log in you’ll be able to view everything you can access on the Navigator website.
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What if I’m not at home and need care?
If your health or life is in serious danger, call 911 or go to the nearest hospital. You’ll be covered as though you stayed within the network.
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How can I use my benefits effectively?
First, register for your secure member website at aetna.com. Next, pick a primary care doctor to lead your care team (if you didn’t already). Then, schedule your annual wellness exam. Finally, check out myaetnawholehealth.com for a member welcome guide and video.