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2024 Plan and Legal Documents

Machine-Readable Files (MRF)

Machine-Readable Files (MRF)

Aetna creates and publishes the Machine-Readable Files on behalf of HISD. To link to the Machine-Readable Files, please click here.

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Benefits Guide

2024 Benefits Guide

HISD-Benefits-Guide-2024-10-5.pdf 32.87 MB (Last Modified on October 16, 2023)

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2023 Benefits Guide

2023_Benefits_Guide_Final_optimized.pdf 5.54 MB (Last Modified on May 24, 2023)

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2022 Benefits Guide

2022_Benefits guide _FINAL.pdf 15.77 MB (Last Modified on November 11, 2021)

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Medical Plan Summary

2024 Kelsey Select ACO Benefits Summary

2024 Kelsey Select ACO Plan SBC FINAL 10-27-2023.pdf 768.08 KB (Last Modified on November 6, 2023)

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2024 Kelsey Basic ACO Benefits Summary

2024 Kelsey Basic ACO Plan SBC FINAL 10-27-2023.pdf 783.59 KB (Last Modified on November 6, 2023)

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2024 Kelsey Plus ACO Benefits Summary

2024 Kelsey Plus ACO Plan SBC FINAL 10-27-2023.pdf 784.46 KB (Last Modified on November 6, 2023)

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2024 Memorial Hermann Basic ACO Benefits Summary

2024 Memorial Hermann Basic ACO Plan SBC FINAL 10-27-2023.pdf 766.21 KB (Last Modified on November 6, 2023)

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2024 Memorial Hermann Plus ACO Benefits Summary

2024 Memorial Hermann Plus ACO Plan SBC FINAL 10-27-2023.pdf 765.14 KB (Last Modified on November 6, 2023)

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2024 TMN Basic Plan Benefit Summary

2024 TMN Basic Plan SBC FINAL 10-27-2023.pdf 764.02 KB (Last Modified on November 6, 2023)

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2024 TMN Plus Plan Benefits Summary

2024 TMN Plus Plan SBC FINAL 10-27-2023.pdf 769.48 KB (Last Modified on November 6, 2023)

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Legal Documents

2024 HISD MetLife links

2024-MLP_Video_Links.pdf 72.43 KB (Last Modified on December 13, 2023)

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2024 TRS Compatibility Plan Year

2024-TRS_Compatability_09012022_Plan_Year.pdf 131.73 KB (Last Modified on December 13, 2023)

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2024 HISD Legal Notices Disclosure

2024-HISD_2022_Legal_Notices_Disclosure_-_w_Non_Creditable_Covrge_Lang.pdf 757.9 KB (Last Modified on December 13, 2023)

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More on MRF requirements here.

Prescription Drugs

2024 Express Scripts High Performance Alpha

High Performance Alpha PRMT1703A-24-CRP1256403-241001-42_100124.pdf 132.38 KB (Last Modified on October 1, 2024)

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2024 Express Scripts High Performance Formulary

High Performance Alpha PRMT1703A-24-CRP1256403-241001_100124.pdf 132.38 KB (Last Modified on October 1, 2024)

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2024 High Performance Formulary Alpha

High Performance Alpha PRMT1703A-24-CRP1256403-241001_100124.pdf 132.38 KB (Last Modified on October 1, 2024)

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2024 National Preferred Alpha with Exclusion List

National Preferred Alpha with Exclusion List.241001-100224.pdf 326.65 KB (Last Modified on October 2, 2024)

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2024 Rx SPD Consumer Plan OA

2024 Rx SPD ConsumerPlan-OpenAccess FINAL 07-24-2023.PDF 612.48 KB (Last Modified on September 18, 2023)

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2024 Rx SPD Select Plan

2024 Rx SPD Select Plan FINAL 07-24-2023.PDF 840.75 KB (Last Modified on September 18, 2023)

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Dental

2024 DHMO Benefits Summary

2024-CA-SDBC-DHMO-PCS-HIXV9_01-01-24_HISD.pdf 139.99 KB (Last Modified on October 5, 2023)

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2024 DPPO Benefits Summary

2024-Ben-Sum-DENT_01-01-2024_HISD_3339209.pdf 196.8 KB (Last Modified on October 5, 2023)

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2024 Dental HMO Fee Schedule

2024-DHMO-PCS-HIXV9_01-01-24_HISD_3339209.pdf 262.28 KB (Last Modified on October 5, 2023)

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2024 Dental Summary BuyUp Plan

2024-Dental-Summary-BuyUp-HISD_3339209-v101723.pdf 117.97 KB (Last Modified on October 17, 2023)

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