Medical Coverage

Memorial Hermann offers two medical plans, so you can choose the plan that’s best for you: the MH Care Plan and the MH Care Broad Access Plan.

Both plans are offered through Aetna and include pharmacy coverage through CVS/Caremark convenient virtual care options and $0 in-network preventive care.

In addition, in both plans, you have the opportunity to pay less for the care you receive when you visit facilities, clinically integrated physicians and other providers that are most closely aligned with Memorial Hermann, called the MH Preferred Tier. You will pay a lower amount when a copay is required and, after meeting your deductible, a lower percentage of total cost (10%) when you visit MH Preferred Tier providers.

How These Plans Differ

Each plan includes coverage outside the MH Preferred Tier: 

  • The MH Care Plan includes coverage for the Basic Tier, which is a network of providers that have agreed to negotiated rates, and consists of all other in-network physicians and pre-approved non-Memorial Hermann facilities for specialty care. Members choosing care from these providers are subject to higher copays and costs than those in the MH Preferred Tier. The MH Care Plan does not offer out-of-network coverage, except in emergencies or out-of-area care.* 
  • The MH Care Broad Access Plan includes the Aetna Broad Network, which consists of providers who are considered outside the MH Preferred Tier, giving you more covered providers to choose from. You will have higher out-of-pocket costs when you visit providers outside of the MH Preferred Tier.

Visit the Memorial Hermann Provider Directory on Aetna’s website to search for in-network providers and download the Aetna HealthSM app, so you can easily find providers on the go (look for the MAXIMUM SAVINGS tag) and access your ID card when you need care.

* Note: If you enroll in the MH Care Plan and cover a dependent who is away at school or who lives out of area, coverage is available through Aetna providers. You’ll need to add your dependent’s physical out-of-area address in Workday. Contact an Aetna Concierge Member Advocate at 800.334.9778 for more information on out-of-area coverage and eligibility. If you need help registering your dependent in Workday, contact HR Shared Services at 713.456.MHHR (6447).

Choose What’s Right for You!

While our medical plans offer coverage for the same services and supplies, they differ in two key ways. 

  • The MH Care Plan will cost you less in premiums, but offers fewer providers to choose.
  • The MH Care Broad Access Plan has higher premiums, but gives you more flexibility to choose providers. 

So, which is more important to you: Keeping your costs lower or having more provider options?

MH Care Plan

MH Care Broad Access Plan

MH Preferred Tier
(MH ACO Network)

Basic Tier

MH Preferred Tier
(MH ACO Network)

Broad Network Tier

Employee Health Credit Available

Yes

Covered Services

Annual Deductible 

$750 individual / $1,875 family

$1,000 individual / $2,500 family

$750 individual / $1,875 family

$2,000 individual / $5,000 family

Annual Medical and Pharmacy Out-of-Pocket Maximum 

$5,500/individual

$11,000/family 

$5,500/individual

$11,000/family 

Physician Office Visit 

$25 copay per visit 

$50 copay per visit 

$25 copay per visit 

30% after deductible 

Procedure in Physician Office 

10% after deductible 

25% after deductible 

10% after deductible 

30% after deductible 

Specialist Office Visit 

$40 copay per visit 

$75 copay per visit 

$40 copay per visit 

30% after deductible 

Physical Therapy, Occupational Therapy, Speech Therapy 

$15 copay per visit 

$30 copay per visit 

$15 copay per visit 

30% after deductible 

Allergy Testing 

$25 copay per visit 

$45 copay per visit 

$25 copay per visit 

30% after deductible 

Allergy Injections 

$15 copay per visit 

$25 copay per visit 

$25 copay per visit 

$25 copay per visit 

Preventive Services

Adult Wellness

$0

$0

Routine Adult Physical 

Exams and Immunizations

$0

$0

Mammogram

$0

$0

Well Child Care

$0

$0

Colonoscopy

$0

$0

Nutrition and/or 

Tobacco Counseling

$0

$0

Depression Screening

$0

$0

Type 2 Diabetes Mellitus Adult Screening

$0

$0

High Blood Pressure Screening

$0

$0

Emergency Care, Urgent Care, Walk-In Services and Telemedicine 

Emergency Department 
(copay in ER is waived, if admitted.)

$300 copay after deductible

$300 copay after deductible

 Ambulance*

25% after deductible

25% after deductible

Memorial Hermann Employee Medical Clinics
(acute visits only)

$0 copay per visit

$0 copay per visit

Urgent Care Visit

Memorial Hermann – Go Health urgent care – $25 copay (all other urgent care locations: $50 copay)

$50 copay

Memorial Hermann – Go Health urgent care – $25 copay (all other urgent care locations: 30% after deductible)

30% after deductible

Walk-In Clinic

$25 copay per visit

$50 copay per visit

$25 copay per visit

30% after deductible

Memorial Hermann eVisit

$15 copay per consultation

$15 copay per consultation

Memorial Hermann Virtual Clinic

$25 copay per consultation

$25 copay per consultation

Teladoc

$15 copay per consultation

$15 copay per consultation

Lab, Diagnostic and Imaging Services

X-Ray/Imaging*

$100 copay per visit  after deductible

25% after deductible

$100 copay per visit  after deductible

30% after deductible

Lab*

10% after deductible

25% after deductible

10% after deductible

30% after deductible

Maternity Services

Prenatal Office Visit

$40 copay, initial visit only

$75 copay, initial visit only

$40 copay, initial visit only

30% after deductible, initial visit only

Professional Fees

$500 copay

$500 copay

30% after deductible

Inpatient Hospitalization*

Included in copay above

Included in copay above

$1,000 per admission + 30% after deductible

Ultrasound

0% deductible waived

$75 copay per visit

0% deductible waived

30% after deductible

Lab*

0% deductible waived

$75 copay, initial visit only

0% deductible waived

30% after deductible

Anesthesiology Services

Included in copay above

Included in copay above

30% after deductible

Other Services

0% after deductible or applicable copay

25% after deductible or applicable copay

0% after deductible or applicable copay

30% after deductible or applicable copay

Infertility (for testing and treatment)*

0% after deductible, up to a $15,000 lifetime maximum

25% after deductible, up to a $15,000 lifetime maximum

0% after deductible, up to a $15,000 lifetime maximum

30% after deductible, up to a $15,000 lifetime maximum

Hospital/Surgical Services*

Inpatient Hospitalization*

10% after deductible, precertification is required or a 35% penalty is applied

25% after deductible, precertification is required or a 35% penalty is applied

10% after deductible, precertification is required or a 35% penalty is applied

$1,000 per admission + 30% after deductible; precertification is required or a 35% penalty is applied

Outpatient Facility Services*

10% after deductible, precertification is required or a 35% penalty is applied

25% after deductible, precertification is required or a 35% penalty is applied

10% after deductible, precertification is required or a 35% penalty is applied

30% after deductible, precertification is required or a 35% penalty is applied

Bariatric Procedures Services*

Limitations

One procedure per lifetime

One procedure per lifetime

Mandatory Non-Surgical 

Weight Loss Program*

Must meet Aetna’s medical management criteria

Must meet Aetna’s medical management criteria

Inpatient Hospitalization*

10% after deductible, precertification is required

10% after deductible, precertification is required

Mental Health and Substance Abuse Services

Inpatient Hospitalization*

10% after deductible, precertification is required or a 35% penalty is applied

10% after deductible, precertification is required, or a 35% penalty is applied

10% after deductible, precertification is required, or a 35% penalty is applied

10% after deductible, precertification is required, or a 35% penalty is applied

Outpatient Facility Services*

10% after deductible

10% after deductible

10% after deductible

10% after deductible

Office Visit and Other 

Outpatient Services

$25 copay

$25 copay

$25 copay

$25 copay

Other Provider Services

Home Health Care*

10% after deductible

25% after deductible

10% after deductible

30% after deductible

Skilled Nursing Facility*

10% after deductible

25% after deductible

10% after deductible

30% after deductible

Durable Medical Equipment*

10% after deductible

25% after deductible

10% after deductible

30% after deductible

Prosthetics and Orthotics*

10% after deductible

25% after deductible

10% after deductible

30% after deductible

Chiropractic Services*

10% after deductible

25% after deductible

10% after deductible

30% after deductible
*May require precertification. Contact Aetna Concierge Member Advocate Services at 1.800.334.9778 (TTY: 711).

You and Memorial Hermann share in the cost of medical coverage, with Memorial Hermann paying the majority. The amount you pay is based on the plan you choose, who you choose to cover, and your pay. It is deducted from your paychecks before taxes are calculated (i.e., on a pre-tax basis) and may be affected by the following surcharges:

  • Spousal surcharge: You will pay a spousal surcharge of $100 per paycheck ($2,600 per year) if your spouse has access to medical coverage through their employer but you choose to cover them in a Memorial Hermann medical plan. If you and your spouse both work for Memorial Hermann, the surcharge will not apply.
  • Tobacco surcharge: You will pay a tobacco surcharge of $25 per paycheck ($650 per year) if you are a tobacco user enrolled in a Memorial Hermann medical plan. You can avoid the surcharge by enrolling in a tobacco cessation program. Memorial Hermann offers two tobacco cessation programs:

When you’re eligible to enroll, you’ll be asked to answer two questions about these surcharges. Choose “Elect” for both surcharge questions and pick the option that applies to your situation. 

You Can Save Money on Your Premium

When you get approved preventive care by the deadline (June 30 in 2024), you earn the Employee Health Credit, which saves you $600 on your annual medical premiums the following Fiscal Year. For more information, go to the Employee Health Credit page on allHR.

Medical Plan Premiums for Employees Making Under $25/Hour Base Pay Rate as of 4/15/24.

MH Care Plan

FY25 Annual

FY25 Biweekly

Coverage

With Employee
Health Credit

Without Employee
Health Credit

With Employee
Health Credit

Without Employee
Health Credit

Employee

 $1,612.00

$2,212.08

 $62.00

$85.08

Employee + Spouse

 $5,642.00

 $6,242.08

$217.00

$240.08

Employee + Child(ren)

 $4,472.00

 $5,072.08

$172.00

$195.08

Employee + Family

 $7,514.00

$8,114.08

 $289.00

$312.08

MH Care Broad Access

FY25 Annual

FY25 Biweekly

Coverage

With Employee
Health Credit

Without Employee
Health Credit

With Employee
Health Credit

Without Employee
Health Credit

Employee

$3,224.00

$3,824.08

 $124.00

 $147.08

Employee + Spouse

$11,284.00

$11,884.08

 $434.00

 $457.08

Employee + Child(ren)

$8,944.00

 $9,544.08

 $344.00 

$367.08

Employee + Family

$15,028.00

$15,628.08

 $578.00

$601.08

MH Care Plan – Supplemental

FY25 Annual

FY25 Biweekly

Coverage

With Employee
Health Credit

Without Employee
Health Credit

With Employee
Health Credit

Without Employee
Health Credit

Employee

 $3,926.00 

$4,526.08 

 $151.00 

 $174.08

Employee + Child(ren)

 $9,516.00

 $10,116.08

 $366.00 

 $389.08

Medical Plan Premiums for Employees Making $25/Hour or More Base Pay Rate as of 4/15/24.

MH Care Plan

FY25 Annual

FY25 Biweekly

Coverage

With Employee
Health Credit

Without Employee
Health Credit

With Employee
Health Credit

Without Employee
Health Credit

Employee

$1,8020.00

$2,420.08 

 $70.00

 $93.08

Employee + Spouse

$6,292.00

$6,892.08 

 $242.00

 $265.08

Employee + Child(ren)

$4,940.00

 $5,540.08

 $190.00

 $213.08

Employee + Family

 $8,372.00

 $8,972.08

 $322.00

 $345.08

MH Care Broad Access

FY25 Annual

FY25 Biweekly

Coverage

With Employee
Health Credit

Without Employee
Health Credit

With Employee
Health Credit

Without Employee
Health Credit

Employee

$3,640.00

$4,240.08 

 $140.00

 $163.08

Employee + Spouse

$12,584.00

$13,184.08

 $484.00

 $507.08

Employee + Child(ren)

$9,880.00

$10,480.08

 $380.00

$403.08

Employee + Family

$16,744.00

$17,344.08

 $644.00 

 $667.08

MH Care Plan – Supplemental

FY25 Annual

FY25 Biweekly

Coverage

With Employee
Health Credit

Without Employee
Health Credit

With Employee
Health Credit

Without Employee
Health Credit

Employee

$4,342.00

$4,942.08

$167.00

 $190.08

Employee + Child(ren)

 $9,542.00

$10,142.08

 $367.00

 $390.08

In addition to aetna.com and the Aetna HealthSM app (App Store Google Play), Aetna offers several valuable resources to help you manage your care and benefits throughout the year.

  • Contact the Aetna Concierge Member Advocate at 800.334.9778 (TTY: 711) for help understanding your benefits and available tools. Advocates can help you:
    • Locate providers in your area  
    • Understand your benefits
    • Plan for upcoming treatment
    • Estimate costs before you make an appointment

Call the 24-hour Nurse Health Line at 713.338.4997 if you’re not sure where to go for care. A specially trained RN will help you weigh your options.

Teladoc

Visit a doctor from the comfort and privacy of your own home. Providers are available 24/7 by computer, phone or mobile app. You can see a board-certified doctor or psychologist, anytime day or night. 

Visit teladoc.com/aetna for additional information and call 855.835.2362 with questions. 

Download the app to register now to ensure this convenient service is available when you need it: 

Memorial Hermann Employee Medical Clinics

Memorial Hermann employee medical clinics also offer convenient virtual care at no cost. Appointments are required. 

Visit Get More out of Your Benefits for a list of locations and contact information.