Get More out of Your Benefits

To better understand your health benefits, it’s important to know key terms. Use this glossary to understand potential costs, how your options compare and the process you’ll follow when you need care.

Brand-Name Drug

A drug sold by a drug company under a specific name or trademark that is protected by a patent. Brand-name drugs tend to be more expensive than generic drugs.

Carrier or Insurer

The companies we have partnered with to provide benefits, such as Aetna for medical coverage and Delta Dental for dental coverage. It is important to understand that these carriers (not Memorial Hermann) determine which services are eligible for coverage, the coverage level and the plan rules and regulations. You can contact a carrier when you have specific coverage questions.

Claim

An expense you incur for services or supplies. Each claim is reviewed by the carrier to determine eligibility and cost share. You will receive an Explanation of Benefits (EOB) regarding each claim.

Coinsurance

Your share of the costs of a covered health care service, calculated as a percentage. You pay coinsurance after meeting your deductible. The plan then pays the rest of the covered amount up to the calendar year maximum. For example, once you reach your deductible for the MH Care Plan, you may pay a percentage of the cost, based on the provider you use. Refer to the medical plan comparison for details. 

Copay

A fixed amount you pay for a covered service under a plan, usually due at the time you receive the service. The amount can vary by the type of service. Refer to the medical plan comparison for details. 

Deductible

The total amount you pay for covered health care services (other than preventive services) before the plan begins to pay. Once you satisfy the deductible, the plan begins paying a percentage of the cost, and the individual’s cost is calculated as coinsurance. 

Eligible Expenses

The services and supplies covered under the plan. The service or supply must be recommended by a physician and must be essential for the necessary care and treatment of an injury or sickness.

Explanation of Benefits (EOB)

A document from a health carrier summarizing how they processed a claim. It details services received, the provider’s charges, the amount covered by insurance, and what you owe. An EOB is not a bill. You should always review the EOBs you receive to confirm they match your expectations. If they don’t, contact the carrier with questions.

Formulary

A list of prescription drugs covered by the plan. These drugs are selected by the insurer based on their safety, cost and effectiveness. Formularies are reviewed and updated by insurance companies often as new medications become available.

Generic Drug

An alternative form of a brand-name drug that has been shown to be equally effective while also being less costly. For example, Sertraline is the generic drug version of the brand-name drug Zoloft.

Non-Formulary Drug

A drug not included as part of the plan’s list of covered drugs.

Out-of-Pocket (OOP) Maximum

The maximum amount you can pay in a calendar year for certain eligible medical expenses. The OOP maximum protects you from unbearable financial burdens by capping the total amount you will have to spend on your healthcare each year.

Pre-Admission Certification/Prior Authorization

Before you can receive certain types of care—like a hospital stay or some outpatient procedures—your health plan may need to approve it in advance. This approval is called Pre‑Admission Certification or Prior Authorization. It confirms that the service is medically necessary and covered under your plan.

In most cases, in‑network providers will request this approval for you, but it’s still your responsibility to make sure it has been obtained. Without it, your benefits may be reduced or the service may not be covered.

Premium

The amount that you pay into a plan to have coverage. This is sometimes referred to as a contribution.

Preventive Care

Services designed to prevent or detect illness before the condition develops or becomes more severe. Preventive care is covered at 100%, with age and frequency limits. For example, an annual physical with your primary care provider (PCP) is considered preventive care. See Preventive care – good for you and your wallet below.

When it comes to your health benefits, you typically have three opportunities to enroll:

• As a new hire, within 30 calendar days of your hire date
• When you experience a qualified event that affects your or a dependent’s eligibility, such as marriage, welcoming a new child, etc. In this case, you must make changes within 30 calendar days of the event.
• Each year during annual enrollment, held in the spring, which is your yearly opportunity to evaluate your current coverage and make changes to meet your evolving needs.

As you consider the health plans that make the most sense for you and your family, this is also a great time to look at other benefits that can help round out your coverage.

Save with a Flexible Spending Account

A Health Care Flexible Spending Account (FSA) is a great savings tool. You can set aside tax-free money to pay for healthcare expenses, including glasses, contacts, medications, copays for medical services and more. See Flexible Spending Accounts for more information. 

Protect yourself from potentially high costs

Memorial Hermann offers Group Accident Insurance and Critical Illness Insurance through MetLife. Each plan pays a cash benefit if you experience a covered event. You can use this benefit for anything: out-of-pocket medical expenses, support services like day care, housekeeping, groceries and more. Refer to Voluntary Health Plans for more information.

Getting preventive healthcare every year is one of the most effective ways to protect your long-term health, even when you feel perfectly fine. Many serious and costly conditions such as high blood pressure, diabetes, heart disease and certain cancers often develop quietly, without obvious symptoms. Annual preventive visits, like an annual physical and certain screenings, can help catch changes early, when they’re easier to manage, far less disruptive and less expensive.

Just as importantly, preventive visits help you build an ongoing relationship with your primary care provider, who understands your history and can guide your care year after year.

Your Memorial Hermann medical plans offer in-network preventive care at no cost to you. In addition, you can save up to $600 on your plan premiums when you receive annual preventive care, including a wellness visit and certain screenings. Visit the Medical Coverage page for a look at the coverage available (under plan comparison) and information on what you pay for coverage (under plan premiums). 

Work with your doctor to determine the preventive care you need to stay on top of your health.

At Memorial Hermann, we are committed to helping you access the care you need, when you need it. That includes convenient, high-quality and free* colonoscopy screenings.

If you’re age 45 or older, or have a family history of colorectal cancer, it may be time to schedule your screening. If you’re not sure, talk with your primary care physician about the right plan for you. Then take advantage of our partnership with United Surgical Partners International (USPI), the leading ambulatory surgery network in the country, to schedule your colonoscopy. 

• Colorectal cancer is the second-leading cause of cancer death in the U.S.
• Regular colonoscopy screenings can prevent up to 60% of deaths by catching problems early.
• A colonoscopy can give you peace of mind so you can stay focused on what matters most.

Ready to take the next step?

USPI’s Direct Screen Colonoscopy Program^® expedites colonoscopy screenings for qualified employees by allowing you to skip the specialist appointment and schedule directly at one of USPI’s 20 locations throughout the Greater Houston Area. 

Make an appointment today.

*Most insurance plans cover colonoscopies at 100%, including Memorial Hermann’s medical plans. Check with your provider for details.

With more options than ever to choose from, it can be hard to know where to go for care. Memorial Hermann is here to help you get the least expensive and most convenient care.

Understand your medical coverage

If you’re enrolled in a Memorial Hermann medical plan, the amount you pay out-of-pocket when you receive care is based on the network your provider participates in. Both plans offer MH Preferred Tier coverage, which includes facilities, clinically integrated physicians and other providers that are most closely aligned with Memorial Hermann. We encourage you to use providers in this network so you can save money on world-class care from providers you can trust. Many services are available at no cost, and you will pay less when you do incur cost.

Refer to the Medical Coverage page for information on available networks and coverage (under plan comparison). When you have questions about specific coverage, contact Aetna Concierge Member Advocates at 800.334.9778 (TTY: 711), Monday through Friday, 8:00 a.m. to 6:00 p.m.

Having a primary care physician is essential!  

Having a primary care physician (PCP) means having one trusted professional who knows your health history, understands your goals and sees the full picture of your health over time. They help catch concerns early, coordinate care across specialists and guide decisions as your needs change. Year after year, that continuity leads to better outcomes, fewer surprises and greater confidence in managing your health.

Choosing a PCP that participates in the MH Preferred Tier means you get trusted, world-class care and will typically pay less for services. To find an MH Preferred Tier provider, visit the Memorial Hermann Provider Directory at Aetna.com > Find a doctor. Log into your account and look for the “Maximum Savings” tag. You can also search the Provider Directory on the Aetna Health mobile app.

Memorial Hermann delivers quality care to the communities we serve, thanks to the dedication and hard work of each team member. We are committed to helping you succeed, and that starts with making sure you have access to quality medical care when you need it.

All Memorial Hermann employees, their spouses and their dependents age 18 and over have access to Memorial Hermann Employee Medical Clinics.

What is a Memorial Hermann Employee Medical Clinic?

Memorial Hermann Employee Medical Clinics have onsite providers available for easy-access, acute care for common illnesses and minor injuries, to help you avoid a trip to urgent care or the emergency room, including flu, strep and COVID tests, urine pregnancy tests and urine analyses. When you visit a clinic for urgent care, the staff may recommend select preventive care, including immunizations and preventive screenings (e.g., mammograms, colonoscopies, A1C tests and more). The staff can help you schedule tests, as needed, as well as a PCP appointment to ensure you have the ongoing support you need.

Urgent care services

The clinics can diagnose and treat a range of conditions, including:

Work-related injuries can be treated at a Memorial Hermann Employee Medical Clinic but must be approved through the SafetyNet plan prior to treatment. If you are injured at work, you must fill out a SafetyNet injury report before seeking care.

Cost

If you’re enrolled in a Memorial Hermann medical plan: You will be seen and treated at no cost. There is no charge for testing and lab work completed at the clinic. However, if you need testing outside the clinic, you will incur charges based on your insurance coverage.

If you’re not enrolled in a Memorial Hermann medical plan: Costs for visiting a clinic, as well as any testing, lab work or imaging, will be determined by your insurance plan. Contact your insurance provider to confirm coverage, eligibility, copay amounts and any other costs you may incur.

Appointments

Both in-person and virtual appointments are available at all six locations.

For in-person visits: To make an appointment at a Memorial Hermann Employee Medical Cinic, please click the name of the clinic below to be directed to our online scheduling option or call us at the number shown. You may visit any of the six locations. Walk-ins are accepted, but appointments are encouraged to be seen more quickly.

For virtual visits: Appointments are required. To schedule a virtual visit, please click the name of the clinic below to be directed to our online scheduling option. You may schedule a virtual appointment with any of the six locations.

Note: A virtual appointment at a clinic is not the same as a Teladoc appointment. You will be seen by a Memorial Hermann provider, and your co-pay will be waived if you are covered by a Memorial Hermann medical plan.

Employee Medical Clinic Locations

Note: To schedule, please click the name of the clinic below. You can schedule online for an in-person OR a virtual visit. You can also call any location to schedule your appointment.