Medical Coverage

Health makes everything else in life possible. Memorial Hermann’s medical plans provide comprehensive, affordable care with flexible support and services so you and your loved ones can thrive. You have two medical plan options, so you can choose the coverage that’s best for you:

The MH Care Plan
The MH Care Broad Access Plan

What’s the Same

Both plans are offered through Aetna and include:

Pharmacy coverage through CVS/Caremark
Convenient virtual care options
$0 in-network preventive care

The MH Care Plan and MH Care Broad Access Plan also cover the same services and require the same deductibles (the amount you pay before the plan begins sharing in the cost of care). They also have the same out-of-pocket maximum (the maximum amount you’ll pay out-of-pocket in a single calendar year).

Both plans offer MH Preferred Tier coverage. We encourage you to use MH providers when you can. You will save money on world-class care from providers you can trust. The MH Preferred Tier includes facilities, clinically integrated physicians and other providers that are most closely aligned with Memorial Hermann. You will pay less when a copay is required and a lower percentage of total cost (10%) after meeting your deductible when you visit MH Preferred Tier providers.

The amount you pay when you receive care is the same in both plans.

What’s Different

The MH Care Plan and MH Care Broad Access Plan differ in two key ways:

The amount you pay for coverage out of your paycheck (also known as “premiums”): Since the MH Care Plan offers narrow networks with pre-negotiated costs, it will cost you less for coverage.
The networks each plan offers beyond 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. The Basic Tier also 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.
  - Beginning July 1, 2025, the MH Care Plan will also offer a third tier for coverage: the Outside Specialty Tier. See MH Care Plan Outside Specialty Tier below for more details.
  - 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.

Aetna Contact Information

Visit Aetna.com and download the Aetna Health^SM app, so you can easily access your coverage details, find providers and show your ID card when you need care.

If you have any questions about your coverage, claims or in-network providers, call your Aetna Concierge Member Advocate at 800.334.9778 (TTY: 711).

ID Cards

Aetna provides one ID card for medical and pharmacy coverage. You can also access your ID on Aetna.com or the Aetna Health app.

Choose What’s Right for You!

Remember, 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 even with three network tiers 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?

This chart quickly compares your out-of-pocket costs per plan and tier.

	MH Care Plan	MH Care Broad Access Plan
Network	MH Preferred Tier	Basic Tier	Outside Specialty Tier (available 7/1/25)	MH Preferred Tier	Broad Network Tier
Premium costs	$	$	$	$$	$$
Costs when you receive care	$	$$	$$$	$	$$$

MH Care Plan

MH Care Broad Access Plan

Network

MH Preferred Tier

Basic Tier

Outside Specialty Tier

(available 7/1/25)

MH Preferred Tier

Broad Network Tier

Premium costs

Costs when you receive care

$$$

Each time you need care, the provider you choose will determine how much you pay out of pocket, with MH Preferred Tier providers costing you less. So it’s important that you understand the impact of this choice: Scroll down to the full plan comparison for a detailed breakdown of services and costs.

MH Care Plan Outside Specialty Tier

Memorial Hermann has increased our capabilities and the specialized care we offer, and we encourage you to use MH providers when you can. You will save money on world-class care from providers you can trust.

We recognize some team members have used Texas Children’s Hospital or MD Anderson Cancer Center for specialized care we didn’t always offer here at Memorial Hermann. Currently, these providers are included in the Basic Tier. Since we’ve added specialty care providers to our MH Preferred Tier, we’ll no longer be covering these facilities under the Basic Tier. However, there may be times when you want to seek care outside the system, even when the same services are available from Memorial Hermann. For that reason, we’re offering a new network – the Outside Specialty Tier.

You continue to have the flexibility to choose your providers, but it’s important that you understand the impact of this choice. Beginning July 1, 2025, you will pay more for the care you receive from Texas Children’s Hospital and MD Anderson Cancer Center.

You may be eligible for an exception:

If services aren’t available in the MH Preferred Tier, you may be able to receive Specialty Tier services at Preferred Tier coverage.
If you’re currently receiving ongoing care from a Specialty Tier provider, you may be able to finish your current course of treatment at Basic Tier coverage.

Contact Aetna at the number on the back of your ID card to discuss your eligibility and apply for an exception.

Visit the Memorial Hermann Provider Directory on Aetna’s website to search for in-network providers. The Provider Directory is also available on the Aetna Health™ app. Download the Aetna Health app, so you can easily find providers on the go (look for the MAXIMUM SAVINGS tag to identify MH Preferred Tier providers) 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).

Plan comparison

	MH Care Plan			MH Care Broad Access Plan
	MH Preferred Tier	Basic Tier	Outside Specialty Tier (available 7.1.25)	MH Preferred Tier	Broad Network Tier
Employee Health Credit Available	Yes	Yes	Yes	Yes	Yes
Covered Services
Annual Deductible	$750 individual / $1,875 family	$1,000 individual / $2,500 family	$6,000 individual / $12,000 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	$9,200 Individual / $18,400 Family	$5,500/individual $11,000/family	$5,500/individual $11,000/family
Physician Office Visit	$25 copay per visit	$50 copay per visit	$100 copay per visit	$25 copay per visit	30% after deductible
Procedure in Physician Office	10% after deductible	25% after deductible	40% after deductible	10% after deductible	30% after deductible
Specialist Office Visit	$40 copay per visit	$75 copay per visit	$150 copay per visit	$40 copay per visit	30% after deductible
Physical Therapy, Occupational Therapy, Speech Therapy – 75 visit annual maximum	$15 copay per visit	$30 copay per visit	$150 copay per visit	$15 copay per visit	30% after deductible
Allergy Testing	$25 copay per visit	$45 copay per visit	$100 copay per visit	$25 copay per visit	30% after deductible
Allergy Injections	$15 copay per visit	$25 copay per visit	$100 copay per visit	$25 copay per visit	$25 copay per visit
Preventive Services
Adult Wellness	$0	$0	$0	$0	$0
Routine Adult Physical Exams and Immunizations	$0	$0	$0	$0	$0
Mammogram	$0	$0	$0	$0	$0
Well Child Care	$0	$0	$0	$0	$0
Colonoscopy	$0	$0	$0	$0	$0
Nutrition and/or Tobacco Counseling	$0	$0	$0	$0	$0
Depression Screening	$0	$0	$0	$0	$0
Type 2 Diabetes Mellitus Adult Screening	$0	$0	$0	$0	$0
High Blood Pressure Screening	$0	$0	$0	$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	$300 copay after deductible	$300 copay after deductible	$300 copay after deductible
Ambulance*	25% after deductible	25% after deductible	25% after deductible	25% after deductible	25% after deductible
Memorial Hermann Employee Medical Clinics (acute visits only)	$0 copay per visit	Not covered	Not covered	$0 copay per visit	Not covered
Urgent Care Visit	Memorial Hermann – GoHealth Urgent Care Centers only – $25 copay per visit	$50 copay per visit	$100 copay per visit	Memorial Hermann – GoHealth Urgent Care Centers only – $25 copay per visit	30% after deductible
Walk-In Clinic	$25 copay per visit	$50 copay per visit	$100 copay	$25 copay per visit	30% after deductible
Memorial Hermann eVisit	$15 copay per consultation	Not covered	Not covered	$15 copay per consultation	Not covered
Memorial Hermann Virtual Clinic	$25 copay per consultation	Not covered	Not covered	$25 copay per consultation	Not covered
Teladoc	$15 copay per consultation	$15 copay per consultation	$15 copay per consultation	$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	40% after deductible	$100 copay per visit after deductible	30% after deductible
Lab*	10% after deductible	25% after deductible	40% after deductible	10% after deductible	30% after deductible
Maternity Services
Prenatal Office Visit	$40 copay, initial visit only	$75 copay, initial visit only	$150 copay, initial visit only	$40 copay, initial visit only	30% after deductible, initial visit only
Professional Fees	$500 copay	$500 copay	$500 copay	$500 copay	30% after deductible
Inpatient Hospitalization*	Included in copay above	Included in copay above	Included in copay above	Included in copay above	$1,000 per admission + 30% after deductible
Ultrasound	0% deductible waived	$75 copay per visit	$150 copay per visit	0% deductible waived	30% after deductible
Lab*	0% deductible waived	$75 copay, initial visit only	$150 copay per visit	0% deductible waived	30% after deductible
Anesthesiology Services	Included in copay above	Included in copay above	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	40% 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	40% 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	40% 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	40% 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*
Mandatory Non-Surgical Weight Loss Program*	Must meet Aetna’s medical management criteria	Must meet Aetna’s medical management criteria	Must meet Aetna’s medical management criteria	Must meet Aetna’s medical management criteria	Must meet Aetna’s medical management criteria
Inpatient Hospitalization*	10% after deductible, precertification is required	25% after deductible, precertification is required	40% after deductible, precertification is required	40% after deductible, precertification is required	30% 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	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	10% after deductible
Office Visit and Other Outpatient Services	$25 copay	$25 copay	$25 copay	$25 copay	$25 copay
Other Provider Services
Home Health Care*	10% after deductible	25% after deductible	40% after deductible	10% after deductible	30% after deductible
Skilled Nursing Facility*	10% after deductible	25% after deductible	40% after deductible	10% after deductible	30% after deductible
Durable Medical Equipment*	10% after deductible	25% after deductible	40% after deductible	10% after deductible	30% after deductible
Prosthetics and Orthotics*	10% after deductible	25% after deductible	40% after deductible	10% after deductible	30% after deductible
Chiropractic Services*	10% after deductible	25% after deductible	40% after deductible	10% after deductible	30% after deductible

*May require precertification. Contact Aetna Concierge Member Advocate Services at 800.334.9778 (TTY: 711).

Plan premiums

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. Your premium is deducted from your paychecks before taxes are calculated (i.e., on a pre-tax basis).

Slight increase to premiums for FY26. Memorial Hermann will continue to cover the majority of your medical premiums and absorb most of these cost increases, but the amount you pay will increase slightly.

Employee Health Credit

Save up to $600 with the Employee Health Credit!

If you receive one of any number of approved preventive care diagnostics, including wellness visits and certain screenings, by the end of the current Fiscal Year (through June 30), you can earn a $600 Employee Health Credit in the next Fiscal Year (July 1 through June 30).

The Employee Health Credit provides a $600 discount on medical insurance premiums in the next Fiscal Year, pro-rated in equal amounts in bi-weekly paychecks. Any employee who will be enrolled in a medical plan in the next Fiscal Year is eligible to receive the credit.

If you cover a spouse, you both must receive one of any number of approved preventive care diagnostics in the current Fiscal Year to receive the $600 credit.

Preventive care services that qualify for the $600 credit.

This chart lists the types of visits that qualify as approved preventive care for the Employee Health Credit. When Aetna processes your claim for coverage with one of the covered codes, you will have met the requirements to receive the credit.

Notes:

If you are not covered for the entire year (July 1 through June 30), you are not required to get your preventive care to earn the Employee Health Credit.
Services from Memorial Hermann urgent cares, e-visits, virtual visits or employee medical clinics do not qualify for the credit.
Prenatal care and regular visits to your OBGYN as part of the maternity process count toward preventive care to meet the requirement. However, the coding for maternity usually doesn’t get submitted until the birth of the baby. Should your Employee Health Credit indicator show as “Not Met,” you may obtain a letter from your treating physician that you are undergoing prenatal care with them and email it to HRSS@memorialhermann.org. We will update the requirement as being “Met.”

Saving $600 is great, but your health is priceless.

Wellness visits, preventive care and screenings can show that your health is right on track. But there’s another reason we offer a $600 discount if you get these services.

Preventive care can help you and your loved ones avoid many illnesses altogether and even catch potentially serious health problems early– when treatment is most effective.

Preventive care is covered at no cost when you see an in-network provider.

Take Action

Check if you have met the requirement to receive the credit:

In the top right corner of your Workday home page, click your Profile Icon (your picture) > View Profile. Your Worker Profile page will display.
Click the Benefits tab inside the blue box on the left side of the screen.
On top of the page, click the View Worker Health Credit tab to see if you or your enrolled spouse has met the requirements to receive the FY25 Health Credit.

Surcharges

Surcharges may increase your cost

The following surcharges are in addition to the medical plan premiums, and they apply only to those employees who choose to cover a spouse who could elect coverage through their employer and/or who choose to use tobacco products. Both choices directly increase the cost of Memorial Hermann’s healthcare plans, which is why we apply these surcharges to help defray some of the cost associated with them.

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. If your spouse’s eligibility to participate in their employer’s plan changes, please contact HR Shared Services at 713.456.MHHR (6447), Monday through Friday, 7:00 a.m. to 5:00 p.m. CT.
Tobacco surcharge: You will pay a tobacco surcharge of $25 per paycheck ($650 per year) if you use tobacco products or elect not to disclose your tobacco-use status and enroll in a Memorial Hermann medical plan. This surcharge aligns with Memorial Hermann’s practice of not hiring tobacco users and having smoke-free facilities. You can avoid the surcharge by enrolling in a tobacco cessation program. Memorial Hermann offers two tobacco cessation programs:
- Quit for Life: Call 866.784.8454 or visit quitnow.net/memorialhermann
- Employee Wellness: Call 713.338.5700 or email wellness@memorialhermann.org

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.

Tobacco and tobacco products include, but are not limited to:

Cigarettes, cigars, clove cigarettes, blunts, pipes, hookahs, chewing tobacco, snuff, rolled tobacco, smokeless tobacco and other items containing any tobacco.

Plan Premiums

Medical Plan Premiums for Employees Making Under $25/Hour Base Pay Rate as of 4/15/24 for FY25 and 5/1/25 for FY26

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

	FY26 Annual		FY26 Biweekly
Coverage	With Employee Health Credit	Without Employee Health Credit	With Employee Health Credit	Without Employee Health Credit
Employee	$1,690.00	$2,290.08	$65.00	$88.08
Employee + Spouse	$5,928.00	$6,528.08	$228.00	$251.08
Employee + Child(ren)	$4,706.00	$5,306.08	$181.00	$204.08
Employee + Family	$7,878.00	$8,478.08	$303.00	$326.08

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

	FY26 Annual		FY26 Biweekly
Coverage	With Employee Health Credit	Without Employee Health Credit	With Employee Health Credit	Without Employee Health Credit
Employee	$3,380.00	$3,980.08	$130.00	$153.08
Employee + Spouse	$11,856.00	$12,456.08	$456.00	$479.08
Employee + Child(ren)	$9,386.00	$9,986.08	$361.00	$384.08
Employee + Family	$15,782.00	$16,382.08	$607.00	$630.08

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

	FY26 Annual		FY26 Biweekly
Coverage	With Employee Health Credit	Without Employee Health Credit	With Employee Health Credit	Without Employee Health Credit
Employee	$4,134.00	$4,734.08	$159.00	$182.08
Employee + Child(ren)	$9,984.00	$10,584.08	$384.00	$407.08

Medical Plan Premiums for Employees Making $25/Hour or More Base Pay Rate as of 4/15/24 for FY25 and 5/1/25 for FY26

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	$1,802.00	$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

	FY26 Annual		FY26 Biweekly
Coverage	With Employee Health Credit	Without Employee Health Credit	With Employee Health Credit	Without Employee Health Credit
Employee	$1,924.00	$2,524.08	$74.00	$97.08
Employee + Spouse	$6,604.00	$7,204.08	$254.00	$277.08
Employee + Child(ren)	$5,200.00	$5,800.08	$200.00	$223.08
Employee + Family	$8,788.00	$9,388.08	$338.00	$361.08

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

	FY26 Annual		FY26 Biweekly
Coverage	With Employee Health Credit	Without Employee Health Credit	With Employee Health Credit	Without Employee Health Credit
Employee	$3,822.00	$4,422.08	$147.00	$170.08
Employee + Spouse	$13,208.00	$13,808.08	$508.00	$531.08
Employee + Child(ren)	$10,374.00	$10,974.08	$399.00	$422.08
Employee + Family	$17,576.00	$18,176.08	$676.00	$699.08

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

	FY25 Annual		FY25 Biweekly
Coverage	With Employee Health Credit	Without Employee Health Credit	With Employee Health Credit	Without Employee Health Credit
Employee	$4,550.00	$5,150.08	$175.00	$198.08
Employee + Child(ren)	$10,010.00	$10,610.08	$385.00	$408.08

Aetna resources

In addition to aetna.com and the Aetna Health^SM 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), Monday through Friday, 8:00 a.m. to 6:00 p.m., for help understanding your benefits and available tools. Advocates can help you:
- Locate providers in your area
- Understand your benefits
- Plan for upcoming treatment
- Plan care for a dependent living outside the Memorial Hermann network through a nationwide network of providers
- Estimate costs before you make an appointment
- Understand any pre-authorization requirements
- Answer questions about claims

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 to save time and money while getting the care you need.

What’s the Same

What’s Different

Employee Health Credit

Surcharges

Plan Premiums

Medical Plan Premiums for Employees Making Under $25/Hour Base Pay Rate as of 4/15/24 for FY25 and 5/1/25 for FY26

MH Care Plan

MH Care Broad Access

MH Care Plan – Supplemental

Medical Plan Premiums for Employees Making $25/Hour or More Base Pay Rate as of 4/15/24 for FY25 and 5/1/25 for FY26

MH Care Plan

MH Care Broad Access

MH Care Plan – Supplemental

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