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:

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).

With both plans, you’ll pay less for care when you visit providers from the MH Preferred Tier – these are 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:

  1. The amount you pay for coverage out of your paycheck (also known as “premiums”): Since the MH Care Plan offers two narrow networks with pre-negotiated costs, it will cost you less for coverage.
  2. The network 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. 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.

MH Care Plan

MH Care Broad Access Plan

Network

MH Preferred Tier

Basic Tier

MH Preferred Tier

Broad Network Tier

Premium costs

$

$$

Costs when you receive care

$

$$

$

$$$

Each time you receive care, you choose whether to use MH Preferred Tier providers or providers in the other network available through your plan. Use this chart to quickly compare your potential annual costs in each plan. Scroll down to the full plan comparison for a detailed breakdown of services and costs.

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).

Aetna Contact Information

Visit Aetna.com and download the Aetna HealthSM 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 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. Your premium is deducted from your paychecks before taxes are calculated (i.e., on a pre-tax basis).

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:

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.

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

$1,802.00

$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

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), 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.

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