Medical Plan Options for 2019-2020
Charter Kelsey-Seybold is an accountable care organization (ACO) plan that utilizes Kelsey-Seybold providers only. Cost sharing consists of copays, deductibles, and co-insurance, much like the Aetna Whole Health plan structure, but with one provider network and lower premiums. Plan members will automatically have Kelsey-Seybold assigned as the primary care physician (PCP), with the ability to go to any Kelsey-Seybold PCP. Referrals will not be required for Kelsey-Seybold specialists and mental health providers, but referrals will be required if care must be obtained outside the Kelsey-Seybold network.
Nexus ACO R Memorial Hermann
Nexus ACO R Memorial Hermann is an ACO plan that uses a tiered design of Memorial Hermann (Tier 1) and UHC Choice (Tier 2) networks. Cost sharing consists of copays, deductibles, and coinsurance, and benefits are for in-network providers only. This arrangement is similar to the Aetna Whole Health plan, with no change in premiums, but will reflect increases in the Tier 1 copay, deductible, coinsurance, and out-of-pocket maximum amounts. Plan members will be required to designate a PCP and obtain a referral for specialist services that are not listed as direct access.
Choice Plus HDHP
Choice Plus HDHP is an exclusive provider organization that operates under a broad network called “Choice Plus,” and it takes the place of the HDHP. Cost sharing is based on deductibles and coinsurance, and there will be a slight decrease in premiums with an increase to the out-of-pocket maximums. Plan members will have direct access to providers for covered services and supplies (no referral required) and will pay lower
out-of-pocket costs when using in-network providers. This plan qualifies as a high deductible health plan, so participants are eligible to contribute to a health savings account (HSA).
2019-2020 Group Health Plan Rates and Plan Design
Negotiations with Houston Methodist
Negotiations are underway between UnitedHealthcare and Houston Methodist about their continued relationship. If they are unable to reach an agreement, Houston Methodist hospitals will be out of network for UnitedHealthcare medical plan members as of January 1, 2020, and its physicians will be out of network effective April 1, 2020.