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 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 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).