Medical plan comparison

Who do you want to cover?

 
District contribution
Rates per pay period
Based on 24 pay periods
Plan limits
Annual deductible - individual/family
Annual out-of-pocket maximum
Your cost for covered servicesCoinsurance applies after you have paid your deductible
Preventive care exams *
Primary care (PCP)
Specialists
Inpatient - hospital
Outpatient - hospital
Outpatient - freestanding and surgical center
Emergency care
Non-emergency care in an emergency room
Urgent care facility
Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital
Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab
Maternity - delivery
Mental health & substance abuse - inpatient **
Mental health & substance abuse - outpatient **
Prescription
Annual pharmacy deductible
Annual out-of-pocket maximum
Prescription drugs - 30-day retail
Prescription drugs - 90-day mail or retail
1.21
2.10
1.21
2.10
2.17
3.54
2.17
3.54
1.57
2.64
1.57
2.64
3.07
4.89
3.07
4.89
1.73
2.88
1.73
2.88
3.47
5.49
3.47
5.49
2.53
4.08
2.53
4.08
5.47
8.49
5.47
8.49
3.41
5.40
3.41
5.40
7.67
11.79
7.67
11.79
4.93
7.68
4.93
7.68
11.47
17.49
11.47
17.49
5.41
8.40
5.41
8.40
12.67
19.29
12.67
19.29
10.21
15.60
10.21
15.60
24.67
37.29
24.67
37.29
20.01
30.30
20.01
30.30
49.17
74.04
49.17
74.04
District contribution
Rates per pay period
Based on 24 pay periods
Memorial Hermann ACO $93.26
Open Access Select $48.00
Plan limits
Annual deductible - individual/family
Memorial Hermann ACO

$2,500/$5,000

Open Access Select

$4,500/$9,000

Annual out-of-pocket maximum
Memorial Hermann ACO

$6,500/$13,000

Open Access Select

$7,100/$14,200

Your cost for covered services
Preventive care exams *
Memorial Hermann ACO

Free

Open Access Select

Free

Primary care (PCP)
Memorial Hermann ACO

$50

Open Access Select

0% for the first $225, then 30%​

Specialists
Memorial Hermann ACO

$100

Open Access Select

0% for the first $225, then 30%

Inpatient - hospital
Memorial Hermann ACO

20% 

Open Access Select

30% 

Outpatient - hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Outpatient - freestanding and surgical center
Memorial Hermann ACO

20%

Open Access Select

30%

Emergency care
Memorial Hermann ACO

20% + $250 copay (waived if admitted)

Open Access Select

30% + $250 copay (copay waived if admitted)

Non-emergency care in an emergency room
Memorial Hermann ACO

40%

Open Access Select

50%

Urgent care facility
Memorial Hermann ACO

$75

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab
Memorial Hermann ACO

20%

Open Access Select

See office visit or 30% if in a facility

Maternity - delivery
Memorial Hermann ACO

20%

Open Access Select

30%

Mental health & substance abuse - inpatient **
Memorial Hermann ACO

20% 

Open Access Select

30% 

Mental health & substance abuse - outpatient **
Memorial Hermann ACO

$50

Open Access Select

30% 

District contribution
Rates per pay period
Based on 24 pay periods
Memorial Hermann ACO $429.82
Open Access Select $312.07
Plan limits
Annual deductible - individual/family
Memorial Hermann ACO

$2,500/$5,000

Open Access Select

$4,500/$9,000

Annual out-of-pocket maximum
Memorial Hermann ACO

$6,500/$13,000

Open Access Select

$7,100/$14,200

Your cost for covered services
Preventive care exams *
Memorial Hermann ACO

Free

Open Access Select

Free

Primary care (PCP)
Memorial Hermann ACO

$50

Open Access Select

0% for the first $225, then 30%​

Specialists
Memorial Hermann ACO

$100

Open Access Select

0% for the first $225, then 30%

Inpatient - hospital
Memorial Hermann ACO

20% 

Open Access Select

30% 

Outpatient - hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Outpatient - freestanding and surgical center
Memorial Hermann ACO

20%

Open Access Select

30%

Emergency care
Memorial Hermann ACO

20% + $250 copay (waived if admitted)

Open Access Select

30% + $250 copay (copay waived if admitted)

Non-emergency care in an emergency room
Memorial Hermann ACO

40%

Open Access Select

50%

Urgent care facility
Memorial Hermann ACO

$75

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab
Memorial Hermann ACO

20%

Open Access Select

See office visit or 30% if in a facility

Maternity - delivery
Memorial Hermann ACO

20%

Open Access Select

30%

Mental health & substance abuse - inpatient **
Memorial Hermann ACO

20% 

Open Access Select

30% 

Mental health & substance abuse - outpatient **
Memorial Hermann ACO

$50

Open Access Select

30% 

District contribution
Rates per pay period
Based on 24 pay periods
Memorial Hermann ACO $307.56
Open Access Select $205.08
Plan limits
Annual deductible - individual/family
Memorial Hermann ACO

$2,500/$5,000

Open Access Select

$4,500/$9,000

Annual out-of-pocket maximum
Memorial Hermann ACO

$6,500/$13,000

Open Access Select

$7,100/$14,200

Your cost for covered services
Preventive care exams *
Memorial Hermann ACO

Free

Open Access Select

Free

Primary care (PCP)
Memorial Hermann ACO

$50

Open Access Select

0% for the first $225, then 30%​

Specialists
Memorial Hermann ACO

$100

Open Access Select

0% for the first $225, then 30%

Inpatient - hospital
Memorial Hermann ACO

20% 

Open Access Select

30% 

Outpatient - hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Outpatient - freestanding and surgical center
Memorial Hermann ACO

20%

Open Access Select

30%

Emergency care
Memorial Hermann ACO

20% + $250 copay (waived if admitted)

Open Access Select

30% + $250 copay (copay waived if admitted)

Non-emergency care in an emergency room
Memorial Hermann ACO

40%

Open Access Select

50%

Urgent care facility
Memorial Hermann ACO

$75

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab
Memorial Hermann ACO

20%

Open Access Select

See office visit or 30% if in a facility

Maternity - delivery
Memorial Hermann ACO

20%

Open Access Select

30%

Mental health & substance abuse - inpatient **
Memorial Hermann ACO

20% 

Open Access Select

30% 

Mental health & substance abuse - outpatient **
Memorial Hermann ACO

$50

Open Access Select

30% 

District contribution
Rates per pay period
Based on 24 pay periods
Memorial Hermann ACO $400.72
Open Access Select $266.24
Plan limits
Annual deductible - individual/family
Memorial Hermann ACO

$2,500/$5,000

Open Access Select

$4,500/$9,000

Annual out-of-pocket maximum
Memorial Hermann ACO

$6,500/$13,000

Open Access Select

$7,100/$14,200

Your cost for covered services
Preventive care exams *
Memorial Hermann ACO

Free

Open Access Select

Free

Primary care (PCP)
Memorial Hermann ACO

$50

Open Access Select

0% for the first $225, then 30%​

Specialists
Memorial Hermann ACO

$100

Open Access Select

0% for the first $225, then 30%

Inpatient - hospital
Memorial Hermann ACO

20% 

Open Access Select

30% 

Outpatient - hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Outpatient - freestanding and surgical center
Memorial Hermann ACO

20%

Open Access Select

30%

Emergency care
Memorial Hermann ACO

20% + $250 copay (waived if admitted)

Open Access Select

30% + $250 copay (copay waived if admitted)

Non-emergency care in an emergency room
Memorial Hermann ACO

40%

Open Access Select

50%

Urgent care facility
Memorial Hermann ACO

$75

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab
Memorial Hermann ACO

20%

Open Access Select

See office visit or 30% if in a facility

Maternity - delivery
Memorial Hermann ACO

20%

Open Access Select

30%

Mental health & substance abuse - inpatient **
Memorial Hermann ACO

20% 

Open Access Select

30% 

Mental health & substance abuse - outpatient **
Memorial Hermann ACO

$50

Open Access Select

30% 

District contribution
Rates per pay period
Based on 24 pay periods
Memorial Hermann ACO $760.21
Open Access Select $484.30
Plan limits
Annual deductible - individual/family
Memorial Hermann ACO

$2,500/$5,000

Open Access Select

$4,500/$9,000

Annual out-of-pocket maximum
Memorial Hermann ACO

$6,500/$13,000

Open Access Select

$7,100/$14,200

Your cost for covered services
Preventive care exams *
Memorial Hermann ACO

Free

Open Access Select

Free

Primary care (PCP)
Memorial Hermann ACO

$50

Open Access Select

0% for the first $225, then 30%​

Specialists
Memorial Hermann ACO

$100

Open Access Select

0% for the first $225, then 30%

Inpatient - hospital
Memorial Hermann ACO

20% 

Open Access Select

30% 

Outpatient - hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Outpatient - freestanding and surgical center
Memorial Hermann ACO

20%

Open Access Select

30%

Emergency care
Memorial Hermann ACO

20% + $250 copay (waived if admitted)

Open Access Select

30% + $250 copay (copay waived if admitted)

Non-emergency care in an emergency room
Memorial Hermann ACO

40%

Open Access Select

50%

Urgent care facility
Memorial Hermann ACO

$75

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital
Memorial Hermann ACO

20%

Open Access Select

30%

Lab, X-ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab
Memorial Hermann ACO

20%

Open Access Select

See office visit or 30% if in a facility

Maternity - delivery
Memorial Hermann ACO

20%

Open Access Select

30%

Mental health & substance abuse - inpatient **
Memorial Hermann ACO

20% 

Open Access Select

30% 

Mental health & substance abuse - outpatient **
Memorial Hermann ACO

$50

Open Access Select

30% 

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