Annual enrollment for HISD benefits ends Nov. 22

What’s new in Benefits for 2020

• Aetna is the medical and Flexible Spending Account administrator in 2020
• There are new medical plan options
• The annual enrollment period for 2020 benefits is Nov. 1-22, 2019

As of January 1, 2020, Aetna will be the administrator for the district’s medical plans and Flexible Spending Accounts. You have a choice of medical plans, including two new Accountable Care Organization (ACO) plans and an Aetna broad network plan.

Annual Enrollment runs November 1-22, so click here for a new video regarding the changes for 2020, which include information about the new medical plan provider. This is the time of year when all benefits-eligible employees should enroll in or change their benefits, so please take a look at what’s new for 2020 at www.HISDBenefits.org. 

The medical plans differ in deductible and coinsurance amounts, as well as the contributions you pay each pay period. There is no increase in contribution costs for 2020 and there is a contribution reduction for some plans. Our goal is to make sure this transition is as smooth as possible.

New medical plans for 2020

You have a choice of three new medical plans. Two of the plans are Accountable Care Organization (ACO) plans—the Kelsey-Seybold Accountable Care Network Plan (also known as KelseyCare) and the Memorial Hermann Accountable Care Network Plan. These plans represent the provider networks available to you and your family.

With an ACO plan, you have a care team working together to coordinate services, provide quality care, and keep you healthy. They share information such as medical history, current medications, and test results. This means everyone is familiar with your treatment, needs, and goals, and gaps in care are easier to spot and address.

A third new option, the Texas Medical Neighborhood Network Plan, is a broad-access network plan. If you enroll in this plan, you will have a primary care doctor and access to a variety of healthcare providers and facilities in a large network. You will need to designate a Primary Care Physician for yourself and any covered family members. If a Primary Care Physician is not selected, one will be assigned to you based on your zip code. There are currently 20 specialties subject to tiering in the Texas Medical Neighborhood Network Plan. You will receive the maximum savings when you select a Tier 1 specialist. Click here for a list of tiered specialties. You will receive the standard savings (higher coinsurance) when you select a Tier 2 specialist.

All the plan options have new networks, so it is important to review your doctors to determine which networks they may be included in. The networks are the same as the plan names, so it will be easy to look them up. Please see Aetna’s Find a Doctor instructions here for directions on how to locate providers in the various networks.

Aetna is available and ready to help

You may contact Aetna Member Services at 1-877-224-6857 with questions about plan benefits and features, network providers, coverage, costs, claims, and more. You will also find a wealth of information, tools, and plan resources on your Aetna member website at www.Aetna.com.  

The Aetna website gives you easy access to your specific medical information and helps you find doctors who belong to the network of the plan option you select. If you were previously an Aetna member and registered with the site, you may use the same username and password to access the site. If you are new to Aetna, you can register at Aetna.com once you have enrolled.

Transition of care benefits

Are you receiving ongoing treatment for a serious/major condition from a provider who is not in the ACO networks or the Texas Medical Neighborhood Network Plan? You may qualify for transition of care benefits. If approved, you may continue seeing the provider for a limited period of time and receive benefits from the plan. To learn more and apply, call Aetna Member Services at 1-877-224-6857 and ask for a Transition of Care request form. You must apply for this benefit beginning in early December.

Voluntary Benefits

There will be no changes to your vision, pre-paid legal, disability, life insurance, and AD&D programs for 2020. There will be a seven percent increase in your dental DPPO and DHMO plan options. The coverage for these options remains the same.

The critical illness, accident, hospital, and cancer and specified diseases plans will ALL have a wellness benefit. Each plan will pay you for getting your routine exams each year. Be sure to read the information in the 2020 Benefits Guide carefully so you will know what is included, and then file the appropriate claim to get your reimbursement.

Convenient ways to speak to a nurse or doctor

Through Aetna, you will have access to the Informed Health® Line, a 24/7 nurse line. The nurses can help guide you to care and answer your medical questions. You will also be able to use CirrusMD to talk with a doctor by phone or video chat. The doctor can diagnose, treat, and prescribe when you are traveling or too busy to make it to the doctor’s office. CirrusMD will be available at no cost for the Memorial Hermann ACO and the Texas Medical Neighborhood Plans. The Kelsey-Seybold plans also have telemedicine available for a flat fee dependent on if you want to speak with a primary care physician or a specialist.

Next Level Urgent Care Centers

Next Level manages HISD’s Health and Wellness Centers at HMW and Attucks Middle School. In addition to these onsite wellness centers, medical plan members and their covered dependents can visit any Next Level Urgent Care Center location across Houston for $20 per visit. Kelsey Select ACO Plan members and covered dependents can access these centers at no cost. This is another convenient way to obtain the medical care you and your family need at a low cost.