Medical coverage options

2024 Medical Plans

Katy ISD offers three medical plan options, each with different features.  

Here's how they work.

compare_arrowsCOMPARE ALL PLAN OPTIONS

Memorial Hermann ACO

ONLY Memorial Hermann doctors and facilities. Very narrow network and you must confirm your doctor is part of this ACO network.

If you are interested in seeing only Memorial Hermann doctors, this plan will give you just what you need. The network is made up of ONLY Memorial Hermann doctors and facilities.

Take note that NOT ALL Memorial Hermann doctors are in this network. Just because they are Memorial Hermann doctors does not mean they are part of the ACO network. Check to see if your doctor is on the Memorial Hermann ACO network before making your choice of medical plans.

 

 

Make sure your doctor is in-network

Seeing an out-of-network doctor is almost always going to cost you more than seeing an in-network doctor. To see what doctors are available with these medical plans, visit www.katybenefits.org/find-a-network-provider.

District contributions
Monthly subsidy from Katy ISD

$385

Rates per pay period
Based on 24 pay periods
Employee $54.50
Employee + spouse $411.00
Employee + child(ren) $202.00
Employee + family $412.00
Plan limits
Annual in-network deductible - individual/family

$1,750 / $3,500

Annual out-of-network deductible

No benefits

Annual out-of-pocket maximum - individual/family

$4,500 / $9,000

Your cost for covered servicesCoinsurance applies after you have paid your deductible
Preventive care exams

Free

Primary care (PCP)

20% after deductible

Specialists

25% after deductible

Inpatient – hospital (pre-certification required)

20% after deductible

Outpatient – hospital (pre-certification required)

20% after deductible

Outpatient – freestanding and surgical center (pre-certification required)

20% after deductible

Emergency care

50% after $250 copay
after deductible; waived if admitted

Urgent care facility

20% after deductible

Lab, X-Ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital

20% after deductible

Lab, X-Ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab

20% after deductible

Maternity - delivery

20% after deductible

Mental health and substance abuse - inpatient and outpatient

20% after deductible

Prescription
Annual prescription deductibles 1
Generic $0
Brand $200
Prescription drug (30-day retail)
Generic $20
Preferred brand $40
Non-preferred brand $80
Prescription drug (90-day mail or retail)
Generic $40
Preferred brand $100
Non-preferred brand $200

1 The deductible applies once per year per person and a copay may also be requested.

HDHP (High Deductible Health Plan)

You’ll pay lower premiums every month, but you’ll have a higher deductible to meet before the plan begins paying.

Our HDHP plan offers a trade-off:  lower premiums but a higher deductible to meet. 
If you want to be able to manage your medical spending more closely, this could be the plan for you.

Under this plan, you are eligible to enroll in a HSA.

 

Make sure your doctor is in-network

Seeing an out-of-network doctor is almost always going to cost you more than seeing an in-network doctor. To see what doctors are available with these medical plans, visit www.katybenefits.org/find-a-network-provider.

District contributions
Monthly subsidy from Katy ISD

$385

Rates per pay period
Based on 24 pay periods
Employee $38.50
Employee + spouse $370.00
Employee + child(ren) $169.50
Employee + family $359.00
Plan limits
Annual in-network deductible - individual/family

$5,000 / $10,000

Annual out-of-network deductible - individual/family

$10,000 / $20,000

Annual out-of-pocket maximum - individual/family

$10,000 / $20,000

Your cost for covered servicesCoinsurance applies after you have paid your deductible
Preventive care exams

Free

Primary care (PCP)

0% after deductible

Specialists

0% after deductible

Inpatient – hospital (pre-certification required)

0% after deductible

Outpatient – hospital (pre-certification required)

0% after deductible

Outpatient – freestanding and surgical center (pre-certification required)

0% after deductible

Emergency care

0% after deductible

Urgent care facility

0% after deductible

Lab, X-Ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital

0% after deductible

Lab, X-Ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab

0% after deductible

Maternity - delivery

0% after deductible

Mental health & substance abuse - inpatient and outpatient

0% after deductible

Prescription
Annual pharmacy deductible 1

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

Prescription drug (30-day retail)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Prescription drug (90-day mail or retail)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

1 The deductible applies once per year per person and a copay may also be requested.

Choice POS

Our Choice POS plan offers a broad network.

Our Choice POS plan offers a broad network. If you love your doctors but can only find coverage for them in this network, this is the plan for you.

 

Make sure your doctor is in-network

Seeing an out-of-network doctor is almost always going to cost you more than seeing an in-network doctor. To see what doctors are available with these medical plans, visit www.katybenefits.org/find-a-network-provider.

District contributions
Monthly subsidy from Katy ISD

$385

Rates per pay period
Based on 24 pay periods
Employee $96.50
Employee + spouse $531.50
Employee + child(ren) $300.00
Employee + family $637.50
Plan limits
Annual deductible - individual/family

$3,250 / $5,750

Annual out-of-network deductible - individual/family

$4,500 / $9,000

Annual out-of-pocket maximum- individual/family

$11,000 / $22,000

Your cost for covered servicesCoinsurance applies after you have paid your deductible
Preventive care exams

Free

Primary care (PCP)

30% after deductible

Specialists

30% after deductible

Inpatient - hospital (pre-certification required)

30% after deductible

Outpatient - hospital (pre-certification required)

30% after deductible

Outpatient - freestanding and surgical center (pre-certification required)

30% after deductible

Emergency care

50% after $750 copay
after deductible; waived if admitted

Urgent care facility

30% after deductible

Lab, X-Ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - outpatient hospital

30% after deductible

Lab, X-Ray, diagnostic mammogram, diagnostic scans (MRI, MRA, CAT, PET) - freestanding facility, independent lab

30% after deductible

Maternity - delivery

30% after deductible

Mental health & substance abuse - inpatient and outpatient

25% after deductible

Prescription
Annual prescription deductibles1
Generic $0
Brand $200
Prescription drug (30-day retail)
Generic $20
Preferred brand $40
Non-preferred brand $80
Prescription drug (90-day mail or retail)
Generic $40
Preferred brand $100
Non-preferred brand $200

1 The deductible applies once per year per person and a copay may also be requested.

Who do you want to cover?

 
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual in-network deductible - individual/family
Annual out-of-network deductible
Annual out-of-pocket maximum - individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Specialists
Inpatient – hospital (pre-certification required)
Outpatient – hospital (pre-certification required)
Outpatient – freestanding and surgical center (pre-certification required)
Emergency care
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 and substance abuse - inpatient and outpatient
Prescription
Annual prescription deductibles 1
Prescription drug (30-day retail)
Prescription drug (90-day mail or retail)
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual in-network deductible - individual/family
Annual out-of-network deductible
Annual out-of-pocket maximum - individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Specialists
Inpatient – hospital (pre-certification required)
Outpatient – hospital (pre-certification required)
Outpatient – freestanding and surgical center (pre-certification required)
Emergency care
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 and substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual in-network deductible - individual/family
Annual out-of-network deductible
Annual out-of-pocket maximum - individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Specialists
Inpatient – hospital (pre-certification required)
Outpatient – hospital (pre-certification required)
Outpatient – freestanding and surgical center (pre-certification required)
Emergency care
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 and substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual in-network deductible - individual/family
Annual out-of-network deductible
Annual out-of-pocket maximum - individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Specialists
Inpatient – hospital (pre-certification required)
Outpatient – hospital (pre-certification required)
Outpatient – freestanding and surgical center (pre-certification required)
Emergency care
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 and substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual in-network deductible - individual/family
Annual out-of-network deductible
Annual out-of-pocket maximum - individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Specialists
Inpatient – hospital (pre-certification required)
Outpatient – hospital (pre-certification required)
Outpatient – freestanding and surgical center (pre-certification required)
Emergency care
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 and substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual in-network deductible - individual/family
Annual out-of-network deductible
Annual out-of-pocket maximum - individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Specialists
Inpatient – hospital (pre-certification required)
Outpatient – hospital (pre-certification required)
Outpatient – freestanding and surgical center (pre-certification required)
Emergency care
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 and substance abuse - inpatient and outpatient
Prescription drug plans
Annual prescription deductibles 1
Memorial Hermann ACO 2024 $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $0 - $200
Prescription drug (30-day retail)
Memorial Hermann ACO 2024 $20 - $80
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $20 - $80
Prescription drug (90-day mail or retail)
Memorial Hermann ACO 2024 $40 - $200
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $40 - $200
Prescription drug plans
Annual prescription deductibles 1
Memorial Hermann ACO 2024 $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $0 - $200
Prescription drug (30-day retail)
Memorial Hermann ACO 2024 $20 - $80
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $20 - $80
Prescription drug (90-day mail or retail)
Memorial Hermann ACO 2024 $40 - $200
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $40 - $200
Prescription drug plans
Annual prescription deductibles 1
Memorial Hermann ACO 2024 $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $0 - $200
Prescription drug (30-day retail)
Memorial Hermann ACO 2024 $20 - $80
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $20 - $80
Prescription drug (90-day mail or retail)
Memorial Hermann ACO 2024 $40 - $200
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $40 - $200
Prescription drug plans
Annual prescription deductibles 1
Memorial Hermann ACO 2024 $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $0 - $200
Prescription drug (30-day retail)
Memorial Hermann ACO 2024 $20 - $80
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $20 - $80
Prescription drug (90-day mail or retail)
Memorial Hermann ACO 2024 $40 - $200
HDHP (High Deductible Health Plan)

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS $40 - $200

Find a network provider

How to use your medical plans wisely

Understand the requirements

When you visit Aetna providers, you have an annual deductible to pay before your insurance helps cover expenses. You can use your health care flexible spending account (FSA) or health savings account (HSA), if you have one, to help meet your deductible and eligible expenses. Once you've met your deductible, you still pay a portion of expenses through coinsurance until you reach your out-of-pocket maximum. After you reach your out-of-pocket maximum, the plan covers your expenses at 100% for the remainder of the year. Preventive care is the only exception. There is no charge for preventive care. (Take advantage of this very important benefit each year.)

Stay in your network

It’s up to you, not your provider, to make sure your provider is in our Aetna network. This includes any medical care outside of your doctor’s office for diagnostic tests such as X-rays, MRI or CT scans, lab work or outpatient surgery—even if your in-network doctor provides the referral. Click for Memorial Hermann ACO, and here for HDHP and Choice POS or call Aetna Member Services at 877-224-6857 to check before you go for these services. 

How the provider networks work
Memorial Hermann ACO

Primary care
You may use any primary care physician in the Aetna network. You’re not required to designate a primary care physician. Find a Memorial Hermann ACO provider here.

Hospitals
You must use a Memorial Hermann facility.

Specialists

You can see a specialist without a referral. Make sure your specialist is in-network by using Aetna Docfind or calling Aetna Member Services at 877-224-6857. You are not covered for out-of-network care, except in case of an emergency.

HDHP and Choice POS

Primary care 
You may use any primary care physician in the Aetna network. You’re not required to designate a primary care physician.
  
Hospitals 

You can go to any hospital or facility within the Aetna network. You will pay considerably more if you go to an out-of-network facility. There is a separate deductible and out-of-pocket max for out of network care.

Specialists 

You do not need a referral to see a specialist of your choice. You’re free to use any specialist in the larger Aetna network. You will pay considerably more if you go to an out-of-network specialist. There is a separate deductible and out-of-pocket max for out-of-network care.

Find out what’s preventive (free) and what’s not

If you go to the doctor for a preventive care checkup, such as your annual physical or well-person exam, it’s free. But if you ask the doctor to take a look at your sore throat, for example, the visit is no longer a preventive checkup. If you’re not sure what services are considered preventive, call Aetna Member Services at 877-224-6857.

Check your costs before you go

You can use the Aetna Navigator cost estimator tool to find out how much you might expect to pay for many common procedures. Under Coverage & Benefits, choose Estimate the cost of care.

Save the emergency room for emergencies only

If you have a true emergency, head straight to your nearest ER. For help deciding if an urgent care or retail clinic is a better choice, call the 24/7 Nurse Line at 866-222-KISD (5473).

Find alternative care options

For alternative health care services such as massage therapy, acupuncture, chiropractic care, dietetic counseling and discounts on vitamins and supplements, log on to Aetna Navigator and search for Aetna Natural Products and Services.