Medical coverage options

2021 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

The network is made up of ONLY Memorial Hermann doctors and facilities.

  • This plan has an annual deductible, copays and coinsurance, along with an out-of-pocket maximum.
  • You're limited to Memorial Hermann facilities for inpatient and outpatient services.
  • There’s no charge for preventive care, which includes your annual physical or well-person exam.
  • You have prescription drug benefits through Express Scripts, which include free 90-day prescriptions of generic medications for high blood pressure, high cholesterol, asthma and diabetes (including injectable insulin).
  • You can see any specialist you choose without a referral.
  • There’s no coverage for out-of-network care, except in the case of an emergency. 
Hospitals

You’re limited to Memorial Hermann hospitals and facilities for inpatient or outpatient care. This includes all Memorial Hermann facilities in the Houston and Katy areas.

Be smart. Save money.

Here's how to use your plan. arrow_forward

District contributions
Monthly subsidy from Katy ISD

$385

Rates per pay period
Based on 24 pay periods
Employee $46
Employee + spouse $262
Employee + child(ren) $168
Employee + family $348
Plan limits
Annual in-network deductible - individual/family

$1,750/$3,500

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

Non-designated specialists (NDS)

25% after deductible

Designated 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 copy
after deductible

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.

  • This plan has an annual deductible and an out-of-pocket maximum.
  • Once you meet your deductible, the plan picks up 100% of your expenses for in-network care.  Your deductible includes medical and prescription costs, combined.
  • You can see a specialist you choose without a referral.
  • There’s no charge for preventive care, which includes your annual physical or well-person exam.  This is covered before you meet your deductible.
  • Out-of-network care is covered at 50% coinsurance after your annual deductible has been met.  You will always pay less by using an in-network provider. Click here to learn more about out-of-network coverage.
  • Prescription benefits, with Express Scripts, do not come with copays in this plan.  The cost of prescriptions are combined with medical plan costs to create one annual deductible.  Until you meet the deductible, you must pay 100% of the cost of prescription drugs.  Once you meet the deductible, the plan pays 100% of your prescription drug costs. 
  • Under this plan, you can enroll in a Health Savings Account.
Hospitals

You can go to any hospital or facility within the Aetna network.

Be smart. Save money.

Here's how to use your plan. arrow_forward

District contributions
Monthly subsidy from Katy ISD

$385

Rates per pay period
Based on 24 pay periods
Employee $32
Employee + spouse $235
Employee + child(ren) $145
Employee + family $303
Plan limits
Annual in-network deductible - individual/family

$5,000/$10,000

Annual out-of-pocket maximum - individual/family

$5,000/$10,000

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

Free

Primary care (PCP)

0% after deductible

Non-designated specialists (NDS)

0% after deductible

Designated 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 II

Our Choice POS II plan offers a broad network.

  • This plan has a broad network of doctors and facilities.  If you have a doctor you prefer who is not in the Memorial Hermann system, this may be the plan for you.
  • This plan has an annual deductiblecopayscoinsurance, and an out-of-pocket maximum.
  • You may use any primary care physician in our Aetna network.
  • There’s no charge for preventive care, which includes your annual physical or well-person exam.
  • You have prescription drug benefits through Express Scriptswhich include free 90-day prescriptions of generic medications for high blood pressure, high cholesterol, asthma and diabetes (including injectable insulin).
  • You can see a specialist you choose without a referral.
  • You will pay more for out-of-network care.
Hospitals

You can go to any hospital or facility within the Aetna network.

   
Be smart. Save money.

Here's how to use your plan. arrow_forward

District contributions
Monthly subsidy from Katy ISD

$385

Rates per pay period
Based on 24 pay periods
Employee $67
Employee + spouse $325
Employee + child(ren) $213
Employee + family $433
Plan limits
Annual deductible - individual/family

$2,250/$4,500

Annual out-of-pocket maximum- individual/family

$5,500/$11,000

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

Free

Primary care (PCP)

25% after deductible

Non-designated specialists (NDS)

25% after deductible

Designated specialists

25% after deductible

Inpatient - hospital (pre-certification required)

25% after deductible

Outpatient - hospital (pre-certification required)

25% after deductible

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

25% after deductible

Emergency care

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

Urgent care facility

25% after deductible

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

25% after deductible

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

25% after deductible

Maternity - delivery

25% 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-pocket maximum - individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Non-designated specialists (NDS)
Designated 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 deductible - individual/family
Annual out-of-pocket maximum- individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Non-designated specialists (NDS)
Designated 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 & substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual deductible - individual/family
Annual out-of-pocket maximum- individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Non-designated specialists (NDS)
Designated 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 & substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual deductible - individual/family
Annual out-of-pocket maximum- individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Non-designated specialists (NDS)
Designated 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 & substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual deductible - individual/family
Annual out-of-pocket maximum- individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Non-designated specialists (NDS)
Designated 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 & substance abuse - inpatient and outpatient
District contribution
Monthly subsidy from Katy ISD
Rates per pay period
Based on 24 pay periods
Plan limits
Annual deductible - individual/family
Annual out-of-pocket maximum- individual/family
Your cost for covered services
Preventive care exams
Primary care (PCP)
Non-designated specialists (NDS)
Designated 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 & substance abuse - inpatient and outpatient
Prescription drug plans
Annual prescription deductibles1
Memorial Hermann ACO $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS II $40 - $200
Prescription drug plans
Annual prescription deductibles1
Memorial Hermann ACO $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS II $40 - $200
Prescription drug plans
Annual prescription deductibles1
Memorial Hermann ACO $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS II $40 - $200
Prescription drug plans
Annual prescription deductibles1
Memorial Hermann ACO $0 - $200
HDHP (High Deductible Health Plan)

Shared deductible
(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

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

Shared deductible
​(medical and prescription)

$5,000 Individual / $10,000 Family

Choice POS II $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. Use Aetna DocFind 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.

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 II

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.

For any benefits question or concern, including 24/7 Nurse Line access, one call does it all.
Call us at 866-222-KISD (5473)