PPO Plan Overview
2016 New Member Kit
PPO Plan Overview
Welcome to
Memorial Hermann Health Insurance.
For more than 100 years, Memorial Hermann has delivered
compassionate, patient-centered care, world-class physicians,
and leading-edge innovation to the Greater Houston area.
That same tradition of excellence continues with Memorial
Hermann Health Insurance, the only health coverage backed
by Memorial Hermann.
By aligning care delivery, physicians and health insurance,
Memorial Hermann has created something unique for Houston
– a truly integrated health system that delivers safer, smarter
and more cost-effective care.
As a member of Memorial Hermann Health Insurance, you
have access to the quality care and service provided by
12 hospitals, nearly 100 urgent care and walk-in facilities,
3 convenient care centers and numerous specialty institutes,
along with a comprehensive portfolio of home health services,
rehabilitation centers, outpatient imaging, laboratory services
and access to more than 3,000 physicians in Houston and the
surrounding areas.
Quick Reference Guide
If you have any questions about your
coverage, or if you need to request
specific forms, obtain certificates of
coverage, or file claims, please use
this handy guide to point you in the
right direction.
Memorial Hermann Health Plan
healthplan.memorialhermann.org
Customer Service: 888.594.0671 or
713.338.4683
Complaints: 888.594.0671 or 713.338.4683
Utilization Review or Medical Management:
888.252.7680
Find a Provider
healthplan.memorialhermann.org/providers
Request a New ID Card
If you have any questions about your coverage, please call us
at 713.338.4683, or toll free at 888.594.0671.
healthplan.memorialhermann.org/members
Thank you for choosing Memorial Hermann Health Insurance.
We wish you the best of health.
humanabehavioralhealth.com
Sincerely,
Behavioral Health Information
Behavioral Health Customer Care:
800.777.6330
Additional Services Provided by Alere
Smoking Cessation: 866.784.8454
Maternity: 855.312.2229
Neil Kennish
Associate Vice President, Marketing and Sales
Memorial Hermann Health Solutions
Quality Care Close to Home
With a PPO plan from Memorial Hermann Health Insurance Co, you
have access to 12 hospitals, nearly 100 urgent care and walk-in facilities,
3 convenient care centers and more than 3,000 physicians in Harris,
Montgomery, Fort Bend, Wharton, Galveston, Brazoria and Walker counties.
1 58
56
Memorial Hermann
The Woodlands
The
Woodlands
57
50
51
60
45
59
52 Spring
48
36
49
27 Humble
21
2
3
28
26
Memorial Hermann
Northeast
20
4
29
13
Jersey Village
Memorial Hermann
Katy
33
11
23
30
14
35
31
55
22
10
Memorial Hermann
Memorial City
17 15 16
34
32
24
Memorial Hermann
Greater Heights
Memorial Hermann
Orthopedic and Spine
12
25
9
TIRR
Memorial Hermann
Texas Medical
Center
Children’s
Memorial Hermann
Pasadena
Memorial Hermann
Southwest
5
6
39
Sugar Land
Memorial Hermann
Sugar Land
55
53
54
42
46
18
Memorial Hermann
Southeast
41
43 44
47
19
40
38
7
8
37
Rediclinic
Take Care Health
Memorial Hermann
Convenient Care Center
Neighborhood
Health Center
MinuteClinic
Memorial Hermann
Urgent Care
For more detailed location information, please go to healthplan.memorial.hermann.org.
Memorial Hermann
Hospitals
Clinic Locations
Name
Address
City
ZIP Code
Phone
1
MinuteClinic - The Woodlands
3705 FM 1488 Rd
Conroe
77384
866.389.2727
2
Take Care Health - Cypress
16211 Spring Cypress Rd
Cypress
77429
281.213.3675
3
MinuteClinic - Cypress
26265 Northwest Fwy
Cypress
77429
866.389.2727
4
Rediclinic - Cypress
24224 Northwest Fwy
Cypress
77429
281.758.2282
5
Take Care Health - Deer Park
3300 Center St
Deer Park
77536
281.479.3488
6
MinuteClinic - Deer Park
3505 Center Rd
Deer Park
77536
866.389.2727
7
Memorial Hermann Urgent Care
1505 E Winding Way Dr, Ste 112
Friendswood
77546
281.993.3860
8
Rediclinic - Friendswood
701 W Parkwood Ave
Friendswood
77546
281.947.0018
9
MinuteClinic - Richmond
1003 Richmond Ave
Houston
77006
866.389.2727
10
Neighborhood Health Center (Northwest)
1800 W 26th St, Ste 103
Houston
77008
713.957.8400
11
Take Care Health - 43rd St
1215 West 43rd St
Houston
77018
866.825.3227
12
Take Care Health - Gray St
1919 W Gray St
Houston
77019
484.351.3200
13
Memorial Hermann Summer Creek
Convenient Care Center
14201 E Sam Houston Pkwy N
Houston
77044
281.436.8800
14
Rediclinic - Bunker Hill
9710 Katy Fwy
Houston
77055
713.932.8800
15
MinuteClinic - Houston
5402 Westheimer Rd, Ste K
Houston
77056
866.389.2727
16
Take Care Health - Westheimer
5200 Westheimer
Houston
77056
866.825.3227
17
Rediclinic - Fountainview
2660 Fountainview
Houston
77057
713.343.2679
18
MinuteClinic - Bay Area Blvd
2469 Bay Area Blvd
Houston
77058
866.389.2727
19
Take Care Health - Space Center Blvd
16185 Space Center Blvd
Houston
77062
484.351.3200
20
MinuteClinic - FM 1960
5603 FM 1960 Rd W
Houston
77069
866.389.2727
21
Rediclinic - Louetta
10919 Louetta Rd
Houston
77070
281.251.1800
22
MinuteClinic - Memorial
15010 Memorial Dr
Houston
77079
866.389.2727
23
Take Care Health - Gessner
2808 Gessner Dr
Houston
77080
866.825.3227
24
Take Care Health - Highway 6
6768 Hwy 6 S
Houston
77083
484.351.3200
25
RediClinic - Alabama St
1701 W Alabama St
Houston
77098
713.522.3200
26
Neighborhood Health Center (Northeast)
9813 Memorial Blvd, Ste H
Humble
77338
281.319.8500
27
Take Care Health - Humble
7440 FM 1960 Rd W
Humble
77346
866.825.3227
28
Rediclinic - Humble
7405 FM 1960 East
Humble
77346
281.913.7255
29
MinuteClinic - Humble
8000 N Sam Houston Pkwy E
Humble
77396
866.389.2727
30
MinuteClinic - Katy
3103 N Fry Rd
Katy
77449
866.389.2727
31
Take Care Health - Katy
411 S Mason Rd
Katy
77450
866.825.3227
32
Memorial Hermann South Katy
Convenient Care Center
22430 Grand Corner Drive
Katy
77494
281.371.1980
33
Rediclinic - Katy
25675 Nelson Way
Katy
77494
281.347.7700
34
Rediclinic - Grand Parkway
6711 S Fry Rd
Katy
77494
281.395.5080
35
MinuteClinic - Katy
602 W Grand Pkwy S
Katy
77494
866.389.2727
Clinic Locations (Cont.)
36
RediClinic - Kingwood
4303 Kingwood Dr
Kingwood
77339
281.358.0013
37
Rediclinic - League City
2955 Gulf Fwy
League City
77573
281.337.7351
38
Rediclinic - Missouri City
8900 Highway 6, Ste 120
Missouri City
77459
281.778.0602
39
Rediclinic - Pasadena
6210 Fairmont Pkwy
Pasadena
77505
832.775.0165
40
MinuteClinic - Pearland FM 518
2900 Broadway St
Pearland
77581
866.389.2727
41
Memorial Hermann Pearland
Convenient Care Center
16100 South Freeway
Pearland
77584
713.413.6500
42
Rediclinic - Pearland
2805 Business Ctr Dr
Pearland
77584
713.436.5208
43
MinuteClinic - Pearland Broadway
9522 Broadway St
Pearland
77584
866.389.2727
44
Take Care Health - Pearland
8430 Broadway St
Pearland
77584
484.351.3200
45
Take Care Health - Porter
24917 FM 1314 Rd
Porter
77365
866.825.3227
46
MinuteClinic - Richmond
1410 Crabb River Rd
Richmond
77469
866.389.2727
47
MinuteClinic - Seabrook
2800 Bayport Blvd
Seabrook
77586
866.389.2727
48
MinuteClinic - Spring - Aldine-Westfield
24802 Aldine Westfield
Spring
77373
866.389.2727
49
MinuteClinic - Spring - Cypress & Champion
8754 Spring Cypress Rd
Spring
77379
866.389.2727
50
MinuteClinic - Spring - Grogans Mill
25110 Grogans Mill Rd
Spring
77380
866.389.2727
51
Rediclinic - Spring
130 Sawdust Rd
Spring
77380
281.419.3162
52
Take Care Health - Spring
19710 Holzwarth Rd
Spring
77388
866.825.3227
53
MinuteClinic - Sugar Land
16515 Lexington Blvd
Sugar Land
77479
866.389.2727
54
Rediclinic - Sugar Land
19900 Southwest Fwy
Sugar Land
77479
281.341.8330
55
Rediclinic - Highway 6
530 Highway 6
Sugar Land
77479
281.325.0311
56
Take Care Health - The Woodlands
8000 Research Forest Dr
The Woodlands
77382
866.825.3227
57
Rediclinic - The Woodlands
10777 Kuykendahl Rd
The Woodlands
77382
281.907.4104
58
Rediclinic - Woodlands
3601 FM 1488 Rd
The Woodlands
77382
936.321.9030
59
Rediclinic - Tomball
28520 Tomball Pkwy
Tomball
77375
281.255.3085
60
MinuteClinic - Tomball
24048 Kuykendahl Rd
Tomball
77375
866.389.2727
How to Find a Provider
Memorial Hermann Health Insurance is here to make access to quality care easy for our members. To get started,
just follow these simple steps.
STEP 1:
STEP 2:
Go to healthplan.memorialhermann.org and click on either
the “Providers” link or the “Find a Doctor” link.
Choose your provider type. You will then be presented with
different options such as choosing a network, depending
upon which provider type you choose. Select the option that
best applies to your plan or your needs.
STEP 3:
STEP 4:
Provide information such as your ZIP code and search radius.
Much of this information is optional. But remember, greater
detail will give you more specific results.
After hitting “Submit,” you will be taken to an overview
page where you will find contact information, addresses
and links to doctor profiles. You may also refine your search
by editing your preferences in the panel located to the left
of your results.
Step Therapy
The main goal of Step Therapy is to promote safer,
more cost-effective treatment by encouraging a “step”
approach in evaluating prescription drug use. To receive
the maximum plan benefit, you may first need to try a
proven, cost-effective option before engaging in a newer
treatment that may be higher-cost and higher-risk.
If your doctor determines that a first-line drug is not right
for you, then your prescription drug benefit will cover
second-line drugs, which are often less-preferred and
more expensive.
Prior Authorization is required for certain high-cost, highrisk drugs, including those with the greatest potential for
misuse. Before medications on the Prior Authorization list
can be covered under your plan, your doctor will need to
give approval.
If you have questions about Step Therapy or Prior
Authorization, please call the Pharmacy Program number
on the back of your Memorial Hermann Health Insurance
ID card.
Teladoc: Where the Doctor Is Always In
Enjoy 24/7 access to board-certified doctors via phone, email, text or mobile app –
all with no copay and an average wait time of less than 10 minutes.
Requesting a consultation is easy. Just have your plan information handy and call
800.835.2362. Or learn more at teladoc.com.
Please note: Teladoc applies to HSA-compatible plans at a $40 service charge.
Frequently Asked Questions
How can I check my deductible status?
After logging in with your username and password, you
can find detailed information about your deductible
amounts and benefit utilizations under “Check
Utilizations.” Please note that your Explanation of
Benefits (EOB) states your deductible status at the time
of claim processing as well. You may also ask about
deductibles and benefit utilizations by calling customer
service at 713.338.4683.
How do I know when to use an Urgent Care facility
versus an Emergency Room?
ER visits should be limited to severe or life-threatening
medical emergencies. Urgent Care facilities offer
treatment for less serious medical concerns and other
medical needs typically addressed by primary care
physicians. Urgent Care visits are less expensive than
Emergency Room care. More often than not, Urgent
Care visits also take less time.
What network would my child use while attending
college outside of the coverage area?
The network is PHCS Healthy Directions. Once your
child returns home or is in the covered service area, he
or she will be required to use our Select Network.
How do I add my newborn to my policy?
Your newborn is automatically covered for the first
31 days. To permanently add your child to the policy,
the application should be completed and received by
Memorial Hermann prior to day 31.
What is the difference between deductibles
and copayments?
A deductible is the amount of covered expenses you
must pay for covered services before benefits are
available to you under the health plan.
Copayments are set amounts paid directly to your
provider by you. In most cases, copayments do not
apply toward your deductible. Please refer to your
Certificate of Coverage for more details.
Health Benefit Quick Tips
Using in-network providers keeps costs down.
Find in-network providers at healthplan.memorialhermann.org.
•Tell us if you or your dependents live outside of the
7-county Memorial Hermann Select Network service
area so we can flag your records to allow access to
the Healthy Directions and MultiPlan Complementary
Network providers where you live.*
•Inform physicians that lab specimens should be sent
to in-network labs such as Memorial Hermann labs,
LabCorp or Quest Diagnostics.
Prior Authorization
Some services may be denied if you do not obtain prior authorization. To confirm whether a service requires prior
authorization, contact Memorial Hermann Health Insurance Company customer service before scheduling
a procedure.
Have more questions?
Call Memorial Hermann Health Insurance Company Customer Service at the numbers on the back of your
member ID card.
* The Memorial Hermann Select Network service area consists of the following counties: Brazoria, Fort Bend,
Galveston, Harris, Montgomery, Walker and Wharton.
Create an Online Account
Creating an online account gives you access to the tools and resources your need to manage your health and
maximize your benefits.
TO CREATE YOUR ONLINE ACCOUNT, FOLLOW THESE SIMPLE STEPS:
1
Have your member ID number (found on your
membership card), your full name and your date
of birth at your fingertips.
5
Once you have selected a username, your
customer service rep will provide you with a
temporary password. Be sure to write both of
these down in a secure location.
2
Call customer service at 888.642.5040.
6
Next, go to healthplan.memorialhermann.org/
members and click on the “Member Login”
button at the top right of the page or “Log in
now” near the bottom right of the page.
3
The automated menu will present you with a list
of options. Please select option 4.
7
You will then be asked for your username and
password. Type in the username you selected
and the temporary password given to you by your
customer service rep.
4
Tell the customer service rep that you need to
create a username and password for online
account access.
8
Upon login, you will be prompted to change your
password. Simply enter your temporary password
where prompted and then type in a password of
your choosing.
If you have any questions about your coverage,
please call us at 713.338.4683, or toll free at 888.594.0671.
healthplan.memorialhermann.org
Insurance coverage is underwritten by Memorial Hermann Health Insurance Company. Memorial
Hermann Health Insurance Company and the Memorial Hermann Health Insurance Company logo
are registered trademarks of Memorial Hermann Health System.
Copyright © 2015 Memorial Hermann. All rights reserved.