Choose The Option That’s Right For You
Compare Your Health Benefit Options
Harris County provides three medical plan options: Base PPO, Plus PPO and the KelseyCare ACO Plan. Base and Plus PPO plans each provide you with the same Aetna network, including out-of-network benefits.
An ACO, or Accountable Care Organization, is a group of doctor, facilities and other healthcare professionals who work together to ensure your care is coordinated. With the KelseyCare ACO plan, your care team provides the personalized care you need, plus a more streamlined healthcare experience.
BASE PLAN
The Base Plan is designed to keep your monthly costs low through higher deductibles and out-of-pocket maximums. You’ll pay more for services that you use, but you’ll pay the lowest premiums.
PLUS PLAN
With the Plus Plan, you’ll pay a higher monthly premium, but your deductibles, out-of-pocket maximums, and costs for services will be lower.
KELSEYCARE ACO PLAN
The KelseyCare ACO plan offers the same out-of-pocket experience as our Plus Plan - no deductible, lower copays - at Base Plan premiums. You are limited to in-network providers only. However, you still have access to Aetna's broad network for Urgent and Emergency Care needs.
Cost and service comparisons follow.
Helpful Terms to Know
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- BENEFICIARY — A person named to receive the income or inheritance from a will, insurance policy, trust, etc.
- COINSURANCE — The amount you pay, as a percentage of the cost of your allowed services, after you reach the deductible until you reach the plan’s out-of-pocket maximum.
- COPAYMENT — The fixed dollar amount you will pay for a healthcare service.
- DEDUCTIBLE — When applicable, the initial amount you pay before your insurance begins covering certain services.
- DEPENDENT— A person who is eligible for coverage under a policyholder's health insurance coverage.
- OUT-OF-POCKET MAXIMUM — The most you will pay per calendar year for covered, in-network healthcare expenses including prescription drugs. Once this limit is met, the plan pays 100% on eligible expenses for the remainder of the calendar year.
- PREMIUM — The amount you pay for insurance. In most cases, Harris County pays all or a portion of the premium.
Understanding In-Network vs. Out-of-Network
Whether you choose the Base, Plus or KelseyCare ACO medical plan, the coverage is through the Aetna Choice POS II (Open Access) network. It’s a large network of providers and facilities covering almost every medical service you may need.
Yet a great benefit of your healthcare plan is that you aren’t limited to in-network providers. You always have the choice to decide when, where and how to receive medical care. So if you prefer to select a primary care physician (PCP) or other provider who isn’t part of the network, you always have that freedom. Just be aware that if you use an out-of network provider or facility, you will be responsible for paying the difference between the covered amount and the amount charged by the provider/facility.
You are limited to in-network providers with the selection of the KelseyCare ACO plan.
YOUR BEST VALUE
We want you and your dependents to have the care you need, so considerable effort has been made to ensure that the OAP network offers a wide range of qualified choices. When you select an in-network provider or facility, you’ll get the lowest costs. The County will save money, too.
To see if a provider or facility is part of the network, go to aetna.com or use the Aetna Health App.
In-Network Only!
Bariatric Surgery • Dialysis
For these services, you will be responsible for the entire cost if you use an out-of-network provider/facility.
Plan Services Overview
Use this overview of services/costs for a deeper comparison between all plans - Base PPO, Plus PPO and KelseyCare ACO.
In all cases, staying in-network provides the best value. In the overview, “You Pay” refers to the amount you are responsible for of eligible expenses. Note that this is not a comprehensive list of services, limitations or exclusions. Please log in at aetna.com for more covered services and to estimate your out-of-pocket cost and additional provisions.
Medicare Primary: If you or your dependent have Medicare as your primary insurance, your Harris County health plan (Aetna) will cover the remaining 20% for in-network covered services once the Medicare Part B deductible is met.
*Preventive Services — In accordance with the Affordable Care Act (ACA), includes age-appropriate care, screenings and standard immunizations.
See the summary plan description for more detailed information on covered preventive services.