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Gold Plans

We offer three levels of plans for individuals and families. Each plan gives members access to world-class care from the Memorial Hermann Health System and the Memorial Hermann Physician Network, in which nearly 4,000 doctors practice.

Our gold plans offer the same core benefits with varying premium, coinsurance and copay costs, detailed in the chart below. Across the health insurance marketplace, most gold plans cover approximately 80 percent of your health care costs, while you pay approximately 20 percent.

Details for our 2017 plans are listed below. Additional information is available via our Brochure.

For information on our 2016 plans, click here.

 001 HMO1000 HMO2500 HMO
Deductible$0$1,000$2,500
Family Deductible$0$2,000$5,000
Out-of-Pocket Maximum (Individual)$7,150$3,000$3,000
Out-of-Pocket Maximum (Family)$14,300$6,000$6,000
Member Coinsurance0%20%0%
PCP $50$30$30
Specialist$100$50$50
Telemedicine/TelehealthNo chargeNo chargeNo charge
Urgent Care$10020% coinsurance after deductible$50
Emergency Room$75020% coinsurance after deductible$500 then deductible
Hearing & Speech Exams$80$50No charge after deductible
Independent & Outpatient Lab/Pathology$4020% coinsurance after deductibleNo charge after deductible
Radiology/X-rays$8020% coinsurance after deductibleNo charge after deductible
MRI/Scans/Nuclear Medicine$35020% coinsurance after deductibleNo charge after deductible
Inpatient Hospital$750/day for first
3 days of admission
20% coinsurance after deductible$600/day
PT/OT/Chiro$8020% coinsurance after deductibleNo charge after deductible
Retail Generic Rx$4$4$4
Retail Brand Rx$50$50$30
Retail Non-Formulary Brand Rx$100$100$60
Retail Specialty Rx50% coinsurance50% coinsurance after deductible50% coinsurance after deductible

*The following notice is required upon enrollment if selecting an HMO Consumer Choice Health Benefit Plan you have the option to choose this Consumer Choice of Benefits Health Maintenance Organization health care plan that, either in whole or in part, does not provide state-mandated health benefits normally required in evidences of coverage in Texas. This standard health benefit plan may provide a more affordable health plan for you although, at the same time, it may provide you with fewer health plan benefits than those normally included as state-mandated health benefits in Texas. If you choose this standard health benefit plan, please consult with your insurance agent to discover which state-mandated health benefits are excluded in this evidence of coverage.

Rates are valid from 1/1/2017 – 12/31/2017

HMO Service Area: Harris, Fort Bend and Montgomery counties.

For individuals, find the rate that matches your age for the plan you’re interested in.

For families, find the rate that matches the age for all members of your family and add them together. If you have more than three (3) children, only add the rate for the three (3) oldest up to age 26.