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For a quote or to obtain additional quoting information please contact us at getaquote@memorialhermann.org.

Questions? Contact Customer Service at (877) 364-2789

Update on COVID-19

Does Memorial Hermann Health Plan cover the cost of COVID-19 testing for Members?

Memorial Hermann Health Plan will waive Member cost sharing including copays for all diagnostic testing for COVID-19, as well as telemedicine fees for HSA plans that have the service fee with Teladoc. This policy will cover Members who meet CDC guidelines and have been ordered by a physician to be tested at an approved laboratory location. This policy is effective for all Commercial, Medicare Advantage and Hybrid members. Self-insured plan sponsors have the ability to opt-out of this policy at their discretion. Please continue to check back to this website for more information.

Are there other resources available to patients?

The CDC (Centers for Disease Control and Prevention) are providing updated information on a regular basis on their website for patients and other stakeholders. For more information, click here.

Please refer to our updates regarding COVID-19 FAQ and Vaccine FAQ for more information.

Access plan information, benefit summaries and other documents from our one-stop resource center.

2023

2023 Select 001 HMO
2023 Select 002 HMO
2023 Select 003 HMO
2023 Select 500-80 HMO
2023 Select 1000-60 HMO
2023 Select 1000-80 HMO
2023 Select 1000-100 HMO
2023 Select 1500-80 HMO
2023 Select 2000-80 HMO
2023 Select 2000-100 HMO
2023 Select 2500-80 HMO
2023 Select 3000-80 HMO
2023 Select 3000-100 HMO
2023 Select 3000-100 HSA HMO
2023 Select 5000-80 HMO
2023 Select 5000-100 HMO
2023 Select 5000-100 HSA HMO
2023 Select 6550-100 HSA HMO
2023 Select 6600-100 Standard HMO

2023 Select 002 PPO
2023 Select 1000-60 PPO
2023 Select 1000-80 PPO
2023 Select 1000-100 PPO
2023 Select 1500-80 PPO
2023 Select 2000-80 PPO
2023 Select 3000-80 PPO
2023 Select 5000-80 PPO
2023 Select 5000-80 HSA PPO
2023 Select 6550-100 HSA PPO
2023 Select 6600-100 Standard PPO

2023 Select Gold 001 HMO
2023 Select Gold 001 IVF HMO
2023 Select Gold 1000 HMO
2023 Select Gold 1000 IVF HMO
2023 Select Gold 1500 HMO
2023 Select Gold 1500 IVF HMO
2023 Select Gold 3000 HMO
2023 Select Gold 3000 IVF HMO
2023 Select Platinum 500 HMO
2023 Select Platinum 500 IVF HMO

2023 Select 001 HMO
2023 Select 002 HMO
2023 Select 500 HMO
2023 Select 1000 HMO
2023 Select 1500 HMO
2023 Select 1500-100 HMO
2023 Select 2350 HMO
2023 Select 3000 HMO
2023 Select 3000-100 HMO
2023 Select 3000 HSA HMO
2023 Select 4000 HSA HMO
2023 Select 5000 HMO
2023 Select 5000 HSA HMO
2023 Select 6350 HSA HMO
2023 Select 6850 HMO
2023 Select 7500 HMO

2023 Select Gold 3000 PPO
2023 Select Gold 3000 IVF PPO

2023 Select 002 PPO
2023 Select 1500 PPO
2023 Select 2350 PPO
2023 Select 3000 PPO
2023 Select 5000 HSA PPO
2023 Select 6350 HSA PPO
2023 Select 7500 PPO

2022

2022 Select 001 HMO
2022 Select 002 HMO
2022 Select 003 HMO
2022 Select 500-80 HMO
2022 Select 1000-60 HMO
2022 Select 1000-80 HMO
2022 Select 1000-100 HMO
2022 Select 1500-80 HMO
2022 Select 2000-80 HMO
2022 Select 2000-100 HMO
2022 Select 2500-80 HMO
2022 Select 3000-80 HMO
2022 Select 3000-100 HMO
2022 Select 3000-100 HSA HMO
2022 Select 5000-80 HMO
2022 Select 5000-100 HMO
2022 Select 5000-100 HSA HMO
2022 Select 6550-100 HSA HMO
2022 Select 6600-100 Standard HMO

2022 Select 002 PPO
2022 Select 1000-60 PPO
2022 Select 1000-80 PPO
2022 Select 1000-100 PPO
2022 Select 1500-80 PPO
2022 Select 2000-80 PPO
2022 Select 3000-80 PPO
2022 Select 5000-80 PPO
2022 Select 5000-80 HSA PPO
2022 Select 6550-100 HSA PPO
2022 Select 6600-100 Standard PPO

2022 Select Gold 001 HMO
2022 Select Gold 001 IVF HMO
2022 Select Gold 1000 HMO
2022 Select Gold 1000 IVF HMO
2022 Select Gold 1500 HMO
2022 Select Gold 1500 IVF HMO
2022 Select Gold 3000 HMO
2022 Select Gold 3000 IVF HMO
2022 Select Platinum 500 HMO
2022 Select Platinum 500 IVF HMO

2022 Select Gold 3000 PPO
2022 Select Gold 3000 IVF PPO

2022 Select 001 HMO
2022 Select 002 HMO
2022 Select 500 HMO
2022 Select 1000 HMO
2022 Select 1500 HMO
2022 Select 1500-100 HMO
2022 Select 2350 HMO
2022 Select 3000 HMO
2022 Select 3000-100 HMO
2022 Select 3000 HSA HMO
2022 Select 4000 HSA HMO
2022 Select 5000 HMO
2022 Select 5000 HSA HMO
2022 Select 6350 HSA HMO
2022 Select 6850 HMO
2022 Select 7500 HMO

2022 Select 002 PPO
2022 Select 1500 PPO
2022 Select 2350 PPO
2022 Select 3000 PPO
2022 Select 5000 HSA PPO
2022 Select 6350 HSA PPO
2022 Select 7500 PPO

2021

2021 Large Group Employer Application
2021 Small Group/Metal Tier Employer Application
2021 Large & Small Group Employee Enrollment Form | Spanish
2021 Hybrid Employee Enrollment | Spanish
2021 Hybrid Employer Application
2021 Hybrid ASO

All Employee Enrollments must also complete the following Attestation Form – if a SSN is not provided on the application for a dependent.

All Hybrid Employee Enrollments must also complete the following Attestation Form (Hybrid) – if a SSN is not provided on the application for a dependent.

2021 Select 002 PPO
2021 Select 1000-60 PPO
2021 Select 1000-80 PPO
2021 Select 1000-100 PPO
2021 Select 1500-80 PPO
2021 Select 2000-80 PPO
2021 Select 3000-80 PPO
2021 Select 5000-80 PPO
2021 Select 5000-80 HSA PPO
2021 Select 6550-100 HSA PPO
2021 Select 6600-100 Standard PPO

2021 Certificate of Coverage - Large Group
2021 Evidence of Coverage - Large Group - State Mandated
2021 Evidence of Coverage - Large Group - Consumer Choice
2021 Plan Form - Large Group - Consumer Choice (CCP1)

2021 Select Gold 001 HMO
2021 Select Gold 001 IVF HMO
2021 Select Gold 1000 HMO
2021 Select Gold 1000 IVF HMO
2021 Select Gold 1500 HMO
2021 Select Gold 1500 IVF HMO
2021 Select Gold 3000 HMO
2021 Select Gold 3000 IVF HMO
2021 Select Platinum 500 HMO
2021 Select Platinum 500 IVF HMO

2021 Select Gold 3000 PPO
2021 Select Gold 3000 IVF PPO

2021 Select 001 HMO
2021 Select 002 HMO
2021 Select 500 HMO
2021 Select 1000 HMO
2021 Select 1500 HMO
2021 Select 2350 HMO
2021 Select 3000 HMO
2021 Select 3000 HSA HMO
2021 Select 4000 HSA HMO
2021 Select 5000 HMO
2021 Select 5000 HSA HMO
2021 Select 6350 HSA HMO
2021 Select 6850 HMO
2021 Select 7500 HMO

2021 Select 2350 PPO
2021 Select 3000 PPO

2021 Certificate of Coverage - Small Group
2021 Evidence of Coverage - Small Group - State Mandated
2021 Evidence of Coverage - Small Group - Consumer Choice
2021 Summary Plan Description - Small Group - Hybrid HMO
2021 Summary Plan Description - Small Group - Hybrid PPO
2021 Plan Form - Small Group - Consumer Choice (CCP1)

Additional Forms

Late Submission Form
Deductible Credit Form
Employee Termination Form
Employee Verification Form
Group Data Submission Agreement
CCHP 2019 Form
ACH Form

2023 Plan

2022 Plan

Broker Compensation

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