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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.

For More Updates and FAQs regarding COVID-19, click here.

2020 Resources

2020 Large Group Employer Application
2020 Small Group Employer Application 
2020 Employee Enrollment Form | Spanish 
2020 Hybrid Employee Enrollment | Spanish
2020 Hybrid Employer Application
2020 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.

2020 Large Group Plans

2020 Select 001 HMO 
2020 Select 002 HMO 
2020 Select 003 HMO 
2020 Select 500-80 HMO 
2020 Select 1000-80 HMO 
2020 Select 1000-100 HMO 
2020 Select 1500-80 HMO 
2020 Select 2000-80 HMO 
2020 Select 2000-100 HMO 
2020 Select 2500-80 HMO 
2020 Select 3000-80 HMO 
2020 Select 3000-100 HSA HMO
2020 Select 5000-80 HMO 
2020 Select 5000-100 HMO 
2020 Select 5000-100 HSA HMO 
2020 Select 6550-100 HSA HMO 
2020 Select 6600-100 Standard HMO 

2020 Large Group PPO Plans

2020 Select 002 PPO 
2020 Select 1000-80 PPO 
2020 Select 1000-100 PPO 
2020 Select 1500-80 PPO 
2020 Select 2000-80 PPO 
2020 Select 3000-80 PPO 
2020 Select 5000-80 PPO 
2020 Select 5000-80 HSA PPO 
2020 Select 6550-100 HSA PPO 
2020 Select 6600-100 Standard PPO 

2020 Large Group COC and EOC

2020 Certificate of Coverage - Large Group 
2020 Evidence of Coverage - Large Group

2020 Small Group HMO Plans

2020 Select Gold 001 HMO 
2020 Select Gold 1000 HMO 
2020 Select Gold 1500 HMO 
2020 Select Gold 2350 HMO 
2020 Select Platinum 500 HMO 

2020 Small Group PPO Plans

2020 Select Gold 2350 PPO 

2020 Small Group HMO Hybrid Plans

2020 Select 001 HMO 
2020 Select 002 HMO 
2020 Select 500 HMO 
2020 Select 1000 HMO
2020 Select 1500 HMO 
2020 Select 2000 HMO 
2020 Select 3000 HMO 
2020 Select 3000 HSA HMO
2020 Select 4000 HSA HMO 
2020 Select 5000 HMO 
2020 Select 5000 HSA HMO 
2020 Select 6350 HSA HMO 
2020 Select 6850 HMO 
2020 Select 7500 HMO 

2020 Small Group PPO Hybrid Plans

2020 Select 2000 PPO 
2020 Select 3000 PPO 

2020 Small Group COC and EOC

2020 Certificate of Coverage - Small Groups 
2020 Evidence of Coverage - Small Groups 

2019 Resources

2019 Large Group HMO Plans

2019 Large Group PPO Plans

2019 Large Group COC and EOC

2019 Small Group HMO Plans

2019 Small Group PPO Plans

2019 Small Group HMO Hybrid Plans

2019 Small Group PPO Hybrid Plans

2019 Small Group COC and EOC

Additional Submission Forms

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