Program Closing

The wind down process involves all commercial group health plans Memorial Hermann currently offers to employers: Memorial Hermann Commercial Health Plan (an HMO), Memorial Hermann Insurance Company (a PPO) and Memorial Hermann Health Solutions (an administrator of self-funded health plans).

The commercial health plans will continue offering coverage to each contracted group through the end of the group’s current plan year.

If the group’s current plan year expires prior to Dec. 1, 2026, it will have the option to renew for a final coverage year.

Members should keep all appointments scheduled through their plan’s contract termination date. If they have appointments scheduled after their plan’s contract termination date, they should work with their employer to confirm that their new coverage includes their current providers before determining whether to keep a scheduled appointment. Patients may be required to pay higher out-of-pocket costs for care depending on the new plan they choose.

In some cases, members who are actively receiving treatment at the time coverage ends may be eligible for Continuity of Care (Transition of Care) provisions, subject to eligibility, plan rules and approval. Employer groups and providers should direct employees with ongoing treatment needs to Member Services by phone at (855) 645-8448 or online through the member resource center for individualized review and assistance.

Members do not need to find new doctors or change any medical appointments now.

Following their plan’s contract termination date, members may opt to find new doctors that are covered by their new plan. If members wish to continue seeing their current providers, we recommend they work with their employer to enroll in a plan that has their providers in network.

Providers may continue to render services to members through the applicable commercial plan termination date. After that date, services will not be covered unless the member has approved Continuity of Care arrangements in place.

Providers must submit claims for covered services rendered during active coverage within standard timely filing limits, as outlined in provider contracts and applicable provider manuals. Claims submitted after timely filing deadlines will be denied.

Yes. Corrected claims and provider appeals for eligible services will continue to be accepted during the run out period and processed according to plan rules. Appeals must still meet standard filing deadlines.

The provider portal will remain accessible for a defined run out period to support claims submission, eligibility checks, remittance review and historical information access. Advance notice will be provided before portal access is discontinued.

Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) payments will continue during the run out period unless otherwise communicated. Providers should ensure banking information remains current to avoid payment delays.

Yes. Prior authorization requirements remain in effect through the plan termination date. Authorizations issued before termination will be honored for dates of service within the member’s active coverage period.

Authorizations do not extend coverage. Services rendered after the termination date require the member to have active coverage with another health plan or an approved Continuity of Care arrangement.

Continuity of Care may allow members who are actively receiving treatment (for example, pregnancy, oncology, post‑surgical or post‑hospital care) to continue ongoing treatment with their current provider for a limited period after coverage ends, subject to eligibility, plan rules and approval. Providers may be asked to submit clinical documentation to support requests.

Employer groups and providers should direct employees with ongoing treatment needs to Member Services by phone at (855) 645-8448 or online through the member resource center for individualized review and assistance.

Eligibility information will remain available through the provider portal and standard verification channels until the plan termination date. Providers are encouraged to verify eligibility before each visit.

Yes. Providers will receive formal written notice of contract termination in accordance with contractual and regulatory requirements. Termination of the commercial product does not automatically terminate participation in other product lines unless specified.

Providers should direct members to the health plan’s Member Services team for questions regarding coverage end dates, Continuity of Care or transition support.

Provider Services will remain available during the run out period to assist with claims, appeals and general inquiries.