Plan Options:
Pasadena ISD offers three medical plans through Aetna. Plan 2 is now a “Grandfathered” plan; therefore, “new” enrollment will not be allowed. You can choose between ACO-Kelsey, and two Exclusive Provider Organization plans (EPO).
Expand plans for details.
Administered by Aetna (medical) & CVS/Caremark (pharmacy)
Point of Service (POS) Plan
POS plans offer a nationwide network of doctors and hospitals and gives you the flexibility to choose any provider, in or out-of-network, to receive benefits. If you choose an in-network provider, your benefits will be greater, and you will generally pay less out-of-pocket than if you choose an out-of-network provider. The plans include a full spectrum of covered services and direct access to specialists without the need to gain approval from a Primary Care Physician (PCP). The POS plans are traditional health plans with copayments, coinsurance and deductibles.
Benefits Booklet – 100+ pages of Aetna plan details including a detailed comparison of Aetna plans, list of covered services, limitations and exclusions, important terms and plan provisions.
DocFind® – When you need to find a doctor or facility, start with DocFind®. It’s quick, easy and online 24/7. To use DocFind® you must register for your own secure Aetna Navigator® website. Once you do, you will get a personalized version of DocFind® that has your medical plan and zip code preprogrammed. Visit: www.aetna.com/docfind/custom/pasadenaisd.
If you have not set up your Aetna Navigator® website and need to find a doctor, use the network as follows.
- Medical Plan II (Grandfathered Plan) – “TX Medical Neighborhood – Houston Choice POSII”
- Medical Plan III – “KelseyCare – ACO”
- Medical Plan IV – “Open Access® Aetna Select”
- Medical Plan V – “Memorial Hermann Accountable Care Network”
Aetna Navigator – Access medical ID cards, medical claims payments and Explanations of Benefits. Your Aetna Navigator® account is personalized for you and your family. The information you see will be based on the health plan you are enrolled in. This site will also keep track of any personal health information that you enter. It is a quick and easy place to begin looking for all of your health care answers.
Aetna Mobile App – Get ID cards and plan information on the go.The Aetna Mobile app puts the most popular online features at your fingertips. It’s available for iPhone®, Android™ and BlackBerry® mobile devices. Visit www.aetna.com/mobile.
Resource Guides – One for each plan explaining what is offered with website links for more info:
- How the plan works – deductibles, co-pays, co-insurance, out-of-pocket maximums
- Choosing network providers and what happens if you go out-of-network
- Routine and emergency care options and costs
- Teladoc – doctors available 24/7 to diagnose, treat and prescribe medications
- 24-Hour Nurse Information Line – registered nurses answer questions and advise on care
- Aetna member discounts – save on health related products and services
- Wellness programs and services
- Care Advocate Team – trained nurses who can help you understand confusing medical conditions and treatments, and coordinate complex medical care
- Beginning Right Maternity Program – obtain support during your pregnancy and receive a $100 gift card for participation
- Finding participating retail pharmacy providers
- Maintenance medications and Specialty medications – options for obtaining them
- How to receive savings on glucose meter and supplies
- Drug Cost Tool – see what medications cost under your plan
Summary of Benefits & Coverage – For each plan, a summary of what you pay/what the plan pays for medical/pharmacy.
Aetna KelseyCare - Accountable Care Organization (ACO)
The KelseyCare ACO plan provides top rated coverage with member copays at lower premium point. You will be required to stay within the Kelsey Seybold network and designate a PCP but will NOT need a referral to see a specialist within the Kelsey Network and Kelsey will help with anything outside their network. There is no out-of-network coverage, except in the case off an emergency. Kelsey also has their own clinic options.
Benefits Booklet – 100+ pages of Aetna plan details including a detailed comparison of Aetna plans, list of covered services, limitations and exclusions, important terms and plan provisions.
DocFind® – When you need to find a doctor or facility, start with DocFind®. It’s quick, easy and online 24/7. To use DocFind® you must register for your own secure Aetna Navigator® website. Once you do, you will get a personalized version of DocFind® that has your medical plan and zip code preprogrammed. Visit: www.aetna.com/docfind/custom/pasadenaisd.
If you have not set up your Aetna Navigator® website and need to find a doctor, use the network as follows.
- Medical Plan II (Grandfathered Plan) – “TX Medical Neighborhood – Houston Choice POSII”
- Medical Plan III – “KelseyCare – ACO”
- Medical Plan IV – “Open Access® Aetna Select”
- Medical Plan V – “Memorial Hermann Accountable Care Network”
Aetna Navigator – Access medical ID cards, medical claims payments and Explanations of Benefits. Your Aetna Navigator® account is personalized for you and your family. The information you see will be based on the health plan you are enrolled in. This site will also keep track of any personal health information that you enter. It is a quick and easy place to begin looking for all of your health care answers.
Aetna Mobile App – Get ID cards and plan information on the go.The Aetna Mobile app puts the most popular online features at your fingertips. It’s available for iPhone®, Android™ and BlackBerry® mobile devices. Visit www.aetna.com/mobile.
Resource Guides – One for each plan explaining what is offered with website links for more info:
- How the plan works – deductibles, co-pays, co-insurance, out-of-pocket maximums
- Choosing network providers and what happens if you go out-of-network
- Routine and emergency care options and costs
- Teladoc – doctors available 24/7 to diagnose, treat and prescribe medications
- 24-Hour Nurse Information Line – registered nurses answer questions and advise on care
- Aetna member discounts – save on health related products and services
- Wellness programs and services
- Care Advocate Team – trained nurses who can help you understand confusing medical conditions and treatments, and coordinate complex medical care
- Beginning Right Maternity Program – obtain support during your pregnancy and receive a $100 gift card for participation
- Finding participating retail pharmacy providers
- Maintenance medications and Specialty medications – options for obtaining them
- How to receive savings on glucose meter and supplies
- Drug Cost Tool – see what medications cost under your plan
Summary of Benefits & Coverage – For each plan, a summary of what you pay/what the plan pays for medical/pharmacy.
Exclusive Provider Organization (EPO) Plan
Aetna’s EPO plans are offered as alternatives to the POS plans with specified network of participating providers and facilities. The EPO provides a wide range of medical services and you will not be required to select a PCP. If your medical condition requires the attention of a specialist, you can schedule an appointment directly without having to go through your PCP.
Benefits Booklet – 100+ pages of Aetna plan details including a detailed comparison of Aetna plans, list of covered services, limitations and exclusions, important terms and plan provisions.
DocFind® – When you need to find a doctor or facility, start with DocFind®. It’s quick, easy and online 24/7. To use DocFind® you must register for your own secure Aetna Navigator® website. Once you do, you will get a personalized version of DocFind® that has your medical plan and zip code preprogrammed. Visit: www.aetna.com/docfind/custom/pasadenaisd.
If you have not set up your Aetna Navigator® website and need to find a doctor, use the network as follows.
- Medical Plan II (Grandfathered Plan) – “TX Medical Neighborhood – Houston Choice POSII”
- Medical Plan III – “KelseyCare – ACO”
- Medical Plan IV – “Open Access® Aetna Select”
- Medical Plan V – “Memorial Hermann Accountable Care Network”
Aetna Navigator – Access medical ID cards, medical claims payments and Explanations of Benefits. Your Aetna Navigator® account is personalized for you and your family. The information you see will be based on the health plan you are enrolled in. This site will also keep track of any personal health information that you enter. It is a quick and easy place to begin looking for all of your health care answers.
Aetna Mobile App – Get ID cards and plan information on the go.The Aetna Mobile app puts the most popular online features at your fingertips. It’s available for iPhone®, Android™ and BlackBerry® mobile devices. Visit www.aetna.com/mobile.
Resource Guides – One for each plan explaining what is offered with website links for more info:
- How the plan works – deductibles, co-pays, co-insurance, out-of-pocket maximums
- Choosing network providers and what happens if you go out-of-network
- Routine and emergency care options and costs
- Teladoc – doctors available 24/7 to diagnose, treat and prescribe medications
- 24-Hour Nurse Information Line – registered nurses answer questions and advise on care
- Aetna member discounts – save on health related products and services
- Wellness programs and services
- Care Advocate Team – trained nurses who can help you understand confusing medical conditions and treatments, and coordinate complex medical care
- Beginning Right Maternity Program – obtain support during your pregnancy and receive a $100 gift card for participation
- Finding participating retail pharmacy providers
- Maintenance medications and Specialty medications – options for obtaining them
- How to receive savings on glucose meter and supplies
- Drug Cost Tool – see what medications cost under your plan
Summary of Benefits & Coverage – For each plan, a summary of what you pay/what the plan pays for medical/pharmacy.
Memorial Hermann Accountable Care (MHAC) Network
It is a small network of Memorial Hermann healthcare providers who are able to share electronic health records such as your medical history, current medications and test results to better provide you with a personalized care plan. Gaps in your current care are easier to spot and address.
During an emergency, call 911 or go to the nearest hospital. Your coverage will be the same as if you were within the Memorial Hermann Accountable Care Network.
Benefits Booklet – 100+ pages of Aetna plan details including a detailed comparison of Aetna plans, list of covered services, limitations and exclusions, important terms and plan provisions.
DocFind® – When you need to find a doctor or facility, start with DocFind®. It’s quick, easy and online 24/7. To use DocFind® you must register for your own secure Aetna Navigator® website. Once you do, you will get a personalized version of DocFind® that has your medical plan and zip code preprogrammed. Visit: www.aetna.com/docfind/custom/pasadenaisd.
If you have not set up your Aetna Navigator® website and need to find a doctor, use the network as follows.
- Medical Plan II (Grandfathered Plan) – “TX Medical Neighborhood – Houston Choice POSII”
- Medical Plan III – “KelseyCare – ACO”
- Medical Plan IV – “Open Access® Aetna Select”
- Medical Plan V – “Memorial Hermann Accountable Care Network”
Aetna Navigator – Access medical ID cards, medical claims payments and Explanations of Benefits. Your Aetna Navigator® account is personalized for you and your family. The information you see will be based on the health plan you are enrolled in. This site will also keep track of any personal health information that you enter. It is a quick and easy place to begin looking for all of your health care answers.
Aetna Mobile App – Get ID cards and plan information on the go.The Aetna Mobile app puts the most popular online features at your fingertips. It’s available for iPhone®, Android™ and BlackBerry® mobile devices. Visit www.aetna.com/mobile.
Resource Guides – One for each plan explaining what is offered with website links for more info:
- How the plan works – deductibles, co-pays, co-insurance, out-of-pocket maximums
- Choosing network providers and what happens if you go out-of-network
- Routine and emergency care options and costs
- Teladoc – doctors available 24/7 to diagnose, treat and prescribe medications
- 24-Hour Nurse Information Line – registered nurses answer questions and advise on care
- Aetna member discounts – save on health related products and services
- Wellness programs and services
- Care Advocate Team – trained nurses who can help you understand confusing medical conditions and treatments, and coordinate complex medical care
- Beginning Right Maternity Program – obtain support during your pregnancy and receive a $100 gift card for participation
- Finding participating retail pharmacy providers
- Maintenance medications and Specialty medications – options for obtaining them
- How to receive savings on glucose meter and supplies
- Drug Cost Tool – see what medications cost under your plan
Summary of Benefits & Coverage – For each plan, a summary of what you pay/what the plan pays for medical/pharmacy.
CVS Caremark Prescription Benefits
When you enroll in one of the three medical plan options, you automatically receive prescription drug coverage through CVS Caremark which gives you access to a large, national network of retail pharmacies.
GENERIC OVER BRAND
To keep costs low, make sure you explore all options with your doctor when you are being prescribed a medication. Most brand-name drugs have a generic equivalent that is equal in strength and quality.
HOME DELIVERY
You could also be saving additional money by having your regular prescriptions delivered to you through Home Delivery.
Effective January 1, 2023, prescriptions for medications you take regularly (such as asthma and high blood pressure) must be filled in 90-day supplies. You will have a choice to receive your prescription via Mail Order or at a CVS Pharmacy.
| CVS CAREMARK PHARMACY BENEFIT | |
| RETAIL PHARMACY*– UP TO 30-DAY SUPPLY | |
| TIER 1: GENERIC | $30 COPAY |
| TIER 2: PREFERRED BRAND | $45 COPAY |
| TIER 3: NON-PREFERRED BRAND | $75 COPAY |
| DEDUCTIBLE (COMBINED TIER 2 & 3 DRUGS ONLY): $200 | |
| HOME DELIVERY – UP TO 90-DAY SUPPLY | |
| TIER 1: GENERIC | $50 COPAY |
| TIER 2: PREFERRED BRAND | $80 COPAY |
| TIER 3: NON-PREFERRED BRAND | $140 COPAY |
ID Cards
AETNA (medical)
- Aetna Mobile App
- Aetna Navigator
- Call Aetna:
1-866-841-3541
CAREMARK (pharmacy)
- Caremark Mobile App
- Caremark Temporary Card
- Caremark Website for ActiveCare
- Call Caremark:
1-888-234-0781
7 days/week, 24 hours/day
