Carrier News

Memorial Hermann Underwriting and Program Updates for 2018

Memorial Herman recently announced a number of underwriting and program updates for 2018 in small group and large group. For more information about their 2018 programs and access to materials, visit their broker resource page.

Small Group PPO Plan Now Available to all Employees

Memorial Hermann made the decision to offer their small group PPO plan to all eligible employees, regardless of residency, for new and renewal business. (Background: When Memorial Hermann announced their 2018 plans, they restricted the PPO plan to employees residing outside of their three county HMO service area only.) They updated their underwriting guide and small group eligibility map to reflect the change.

Service Area, Plan Availability, and Group Eligibility

The following rules apply to an employer whose headquarters is located within the HMO service area. For further clarification, please download the Memorial Hermann Health Plan Network vs. PHCS Network Chart.

  • At least 75% of the Employer’s population must reside within our HMO Service Area in order to qualify.
  • Employees who live outside of the HMO Service Area (up to 25%) may elect HMO coverage from their Employer as long as they live within 100 miles of our HMO Service Area. However, those that that live outside of the HMO Service Area (up to 25%) and have elected HMO coverage from their Employer must drive into our HMO Service Area to use their HMO benefits.
  • Dependents of those Employees that live outside of the HMO Service Area (up to 25%) and have elected HMO coverage from their Employer may use their HMO benefits in the PHCS Network as long as it is disclosed that those dependents have Out-of-Area addresses and are marked as such in our system. All other HMO Dependents (e.g.: a college student or a living arrangement due to divorce, etc.) must also be marked as Out-of-Network to use their HMO benefits in the PHCS network.

Submission Deadline Guidelines

The submission deadline will remain unchanged for 2018. You must meet the deadlines listed below in order to maintain your requested effective date. All group administrators and brokers will acknowledge the possibility of service delays by completing a Late Submission Form with their group application. Service delays may include—but are not limited to—access to care and pharmacy services delays for up to 30 days.

  • Small Group (2-50) – In order to receive an effective date of the 1st, the group application must be submitted by the 20th of the month prior with all additional forms and enrollment documentation turned in before the end of the month. Example: Group application submitted by February 20th, all other forms turned in by February 28th, therefore group will receive effective date of March 1.
  • Large Group (51+) – The group application must be submitted by the 1st of the month to receive an effective date for the same day. All additional forms and enrollment documents are due by the 10th of the same month. Example: Group application submitted by February 1st will receive effective date of February 1st, and all forms must be submitted by February 10th.

Renewal Changes for Small and Large Groups

Memorial Hermann will use a new auto-renewal process for renewals in 2018. All renewal proposals will identify the closest comparable 2018 plans available to the group.

  • If the group accepts the renewal with the mapped plans, no action is needed from the employer or broker. Memorial Hermann will install the mapped plans.
  • If the group selects different plans, they must complete the Acceptance Agreement and COBRA and Medicare Survey contained within the renewal package. The submission deadline is the same as new business (see section above).

Billing Changes

Effective December 2017 for January 2018 invoices, Memorial Hermann’s Bill Invoice Production Date is moving from 10th of the month to the 18th of the month. However, the due dates and the length of their grace period remains the same. All adjustments and maintenance changes need to be submitted by the 15th of the month. ACH payments are processed the first day of the month that they are due. Invoices are produced in the second week of the month, and mailed shortly thereafter.

These changes are summarized in the table below. As always, all payments are due on the 1st day of the month of coverage and groups are subject to loss of coverage if full payment is not received by the end of that month.

Old Timeline New Timeline
Invoice Production 10th 18th
Invoice Mailing 11th-15th 21st-25th
ACH Run 1st of month 1st (coverage month)

Creditable Coverage for 2018 Plans

Memorial Hermann determined that the prescription drug benefits of the following plans are Non-Creditable Coverage for Medicare. The plans are not expected to pay out as much as standard Medicare prescription drug coverage pays. All other plans offered by Memorial Hermann in Small Group and Large Group are creditable.

Small Group Select Bronze 6850 HMO
Large Group Select 5000-100 H.S.A. HMO
Large Group Select 6550-100 H.S.A. HMO
Large Group Select 5000-80 H.S.A. PPO
Large Group Select 6550-100 H.S.A. PPO

Other Items

  • Pharmacy Resources for 2018 including a comprehensive formulary and preventive drug list are now available on Memorial Hermann’s Pharmacy Benefit webpage.
  • The Employer Applications for Large Group and Small Group now combine HMO and PPO. Previously, employers were required to use separate forms if offering both HMO and PPO plans.
  • Member ID Cards are mailed directly to members, not the employers.
  • All Individual Health Policies will terminate on Dec 31, 2017. In June 2017, Memorial Hermann announced that they will fully exit the individual health plan market at the end of this year.
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