Teladoc Health
$58 or less
General medical visits are available 24/7. Therapist visits are $90 or less, dermatology consults are $85 or less, and psychiatry is $215 or less for the first visit and $100 or less for ongoing visits.
Teladoc fees ↗Benefit information
Understand how your benefits work
Find the details for your enrolled plan below. Use the official PDFs for complete exclusions, limits and definitions.
Before the deductible: preventive care only
Preventive list ↗All three HSA plans cover eligible in-network preventive care at no charge.
Medical plan overview
| Benefit | Plan 1 · $4,500 HSA | Plan 2 · $2,500 HSA | Plan 3 · $2,500 Memorial Hermann HSA |
|---|---|---|---|
| Network | Aetna Select℠ (Open Access) | Aetna Select℠ (Open Access) | Memorial Hermann / Aetna Select |
| HSA eligible | Yes | Yes | Yes |
| Primary care physician | Not required | Not required | Not required |
| Specialist referral | Not required | Not required | Not required |
| Additional network access | Emergency care only | Emergency care only | Aetna Select for urgent care, walk-in clinics, emergency care and services unavailable through Memorial Hermann |
| Deductible | $4,500 individual / $9,000 family | $2,500 individual / $5,000 family | $2,500 individual / $5,000 family |
| Out-of-pocket maximum | $7,500 individual / $15,000 family | $3,750 individual / $7,500 family | $3,750 individual / $7,500 family |
For provider searches, Plan 3 is listed as “(TX) Aetna Whole Health℠ - Memorial Hermann Accountable Care Network - Elect Choice/Aetna Select.”
Medical services after the deductible
| In-network service | Plan 1 · $4,500 HSA | Plan 2 · $2,500 HSA | Plan 3 · $2,500 Memorial Hermann HSA |
|---|---|---|---|
| Primary care office visit | Covered in full | $25 copay | $25 copay |
| Specialist office visit | Covered in full | $75 copay | $75 copay |
| Virtual primary care (Teladoc) | Covered in full | Covered in full | Covered in full |
| Designated walk-in clinic (MinuteClinic) | Covered in full | Covered in full | Covered in full |
| Urgent care | Covered in full | $75 copay | $75 copay |
| Emergency room | $500 copay | $500 copay | $500 copay |
| Inpatient hospital | Covered in full | $250 per admission | $250 per admission |
| Outpatient surgery facility | Covered in full | $250 copay | $250 copay |
| Diagnostic lab / X-ray / imaging | Covered in full | Covered in full | Covered in full |
All amounts in this table are in-network and shown after the deductible when the deductible applies. Emergency-room copay is waived if admitted. See the official plan summary for limits and exceptions.
Prescription drugs after the deductible
| Prescription category | Plan 1 · $4,500 HSA | Plan 2 · $2,500 HSA | Plan 3 · $2,500 Memorial Hermann HSA |
|---|---|---|---|
| Rx deductible | Medical deductible applies; preventive medications may be waived | Medical deductible applies; preventive medications may be waived | Medical deductible applies; preventive medications may be waived |
| Tier 1A / Tier 1 generic · retail | $3 / $10 | $3 / $10 | $3 / $10 |
| Tier 1A / Tier 1 generic · mail order | $6 / $20 | $6 / $20 | $6 / $20 |
| Preferred brand · retail / mail order | $50 / $100 | $50 / $100 | $50 / $100 |
| Non-preferred generic or brand · retail / mail order | $100 / $200 | $80 / $160 | $100 / $200 |
| Preferred specialty | 20% up to $250 | 20% up to $250 | 20% up to $250 |
| Non-preferred specialty | 40% up to $500 | 40% up to $500 | 40% up to $500 |
| Maintenance drugs | 90-day after two retail fills or opt-out process | 90-day after two retail fills or opt-out process | 90-day after two retail fills or opt-out process |
All prescription amounts are after the medical deductible unless the medication qualifies for preventive coverage. Review the formulary and official plan documents for complete details.
Medical programs included with the plan
CVS Virtual Care
$55 quick care
24/7 care for minor illnesses and injuries, plus scheduled mental health and primary care. On a qualified high-deductible plan, the deductible must be met before covered non-preventive services can be provided with no cost share.
CVS fees ↗Medical and dental OTC allowances
One CVS portal
Use the same OTC Health Solutions account for both allowances. Medical provides $35 each calendar quarter for eligible health and wellness products. Dental provides $50 each plan year for eligible oral-care products. To use either allowance in person at CVS, have the barcode on the back of your Aetna member ID card scanned at checkout.
Employee Assistance Program
Free and confidential
Employees and household members have 24/7 access to counseling support, daily-life assistance, and legal and financial consultations. Call 1-866-326-7172 (TTY: 711).
EAP guide ↗Dental, vision and income protection
Your other ENNOVA benefits
Aetna Dental DMO 1.2A
No annual maximum
A participating primary care dentist must be assigned for the plan to cover services. The plan has no annual benefit maximum, and many diagnostic and preventive procedures are available at no charge.
Dental schedule ↗Aetna Vision E160
$160 allowance
$10 eye exam copay and a $160 allowance for frames, eyeglass lenses and contacts. Contacts and eyeglass lenses can both receive the allowance in the same plan year when contacts are purchased first. Each benefit is available once every 12 rolling months.
Vision summary ↗UHC Life + AD&D
$50,000
Employer-paid basic life and matching AD&D. Benefits reduce to 65% at age 65 and 50% at age 70, subject to certificate terms.
Life certificate ↗UHC Disability
60% of earnings
STD: up to $750 weekly, 13 weeks, with 0-day injury and 7-day sickness elimination periods. LTD: up to $5,000 monthly after 90 days, with a five-year reducing benefit duration.