The university provides various options for medical coverage. Coverage is provided through Aetna.
Medical Plans
- Aetna Memorial Herman ACO
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Primary Care Physician (PCP) designation is required and a referral must be in place before visiting a Specialist. Local, in-network coverage only.
Plan Documents:
DocFind ACO Providers:
While searching, please use the following:
Aetna Memorial Hermann ACO = Aetna Whole Health Plans, (TX) Aetna Whole Health℠ - Memorial Hermann Accountable Care Network - Elect Choice/Aetna Select
- Aetna Select HMO
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Primary Care Physician (PCP) designation is required, and a referral must be placed before visiting a Specialist. National, in-network coverage only.
Plan Documents:
DocFind HMO Providers:
While searching, please use the following:
Aetna Standard Plans, Aetna Select
- Aetna Consumer-Direct Health Plan (CDHP)
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No PCP or referrals are required. Open access.
Plan Documents:
DocFind CDHP Providers:
While searching, please use the following:
Aetna Open Access Plans, Aetna Choice POS II (Open Access)
- Aetna Choice POS II
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No PCP or referrals requires. Open access
Plan Documents:
DocFind POS Providers:
While searching, please use the following:
Aetna Open Access Plans, Aetna Choice POS II (Open Access)
- Out-of-Area PPO Plan
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If you are enrolled in the Aetna Select HMO plan or Memorial Hermann ACO plan and your dependent is out of the area and needs access to network providers, your dependents are eligible for the Out-of-Area (OOA) PPO plan. Enrolling a dependent in this plan does not cost you any additional premiums.
- Summary
- Schedule of Benefits
- Booklet
The OOA PPO will cover your dependent in Houston and while away, so there is no need to switch back and forth between plans as your dependent comes to Houston to visit.
Be sure to review the Summary of Benefits Coverage or SBC, for the OOA plan, as it is a standardized model for comparison to the HMO and other plans. Contact a member of the Benefits Team about enrolling a dependent in this plan if you qualify.
Premiums
For convenience, the current Benefits Booklet and Enrollment Guide for the current plan year and the next plan year are provided to help employees plan during their new hire or annual enrollment period.
Annual Enrollment Guide 2023-2024 PDF
Dependent Eligibility
Once eligible for benefits, employees may also choose to cover eligible dependents in the medical, dental, optional life insurance, and optional accidental death and dismemberment insurance.
All eligible dependent children may continue under the benefits plan until they reach age 26, regardless of their status as a student.
Unmarried dependent children, age 18 or older, who are mentally or physically impaired and incapable of taking care of themselves are also eligible for coverage (the disability must have begun before the dependent turns 19). Proof of disability must be provided to Human Resources. Coverage for a disabled dependent can continue for as long as the dependent is incapable of self-support, remains unmarried, and depends on the Rice employee for support.
Eligible dependents include:
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Spouse (unless legally separated), including legally recognized same-sex spouse Domestic partner (complete the Domestic Partner Registration Packet); not eligible for long-term care.
All eligible children up to age 26 (as of July 1, 2010) for the medical plan. Eligible children include:
- Natural children
- Legally adopted children
- Stepchildren
- Children for whom the Rice employee is the legal guardian
- Foster children
- Children placed with the Rice employee for adoption
- Children of domestic partners (who depend on the Rice employee for support and live with the Rice employee in a regular parent/child relationship)
- Unmarried dependent grandchildren (must provide court-ordered documentation of dependent status).
Legal Disclaimer
By proceeding with enrollment, you certify that any enrolled dependents are eligible for coverage, as specified above. Dependent eligibility is subject to audit at any given time, and in the event of an audit, you will be asked to provide documentation of your dependents’ eligibility. The inclusion of any ineligible dependents will result in immediate termination of coverage and the employee will be responsible for financial restitution to the plan.
Helpful Information
- Enrollment Videos and Information
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Providing Documentation for my Benefits Enrollment and/or Qualified Life Event
- Recursos en Español
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¿Cómo me inscribo en los beneficios?
Como proporcionar documentación para mi inscripción en beneficios y/o cambio de vida
- Glossary of Health Coverage and Medical Terms
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A guide to health coverage and medical terms is available online and can be downloaded for your use: Glossary of Health Coverage and Medical Terms downloadable PDF.
- Emergency Room & Urgent Care
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The emergency room copayments for the ACO, HMO, and POS plans are $200 and our urgent care center copayments are $50. This differential exists in an effort to help you think about what appropriate care is and where the appropriate location is to take care of your situation.
If you go to the emergency room for a problem that is not a true emergency:
- It will cost a lot more than it would at your doctor's office or a walk-in clinic. A trip to the emergency room for an earache, for example, may cost three to four times as much as it would at your doctor's office, and there are lots of sick people in emergency rooms.
- You will probably spend a lot more time there than you would at a walk-in clinic or doctor's office.
- You will get care from a doctor who has probably never seen you before. It's always best to get as much of your care as you can from a doctor who knows and understands your particular needs.
How Do You Know If You Have an Emergency?
Technically, an emergency is "fear of loss of life or limb." It is usually clear if you are having a heart attack or are in a car wreck and need immediate medical assistance, but it is not always clear if you cut yourself and are bleeding or have a high fever.
If You Have a Clear Emergency Situation:
So, if it is a clear-cut emergency, go to the closest or most appropriate emergency room. Let the ambulance driver assist you in that decision. Sometimes, when you should go to the emergency room, include:
- chest pain that could be a heart attack,
- not being able to breathe,
- severe and uncontrolled bleeding, and
- stroke symptoms.
If You are Uncertain that You Have an Emergency:
- You may want to take care of the problem right away because you feel sick or uncomfortable, but if nothing bad is going to happen to you if you wait a while, then you probably don't have a true emergency. Then again, you don't always know that for sure. Some problems that seem minor can become serious if you ignore them. And it may be even harder to know what to do when a child is sick.
- If you are not certain if it is a real emergency, follow these steps:
- Consider calling your doctor. Most primary care physicians and pediatricians have answering services that will get in touch with your doctor, and your doctor will call you back relatively quickly. This is a great way to get a second opinion as to what you should do, given your situation.
- Consider using a Minute Clinic, normally located within CVS stores.
- Consider a network urgent care center. Urgent care centers are for minor emergencies, and they can treat you much quicker and for a lot less money than at an emergency room. If it turns out you are having a true medical emergency, a walk-in clinic will send you to the ER.
- When you have an urgent situation, you often won't have time to look for the closest urgent care facility. Know ahead of time which facilities near you (home or work) are in Aetna's network. Downloading the Aetna app ahead of time will help you be prepared and find the nearest medical facility.
- Take a "wait and see" approach. This often works with a fever or a viral infection. If you are ill for more than two weeks or have a fever and have other complications, consider calling your doctor. In most cases, the illness that caused the fever will clear up in a few days. You likely can treat the fever at home if you are in good health and do not have any medical problems or significant symptoms with the fever. It is easy to become dehydrated when you have a fever. Make sure that you are taking enough food and fluids and urinating in normal amounts.
- Stay in-network if at all possible! Out-of-network facilities can cost 5-10 times what in-network facilities charge. Depending on the circumstances, you might be billed for the difference, a practice known as balance billing.
Clinical Source: WebMD
- Medical Claim Forms
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Occasionally, you may need to submit a claim directly to Aetna for reimbursement. Please use the following forms:
Be sure to send the claim with documentation to the address on the form. Also, keep a copy for your records. You should receive an explanation of benefits for all claims. You can also review your claims history and claims status online at Aetna Navigator.
- ID Cards
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Your ID card should arrive within 10-15 business days of your enrollment. If you have not received an ID card or need to order a replacement ID card, please get in touch with Aetna.
Need an ID Card now? Aetna Navigator Can Help:
Did you know you can print a temporary ID from Aetna's secure member website, Aetna Navigator? Anytime, anywhere — log in to Aetna Navigator and select "ID Card" under the Requests & Changes menu. A temporary ID lets you visit your doctor and fill a prescription when you haven't yet received your permanent ID card. Use your permanent ID card once you receive it. If you ever need to replace your ID card, you can order one online, too. Your replacement ID card should arrive within 10 business days.
Additional Resources Available
- Teledoc TeleHealth
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Teladoc Telehealth (in addition to Teladoc Medical Expert, formerly Best Doctors) is available for Faculty and Staff enrolled in a Rice Aetna plan starting July 1, 2023.
- Teladoc will offer a 24/7 alternative to your regular doctor (including pediatric care) for urgent issues or when your doctor is not available, including:
- Non-emergency care such as the flu, sinus infections, sore throat, and more
- Short-term medicine refills
- Available anywhere in the U.S. (so you can use it when traveling)
- Do not call Teladoc for emergency issues such as broken bones, chest pain, or other care that may require x-rays or lab tests
- For those enrolled in the POS and CDHP plans, Teladoc also offers Primary 360, or a virtual primary care service including:
- An ongoing relationship with a primary care doctor that will provide for longitudinal planning, ongoing support via web/app/phone, and appointments within 5 business days
- Mental Health Care 7 days a week (from 7:00 am to 7:00 pm local time)
- Psychiatrist, psychologist, or therapist care within 72 hours of the initial need
- Ongoing care from the same provider, if desired
- Also available to dependent adolescents from age 13+
- Dermatologist appointments
- Board-certified dermatologist
- Treatment for sudden or ongoing skin conditions, including rashes, acne, psoriasis, skin infections, and more
- Follow-up appointments within 7 days are at no additional charge.
For more information see the TelaDoc flier (en español). Register via Teladoc.com/Aetna or call 1-855-Teladoc (835-2362).
Please note: When registering, Rice University does NOT have a Teladoc Health Code. Please ensure the box for "I received a Teledoc Health code from my employer or insurance company" is not checked before clicking next.
- Teladoc will offer a 24/7 alternative to your regular doctor (including pediatric care) for urgent issues or when your doctor is not available, including:
- Teledoc Medical Experts
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Teladoc Medical Experts is a go-to service for peace of mind for a troubling medical issue. This service is provided at no cost to benefit eligible employees and their enrolled dependents. With Teladoc Medical Experts, employees can access expert medical opinions and answers to medical questions from the leading physicians in their fields.
They can help you or a family member:
- Get an Expert Medical Opinion - If you are unsure about a diagnosis or need help deciding on a treatment option.
- Find a Doctor- Help find a doctor specializing in your condition.
- Get Critical Case Support- Have been admitted into the hospital and want Medical Expert guidance.
- Ask the Expert- Have medical questions or concerns and want a leading expert advice.
- Use Mental Health Navigator- Guidance on a mental health condition or treatment that isn't improving.
For more information, please visit BestDoctors.com or call them at 866-904-0910.
- AbleTo through Aetna
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Sometimes life can be overwhelming, leading to worry, stress, and sadness. These are common feelings with significant life changes or chronic pain. But help is now just a phone call away. AbleTo through Aetna is personalized support when you need it.
Benefits-eligible employees enrolled in one of Rice's medical plans may receive virtual, personalized support to help them feel better with the AbleTo program. You'll learn to manage your emotions better and improve your health. And your mental and physical health can improve in as little as eight weeks. Plus, this program is already included in your Aetna membership.
More information is available:
Visit the website: AbleTo.com/Aetna Call 1-844-330-3648, Monday through Friday from 9:00 am until 8:00 pm EST, or view the AbleTo Brochure.
- Virta
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Rice University is fully covering the cost of Virta for all benefits-enrolled employees and dependents with type 2 diabetes and prediabetes who are enrolled in any Rice University health plan.
What you will get with Virta:
- Digital weight scale and blood meter that syncs with your phone
- One-on-one health coach to guide and support you
- Medical providers to safely reduce unwanted medications
Please note: There are some serious medical conditions that would exclude patients from the Virta treatment. Start the application process now to find out if you qualify.
For additional questions or concerns, please get in touch with the Aetna Medical Concierge at 1-800-905-7670.
For information on your coverage while traveling outside the United States, please visit our travel services website. If you would like to receive a personalized letter explaining how your plan will work while traveling outside the United States, you can contact the Aetna Medical Concierge listed above.
For information about how you may qualify for a subsidy of your Rice medical premiums through state Medicaid or CHIP programs, please review this document or go to http://www.gethipptexas.com/ for information about Texas subsidy programs.
Medical Plan FAQs
- When do my benefits start?
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Please visit our Eligibility and Timing page for more information.
- How do I contact Aetna?
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Please use the Aetna Concierge telephone number, 1-800-905-7670, to contact Aetna for medical issues or log in to Aetna Navigator online. The Concierge Service should be able to assist you with any Aetna-related medical issue you have.
- What’s the best plan for me and my family?
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Choosing the right plan for you and your family is a very personal choice. Please consult the plan comparison chart in the annual enrollment guide for key information.
Some things to consider are:
- Monthly premium
- Deductible
- Out-of-pocket maximums
- In and out of network coverage
- Size of the network
- Which plans offer out-of-network coverage?
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The Aetna Consumer Directed Health Plan (CDHP) and Aetna Choice POS II (POS) both offer in and out-of-network coverage levels. However, the HMO, POS, and CDHP all have very broad networks and most people stay within the network for the majority of their care.
- What is the Spousal surcharge?
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Employees whose spouse is eligible and has access to coverage through their employer are assessed a Medical Coverage Surcharge if the employee chooses to cover the spouse on the Rice plan
- What is the Tobacco/Nicotine surcharge?
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Employees and spouse or domestic partners who use nicotine and/or tobacco products and enroll in one of Rice’s medical plans are assessed a Smoker Surcharge
- Can I waive my coverage?
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Yes, you are not required to enroll in Rice’s medical plan; but we strongly suggest you have health insurance coverage for any unexpected accidents or illnesses.
- Will my premiums come out of each paycheck?
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Yes, premiums will be deducted from each check. You may see a double deduction if you make changes mid-month. Faculty and Staff who have deductions taken out over 9 months will have slightly higher rates to compensate for the fewer deductions. Please refer to the payroll schedule.
- If my spouse is currently covered on his or her employer's health plan, and they lose coverage, am I able to add them to my Rice plan?
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Yes. Your spouse's and/or dependent’s loss of coverage would be considered a QLE. You should report the change under Me, Benefits and click on Report a Life Event in iO within 30 days of the effective end date of your spouse’s coverage. You will be required to submit documentation under Document Records proving your QLE.
- When will I receive my medical card?
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You will receive a new card to your home address from Aetna for medical and prescription coverage before the start of the plan year if there are changes to your coverage. If you do not make any changes to your medical plan enrollment, please continue to use your existing ID card.
New employees will receive a card to their home address approximately 2-3 weeks after you enroll from Aetna for medical and prescription coverage.
- Do the Rice medical plans offer prescription drug coverage?
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All four plans offered at Rice include prescription drug coverage through Express Scripts. You may purchase your medications at any network pharmacy or through the Express Scripts mail-order program. Note that a 90-day prescription will be required for maintenance medication after your second 30-day fill, your doctor will need to write the prescription for that amount.