Page ContentFrequently Asked QuestionsAbout Boon-Chapman Who can I contact if I'm interested in learning more?Contact Julio Iturriaga, KelseyCare sales manager, at Julio.Iturriaga@kelsey-seybold.com or 713-442-5852, or Jody Bright, Boon-Chapman, at email@example.com or 512-769-4989.If you are a broker or employer requesting a quote, you will need to provide the following: Census: number of employees, their ages, genders, dependents and zip codes.Summary of benefits.Past three (3) years of claim experience.Large claims: any claim over a specific financial threshold ($15,000, for example) for claims such as premature births or emergency bypass surgery.Current premium rates.Stop-loss terms for insurance of self-funded claims.Who is this available to?KelseyCare is available to partially self-funded companies or companies wishing to move to self-funding with more than 50 covered employees in the Greater Houston Service Area. View our Service Area Map.Who provides reinsurance, sometimes referred to as stop-loss coverage?American International Group, Inc., or AIG, is our reinsurance partner. AIG is an American multinational insurance corporation with headquarters in New York City and with offices worldwide, including one in Houston.With a history dating back to 1919, AIG brings considerable reinsurance expertise and management experience presents a cost-effective model with competitive pricing. (KelseyCare has consistently delivered a medical cost between 15 and 30 percent below other carriers in the same healthcare market.)"What is a Pharmacy Benefit Manager?A Pharmacy Benefit Manager (PBM) is a third-party administrator (TPA) of prescription benefit plans. PBMs are responsible for implementing cost management programs and arrangements designed to control an employer group’s prescription drug costs.What are the advantages of a company implementing a partially self-funded plan?Partially self-funded plans are regulated by federal ERISA law and not state insurance departments, so the plan designs are not subject to state mandates. Other advantages include: Allows employers to design benefit plans to meet the specific needs of the employees, instead of offering state-mandated benefits.With the flexibility to implement specific cost management programs, as well as cost effective vendor and provider partnerships, employers have more control over their plan costs,More control over plan costs means better plan performance. If the plan performs well, the employer, as opposed to the insurance company with a fully insured plan, realizes the financial benefits.The plan is protected against excessive claim costs with stop-loss insurance. What does partial self-funded mean?“Partial” self-funding is an employee benefit plan strategy whereby employers secure stop-loss insurance to limit their risk on excessive claim costs. Stop-loss policies typically insure against excessive aggregate claim costs, as well as excessive costs on an individual covered member. An employer would look at the fixed costs and estimated claims costs instead of a traditional per-employee premium under a fully insured plan.The structure of this type of arrangement is: Employers can realize savings if the plan performs at, or better than, expected.Employers enjoy greater flexibility in plan designs and payment strategies as opposed to the sunken premium costs of a fully insured arrangement. When properly structured, self-funded plans give employers a great opportunity to manage healthcare costs. With KelseyCare administered by Boon Chapman, these functions are consolidated into a single process to make it easier on employers. Under this arrangement, the employer would pay their fixed costs for their services; then pay claims up to a certain amount. If claims exceed this amount, the employer would be covered against further expenses by the stop-loss policy.What does self-funded mean?“Self-funded healthcare” is a self-insurance arrangement whereby an employer provides health benefits to employees with its own funds. This is different from fully insured plans where the employer contracts with an insurance company to cover employees and dependents. In self-funded healthcare, the employer assumes the direct payment of claims. Typically, self-funded employers hire a third-party administrator (TPA) to pay healthcare claims on their behalf.In practical terms, self-insured employers pay for claims out-of-pocket as they are presented instead of paying a predetermined premium to an insurance carrier for a fully insured plan.Self-funding is one of the most effective ways employers can control the rising costs of healthcare coverage.Key guidelines of a self-funded plan: Lower cost of administration: Employers find that administrative costs for a self-insured program administered through a TPA are significantly lower. Control of plan design: Employer has flexibility in determining the appropriate plan design to meet the needs of the employer and employees. The employer can redesign the plan at any time. Cash flow benefit: Employer's cash flow is improved when money formerly held by the insurance carrier in the form of reserves (for unreported and pending claims) is freed for use by the employer. What is a third-party administrator of managed healthcare?A third-party administrator (TPA) has the expertise and capability to administer all or a portion of the claims enrollment and billing processes for self-funded benefit plans. A TPA may be contracted by a health insurer or self-insured company to administer services, including claims administration, premium collection, enrollment and other administrative activities. A hospital or provider organization desiring to set up its own health plan will often outsource certain responsibilities to a TPA.Who is Boon-Chapman?Headquartered in Austin, Boon-Chapman is the oldest Texas domiciled third-party administrator. Boon-Chapman has an integrated network of employee benefits with over 700 clients and 75,000 covered employees. Boon-Chapman identifies health-benefit needs and develops solutions to help meet those needs.Boon-Chapman has more than 50 years of experience serving the needs of self-funded employer groups. Boon-Chapman believes that exceptional customer service matters – and that is a true differentiator.The Boon-Chapman mission: Create innovative solutions in the healthcare environment.Maintain a positive environment for our employees.Provide superior products and exceptional service for clients.Operate with the highest ethical and moral standards.Promote professional management, producing planned results by means of specific goals, objectives, priorities and strategies.About KelseyCare How do I get more information?Call the KelseyCare Concierge at 713-442-0006 or toll-free at 866-609-1630, between 8 a.m. and 5 p.m., Monday thru Friday. Or email firstname.lastname@example.org for more information.What is the KelseyCare Concierge?To make your healthcare experience with KelseyCare as hassle-free as possible, we offer a special complimentary concierge service. The KelseyCare Concierge is available exclusively to KelseyCare members. Call the KelseyCare Concierge at 713-442-0006 or toll-free at 866-609-1630, 8 a.m. - 5 p.m., Monday thru Friday. Here are just some of the services provided by your KelseyCare Concierge: Personalized assistance in scheduling appointments and selecting physicians.Assistance in finding nearby clinic locations.Expert guidance regarding specific services available at each clinic location.Resolution of complex billing and eligibility issues.Expert help resolving your questions and concerns regarding the KelseyCare plan. What after-hours services does KelseyCare offer?It is important to get the care you need when you need it. Kelsey-Seybold offers resources to help guide you to the right care for you and your family. Our KelseyCare After-Hours Services include: The reassurance of our After-Hours Nurse at 713-442-0000. Call our After-Hours Nurse after regular office hours, on weekends and on holidays. A KelseyCare After-Hours Nurse will answer your questions, page your physician if necessary and schedule needed appointments. If a situation seems life threatening, take immediate action and call 911.Saturday Ill-Care Appointments for children and adults are available from 9 a.m. to 2 p.m. at Kelsey-Seybold’s Clear Lake Clinic on Gemini Ave., West Clinic near the Galleria, Spring Medical and Diagnostic Center in the FM 1960 area, Fort Bend Medical and Diagnostic Center in Sugar Land. Call our 24-hour Contact Center at 713-442-0000 after 5 p.m. on Friday or on Saturday morning for a Saturday appointment.Saturday Pediatric Appointments are available at our Katy Clinic. Whether your child needs a physical or is a little under the weather, call our 24-hour Contact Center at 713-442-KIDS (5437) to schedule an appointment or go to AppointmentsNOW to schedule online.Emergency Room (ER) services are described in your plan document. These include medical, psychiatric, surgical, hospital and related healthcare services and testing, such as ambulance service, which are required to treat a sudden, unexpected onset of a bodily injury or serious sickness. Examples of emergency situations include uncontrolled bleeding, seizures or loss of consciousness, shortness of breath, chest pains or severe squeezing sensations in the chest, suspected overdose of medication or poisoning and sudden paralysis or slurred speech. Are convenience care clinics covered?No. Convenience care clinics are not covered, but there are many ways to access KelseyCare after regular business hours. See below for a description of our KelseyCare After-Hours Services.What is Continuity of Care?Patients who are currently undergoing active treatment for a particular medical condition (for example, in their 24th week of pregnancy, undergoing chemotherapy or in the immediate post-operative period) may be approved for Continuity of Care coverage. This means the patient will receive his or her ongoing care for a particular medical condition at the in-network level of coverage. You will need to complete a Transition of Care Form within 60 days of the date of our effective plan coverage. Download the "Transition of Care" form.What if I am currently undergoing radiation oncology treatment or pregnant and not using a Kelsey-Seybold physician?You may be eligible to continue to receive medical coverage through Transition of Care or Continuity of Care with either your current non-Kelsey provider or with a KelseyCare Affiliate Specialist. You will need to complete a Transition of Care Form within 60 days of the date of our effective plan coverage. Download the "Transition of Care" Form. What is the KelseyCare service area?Service area includes Brazoria, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller counties. View our Service Area Map.I have a college student attending school outside of Houston. Will my child be covered under KelseyCare?Yes, college students can be covered under the plan. College students only have emergency room coverage out of area. They must see Kelsey-Seybold doctors for all nonemergency and routine care.Which medical specialties does Kelsey-Seybold Clinic offer?Kelsey-Seybold Clinic offers comprehensive medical specialty care. More than 370 physicians work for Kelsey-Seybold Clinic. You may see any Kelsey-Seybold physician or specialist at any Kelsey-Seybold location – and no referrals are required. Kelsey-Seybold offers board-certified specialists trained in Family Medicine and Internal Medicine and medical specialties, including Cardiology, Obstetrics and Gynecology (OB/GYN), Ear Nose and Throat (ENT), Endocrinology, Gastroenterology, Urology, Orthopedics and Sports Medicine, Dermatology, Rheumatology, Allergy and Immunology, Pediatrics, General Surgery, Reconstructive Breast Surgery and many others. How do I know if there is a Kelsey-Seybold Clinic location near me?Kelsey-Seybold Clinic offers 20 locations throughout the Greater Houston area with a new clinic location opening in Meyerland, spring 2013. For personalized assistance in finding a location close to you, call the KelseyCare Concierge at 713-442-0006. For detailed information and driving instructions to a Kelsey-Seybold location, view our locations map.What happens if I'm not sure which Kelsey-Seybold primary care physician to choose?You’ll select Kelsey-Seybold Clinic as your overall provider of care. That’s what will appear on your ID card. There are many services available to help you choose a primary care physician. For personal assistance in selecting a physician, call your KelseyCare Concierge at 713-442-0006 or toll-free at 866-609-1630 between 8 a.m. and 5 p.m., Monday thru Friday. Or email email@example.com.You can also access our KelseyCare Guide to Clinics and Providers (click here for a pdf of our Guide); the Kelsey-Seybold website at kelsey-seybold.com; our online physician search and the Kelsey-Seybold Contact Center available 24/7 at 713-442-0000. Our goal is to help you make your own choice of a primary care physician. We do not assign a physician to you.What if I have an emergency and don't have time to call Kelsey-Seybold?We also recommend that you call the KelseyCare After-Hours Nurse at 713-442-0000. Our after-hours nurses can access your secure electronic medical record (EMR) and can page your physician if necessary. You can call our KelseyCare After-Hours Nurse at any time after normal business hours, with questions or concerns regarding symptoms or illnesses you or a family member may be experiencing.How do I receive care when I select KelseyCare?When you select KelseyCare, you are exclusively selecting Kelsey-Seybold physicians and KelseyCare Affiliate Specialists to coordinate and deliver your care and treatment. KelseyCare offers comprehensive benefits, including physician care; hospitalization; outpatient surgery and treatment; diagnostic services and preventive care, including exams to diagnose and treat diseases and conditions of the eye.Does the KelseyCare plan offer all the specialist providers I need?KelseyCare physicians include all Kelsey-Seybold physicians, as well as 1,800 KelseyCare Affiliate Specialists. As part of your care coordination, your Kelsey-Seybold physician will guide your treatment and may “refer” you to a KelseyCare Affiliate Specialist. KelseyCare Affiliate Specialists – like Kelsey-Seybold physicians and specialists – are among Houston’s top doctors and include physicians from the Texas Heart Institute, Baylor College of Medicine, UT Health Science Center and leading private practitioners.Do I need a referral to see a specialist with the KelseyCare plan?You do not need a referral to see a Kelsey-Seybold specialist, including more than 370 doctors in more than 50 medical specialties. (However, you do need a referral from your Kelsey-Seybold physician to see a KelseyCare Affiliate Specialist.)If I enroll in KelseyCare, can I withdraw from the plan before the next annual enrollment period?If you were to withdraw, you would not be covered until the next open enrollment. Your enrollment election is a one-time annual election and may not be changed during the plan year. The only exception to this restriction occurs if you experience a qualifying event. Qualifying events include, but are not limited to: marriage, birth of a child or change in employment status.How long may I keep my children enrolled in the plan?Generally, your dependent children are eligible to be on the plan until their 26th birthday.Will our Social Security numbers appear on our membership identification cards?No. Each member will be issued a unique identification number.Is emergency room (ER) care included in my KelseyCare Plan?Yes, emergency room (ER) services are covered in your plan. If you have a medical emergency, you should go to the nearest medical facility offering emergency care. (You should notify your Kelsey-Seybold physician as soon as possible.)What happens when I need to go to the hospital?KelseyCare partners with Premier Hospital Partners in the Texas Medical Center and surrounding communities. A partial list of our hospital network includes: St. Luke’s Episcopal Health System, including St. Luke’s Episcopal Hospital in the Texas Medical Center; St. Luke’s Sugar Land Hospital; St. Luke’s The Woodlands Hospital; and St. Luke’s Patients Medical Center.Clear Lake Regional Medical Center.Texas Children’s Hospital.The Woman’s Hospital of Texas. Where can I get a prescription filled?You can get prescriptions filled at many of our locations. Learn more about our 14 Kelsey Pharmacy locations. Pick up your prescription right where you see your doctor.Do any Kelsey-Seybold clinics offer Saturday appointments?Saturday Ill-Care appointments between 9 a.m. and 2 p.m. are available for children and adults at four locations: our Tanglewood Clinic near Memorial and the Galleria; the Spring Medical and Diagnostic Center; Clear Lake Clinic; and Fort Bend Medical and Diagnostic Center in Sugar Land.Our Katy Clinic offers Saturday appointments for well-child care as well as ill care. For appointments, call 713-442-KIDS (5437).What do I need to bring to my first appointment?For your first visit, we suggest bringing your: Prescriptions You will need a list of your current medications. Bring your prescription bottles or a written list. If you bring in a list of your medications, be sure to include the name of the medication, dosage and the pharmacy where last filled.Previous Medical Records. There are two ways to have your records transferred to Kelsey-Seybold.First, a Kelsey-Seybold physician can request your medical records from your previous physician(s). A copy of Kelsey-Seybold's Authorization for Release of Healthcare Information is available for download. Please complete this form, sign and bring to your first appointment. (Note: There is no charge for physician-requested records.)Second, you have the right to request a copy of your medical records from your previous physician(s). You may do so and bring the records to your first Kelsey-Seybold appointment. (Note: You may be asked to pay for copies of your records.) For pediatric patients, parents should bring a copy of their child’s shot records to the first appointment. What is MyKelseyOnline?When you enroll in MyKelseyOnline.com, you can email your doctor’s office and get replies to your healthcare questions. You’ll directly schedule appointments with your primary care physician and an ever-expanding list of specialty-care physicians and providers, including endocrinologists, rheumatologists, obstetricians and gynecologists, dietitians and diabetes educators.How can I make an appointment?Here’s how: Call our 24/7 Contact Center at 713-442-0000 at any time. You can also request and schedule appointments online through MyKelseyOnline.com, your secure online connection to your physicians. For personalized assistance in finding doctors and scheduling appointments, call your KelseyCare Concierge at 713-442-0006 or toll-free at 866-609-1630, 8 a.m. to 5 p.m., Monday thru Friday.How do I go about choosing a primary care physician?Your primary care physician is your personal physician and the gatekeeper to help you achieve good health. You do not need to designate a Kelsey-Seybold physician as your personal physician to participate in the KelseyCare plan. However, we encourage you to choose a primary care physician before you get sick or need to make an appointment for your annual physical. We also encourage you to review our primary care physician bios. You can search by Family Medicine, Internal Medicine or Pediatrics to find a primary care physician that is right for you. Many of our video bios also explain the physician’s philosophy of care.I already see a Kelsey-Seybold doctor. Why should I choose the KelseyCare Plan?When you choose KelseyCare, you are selecting the doctors of Kelsey-Seybold Clinic to coordinate your care. The KelseyCare plan offers many advantages, including affordable copays and predictable coinsurance. Plus, you get personalized assistance through the KelseyCare Concierge program.Why should I choose the KelseyCare Plan and Kelsey-Seybold Clinic for my medical care? With KelseyCare, you'll get quality care from leading physicians and premier hospitals. You'll also save money with KelseyCare's lower total plan cost. Kelsey-Seybold physicians are Houston's Doctors for Life – with local, regional and national recognition for medical excellence. The bottom line – Kelsey-Seybold Clinic and KelseyCare are the partners you want for convenient, affordable and effective quality care.Here's more: Complete Access to Care, 24/7 – Choose the Kelsey-Seybold physician you want to see at any of our 20 care centers, and make an appointment with no referral required. Contact our 24/7 Contact Center for appointment scheduling. Speak to an expert Kelsey-Seybold nurse whenever you have a concern after-hours – just call 713-442-0000. Make appointments for ill care at many of our locations on Saturdays. Access to Top Doctors and Premier Hospital Partners – Your Kelsey-Seybold physician may refer you to a selected Affiliate Specialist as part of your treatment plan. KelseyCare Affiliate Specialists – like Kelsey-Seybold physicians and specialists – are among Houston's top doctors and include physicians from the Texas Heart Institute, Baylor College of Medicine, UT Health Science Center and leading private practitioners. You'll need a referral from your Kelsey-Seybold physician to see an Affiliate specialist.You'll have access to leading hospitals – KelseyCare's Premier Hospital Partners include: the St. Luke's Episcopal Health System in the Texas Medical Center, including St Luke's Episcopal Hospital: St. Luke's Sugar Land Hospital; St. Luke's The Woodlands Hospital; The Woman's Hospital of Texas (OB/GYN services only); Texas Children's Hospital; and Clear Lake Regional Medical Center. One-Stop Care – KelseyCare's state-of-the-art care centers are located throughout the Greater Houston area and bring primary care, many specialists, lab and X-ray and onsite pharmacies together for you. We offer advanced imaging (MRI, CT, PET, digital mammography, bone densitometry) and Outpatient Surgery on a scheduled basis. Secure Access Online to Your Physician – Join MyKelseyOnline to securely view your lab results and email your physician's office with questions and follow-ups. Rely on Our Reputation for Excellence – Kelsey-Seybold is consistently recognized for excellence, with the most physicians in the state of Texas recognized by the National Committee for Quality Assurance (NCQA) for excellence in diabetes care and heart and stroke care. Kelsey-Seybold Clinic has also been recognized by the NCQA as the nation's first accredited Accountable Care Organization. Experience the Benefits of Coordinated Care – Ever wish your physicians talked to each other? You don't have to wish any longer. Kelsey-Seybold physicians are experts on coordination and collaboration. We know that coordinated care is the key to superior care. Your secure medical information is available to your Kelsey physicians 24/7 through our state-of-the-art Electronic Medical Record (EMR). Your KelseyCare Concierge – This exclusive service for KelseyCare members provides personalized assistance in scheduling appointments and selecting physicians. Call the KelseyCare Concierge at 713-442-0006 or toll-free at 866-609-1630, 8 a.m. - 5 p.m., Monday thru Friday.