Your Special Hospital Benefits

If you or a covered dependent need inpatient or outpatient hospital care, you can save money by using Houston Methodist Hospital or its community hospitals, or the East Texas Medical Center (ETMC) hospital system. Both of these systems have agreed to not collect deductibles and co-insurance from eligible participants enrolled in the Texas Annual Conference of the United Methodist Church (TAC) standard PPO plan. This could mean substantial savings if you or your dependents need hospital care. This non-collection (write-off) of deductibles and co-insurance only applies to hospital facility charges (not doctor charges) which are covered under the TAC standard PPO plan. Participants in the high-deductible PPO plan are not eligible for this benefit.

Who is eligible?

What services are covered?

What services are not covered?

If you live in the Houston area

If you live in East Texas

How to use this benefit

Houston Methodist Hospital inpatient admission non-utilization co-pay

Who is eligible?

  • Active clergy and lay employees of the TAC Fiscal Office and their eligible dependents (including spouses, children and surviving spouses) enrolled in the TAC standard PPO plan.
  • You are NOT eligible if:
    • You are enrolled in the high-deductible PPO plan;
    • Medicare is your primary coverage;
    • The TAC standard PPO plan is secondary rather than your primary coverage
      (applies to ETMC hospitals only); or
    • You serve on The Methodist Hospital board.

Return to top

What services are covered?

Houston Methodist or participating ETMC hospital facility charges for benefits covered under the TAC standard PPO plan. Clergy are eligible for private room, space-available upgrades.

Return to top

What services are not covered?

  • Services or supplies listed as exclusions in the standard PPO plan document (for example, elective cosmetic surgery and experimental procedures) are not eligible for this benefit.
  • Your hospital bill is separate from your doctor bills. The write-off does not apply to doctor bills. You will still owe deductibles and co-insurance amounts for any physician charges associated with your care at a Houston Methodist or ETMC hospital (including but not limited to surgeons, anesthesiologists, radiologists, and pathologists).

Return to top

If you live in the Houston area

  • The Houston Methodist Hospital system is renowned for its high quality of care, its internationally recognized research and its caring, spiritual environment.
  • Eligible facilities include Texas Medical Center - Fannin, Willowbrook, Sugar Land, San Jacinto, Clear Lake - St. John, Katy - West Houston, and Katy - St. Catherine.

Return to top

If you live in East Texas

  • The East Texas Medical Center is a system of high-quality hospital facilities serving eastern Texas, north of Trinity, Texas.
  • As of August 1, 2015, eligible ETMC hospital facilities include Athens, Carthage, Fairfield, Henderson, Jacksonville, Tyler, Pittsburg, Quitman, and Trinity. ETMC hospital facilities can change from time to time. It is the participant's responsibility to verify with the ETMC hospital in advance of receiving services if the hospital is a participating facility in the TAC non-collection benefit.
  • The TAC standard PPO plan must be your primary coverage. Employer coverage is always primary, so if your enrolled dependent has health insurance through his or her employer, the dependent's employer coverage would be primary for that dependent.

Return to top

How to use this benefit

1. When you pre-register at the hospital

When you or your dependents need services from a Houston Methodist or participating ETMC hospital:

  • Explain that the Texas Annual Conference of the United Methodist Church has a non-collection agreement with Houston Methodist hospitals and participating ETMC hospitals for participants in the TAC standard PPO plan whereby you and your enrolled dependents do not owe any deductible or co-insurance amounts to the hospital for inpatient or outpatient hospital facility charges.
  • It might be useful to print and take a copy of this webpage with you and provide it to the pre-registration clerk or keep a copy in your car glove compartment for emergencies because not all hospital personnel are acquainted with this special benefit.
  • You should not pay any pre-registration fees to the hospital for hospital facility charges for benefits covered under the standard PPO plan (the write-off does not apply to services that are not covered under the standard PPO plan or if you are enrolled in the high-deductible PPO plan). 

2. Review your explanation of benefits (EOB) from Boon-Chapman

  • After receiving services from a Houston Methodist or participating ETMC Hospital, review your explanation of benefits (EOB) that you receive from Boon-Chapman.  Be sure that the provider shown on the EOB is a Houston Methodist or participating ETMC Hospital. The EOB will correctly indicate any patient responsibility amounts (deductibles or co-insurance) that you would normally have to pay to the hospital. 
  • Even though you don’t have to pay any amounts covered by the non-collection agreement to the hospital, you will still receive credit towards meeting your deductible or out-of-pocket maximums as if you had paid them – a double blessing!

3. Review your statements from the hospital

If you receive a statement from a Houston Methodist or a participating ETMC hospital after Boon-Chapman has paid the hospital bill which shows that there is a balance you still owe to the hospital:

  • Review the statement to see if the services are for Houston Methodist hospital or participating ETMC hospital facility charges for a benefit covered under the standard PPO plan. 
  • If so, call the hospital billing department number found on the statement, explain about the write-off you (or your dependents) receive as a participant in the TAC standard PPO plan, and ask the billing department to apply the write-off and send you a corrected statement showing a $0 balance owed.
  • You may need to call a second time if you receive another statement showing that you still owe a balance to the hospital, but politely persist until the matter is resolved.
  • If you receive a hospital statement showing that you owe a balance to the hospital, do not assume that eventually the hospital will correctly apply the write-off and that you do not need to take any action.  You must take the initiative in contacting the hospital to resolve the billing error since you do not want the outstanding charges to be sent to a collection agency. 
  •  If the services are for benefits not covered under the TAC standard PPO plan, you will need to pay your patient responsibility balance owed to the hospital.

4. Pay any doctor charges you owe

Remember that the write-off only applies to inpatient or outpatient Houston Methodist or ETMC hospital facility charges – not to doctor charges. You will still owe any deductible and co-insurance amounts to physicians even if they are affiliated with the hospital and have “Methodist” or “ETMC” as part of their name, such as “Methodist Surgical Associates” or “Methodist Radiology Associates.”  Even though these providers are affiliated with the hospital, “Associates” always refers to a group of physicians, so a statement from a group of “Associates” would be a doctor bill, not a hospital bill, and you would need to pay any patient responsibility amounts owed to the doctor.

Houston Methodist Hospital inpatient admission non-utilization co-pay

If you live within 50 miles of any Houston Methodist Hospital facility and choose NOT to use a Houston Methodist Hospital facility for an inpatient admission, you will pay a $1,000 per-occurrence co-pay for inpatient hospital services that could have been performed at a Houston Methodist Hospital facility. This co-pay will be waived for emergencies or services unavailable at a Houston Methodist Hospital facility.

 

Want to know more?

 

Benefits Disclaimer         About Your Benefits