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Kelsey-Seybold Greater Houston Plan

We have answers for some of the most commonly asked questions. We know you probably have a lot of questions about the Kelsey-Seybold Greater Houston Plan. We’ve compiled our most frequently asked questions and grouped them into categories below. If you aren’t able to find the information you’re looking for, please contact us.


About a Plan

1. Is there a specific geographic area I must live in to join the Kelsey-Seybold Greater Houston Plan?

Yes, and it includes most of the Greater Houston-Galveston area. Specifically, the Kelsey-Seybold service area includes all zip codes in Harris, Fort Bend, or Montgomery counties as well as most zip codes throughout Brazoria, Galveston, Liberty, Walker, Grimes, San Jacinto, Chambers, Austin, and Waller counties. If you have a question about your eligibility for the plan, call the Shell Benefits Service Center at 1-800-30-SHELL (1-800-307-4355).

2. What if I am currently under treatment with a non-Kelsey-Seybold physician at the time I switch to the Kelsey-Seybold Greater Houston Plan?

If you’re currently under treatment for a serious medical condition, or you’re in your second or third trimester of pregnancy with a non-Kelsey-Seybold physician, you should complete the Transition of Care Request Form no later than 30 days after the effective date of your coverage to continue seeing your non-Kelsey-Seybold provider.

Your request will be reviewed for medical necessity. If approved, you will be able to continue seeing your current provider for the amount of time specified on the approval. Your care will then be transitioned into Kelsey-Seybold to establish a relationship with a Kelsey-Seybold physician. Download and print out a copy of the Transition of Care Request Form and other helpful documents here.

Completed forms should be returned no later than 30 days after the effective date of your coverage to:
The Kelsey-Seybold Greater Houston Plan
11511 Shadow Creek Parkway
Pearland, TX 77584
Attn: Kelsey UM

You will receive a letter from Kelsey-Seybold to confirm Transition of Care approval including authorization dates and additional instructions such as where to obtain lab tests and X-rays.

For behavioral health related services (mental health/substance abuse care), please see below.

3. If I am currently receiving behavioral health related services (mental health/substance abuse care), will I need to find a new provider if I enroll in the Kelsey-Seybold Greater Houston Plan?

The Kelsey-Seybold Greater Houston Plan offers behavioral health (mental health/substance abuse) benefits for covered services received from providers who participate in Cigna’s Behavioral Health network. To see if your current provider is participating in the network, contact Cigna directly through the Customer Service Line at 1-855-279-1509. If you find that you current provider is not participating in Cigna’s network, and you have concerns about changing providers, Transition of Care may be authorized for the current practitioner to complete treatment and/or prepare you to transition to a Cigna Behavioral Health network practitioner. Cigna will review each case on an individual basis. If your situation is approved for Transition of Care benefits, you will be able to continue seeing your current provider for a specified period until the safe transfer of care to a Cigna Behavioral Health provider can be arranged. Please call the Customer Service Line at 1-855-279-1509 or ask your healthcare professional to call on your behalf to initiate the Transition of Care process. You or your provider must call within the first 30 days of your enrollment in the Kelsey-Seybold Greater Houston Plan.

4. Why should I choose the Kelsey-Seybold Greater Houston Plan and Kelsey-Seybold Clinic for my medical care?

The Kelsey-Seybold Greater Houston Plan offers you the high-quality doctors and care coordination that Kelsey-Seybold is known for. You’ll enjoy many conveniences, including 24/7 appointment scheduling, the reassurance of our After-Hours Nurse Hotline at 713-442-0000, the ability to email your doctor’s office and schedule appointments online, Saturday appointments at four regional locations, and the freedom to choose from any of Kelsey-Seybold’s doctors for your care – with no referral required.

About the Premier Prevention Wellness Checks

5. If I join the Kelsey-Seybold Greater Houston Plan, will I still be able to receive my Be Well @ Shell wellness check?

Of course! Participants in the Kelsey-Seybold Greater Houston Plan can (and should!) continue to complete their annual wellness check as provided under the Be Well @ Shell Prevention Program. For details on wellness check options, see the Be Well @ Shell Prevention and Rewards Guide available at netbenefits.com > Health and Insurance > Reference Library. To read more about the Premier Prevention Exam at Kelsey-Seybold, visit kelsey-seybold.com/shellexam.

6. Will I have access to MD Anderson and the Shell Centers of Excellence program for cancer care if I join the Kelsey-Seybold Greater Houston Plan?

You have access to two nationally accredited cancer centers. Since Jan. 1, 2020, you have access to The University of Texas MD Anderson Cancer Center through the Shell Centers of Excellence program for cancer care, MD Anderson Cancer Center Direct™, in addition to the nationally accredited Kelsey-Seybold Cancer Center. Enrollment is required to receive 100% coverage for cancer prevention, diagnosis, and treatment.

About cancer care at the nationally accredited Kelsey-Seybold Cancer Center: National accreditation means that Kelsey-Seybold's Cancer Center meets and exceeds rigorous accreditation standards and compliance with nationally recognized treatment standards and guidelines by the National Comprehensive Cancer Network (NCCN). It means that cancer care is delivered according to the latest validated, evidence-based guidelines for effective treatment. Kelsey-Seybold has received the prestigious national certification of the Quality Oncology Practice Initiative (QOPI®) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). ASCO is the world's leading professional organization for physicians and Oncology professionals caring for people with cancer. The QOPI® Certification Program (QCP) certifies Hematology/Oncology practices that meet the highest quality criteria for cancer care. To learn more about the nationally accredited Kelsey-Seybold Cancer Center, visit kelsey-seybold.com/CancerCenter.

Important Contact Information

7. I have selected the Kelsey-Seybold Greater Houston Plan. Who should I contact when I have questions?

You should call your Kelsey-Seybold Concierge at 713-442-7455 (SHLL) or toll free 1-844-729-1219 for questions about appointment scheduling, participating physicians, clinic locations, and services. Contact the Customer Service Line at 1-855-279-1509 for questions about benefits, claims, Transition of Care, the Cigna Guest Privileges program (for family members residing temporarily in another network location), or for mental health/substance abuse care needs. Questions about eligibility, enrollment, or premium contributions should be directed to the Shell Benefits Service Center at 1-800-30-SHELL (1-800-307-4355).

Important Phone Numbers

Contact Services Services
Be Well @ Shell Kelsey-Seybold Concierge (answered by Kelsey-Seybold) Personalized assistance in scheduling appointments and selecting physicians. 713-442-7455 or 1-844-729-1219 Email: shellquestions@kelsey-seybold.com
Be Well @ Shell Kelsey-Seybold Health Plan Member Services (answered by Cigna) Benefit and Claim questions, Guest Privileges, Behavioral health (mental health/substance abuse) benefits. 1-855-279-1509
After-Hours Nurse Hotline at Kelsey-Seybold Speak with Kelsey-Seybold nurses about medical issues after hours. 713-442-0000 or toll free 1-800-231-6421
Appointment Scheduling 24/7 at Kelsey-Seybold Schedule appointments. 713-442-0000 or toll free 1-800-231-6421
"MyKelseyOnline" Help Desk Help with setting up or using your online account.  713-442-6565
Shell Benefits Hotline Questions about eligibility, enrollment, and plan premiums. 1-800-30-SHELL (1-800-307-4355)
CVS/Caremark Customer Care Questions about prescription copays, formulary (drugs covered), network pharmacies, requests for Prescription Drug Plan ID Card. 1-866-221-4207

After-Hours Services, Urgent Care, Hospital Care, and Emergency Care

8. What do I do in case of a medical emergency when I am in the Kelsey-Seybold Greater Houston Plan?

Please seek care at the closest emergency room if you are experiencing a serious medical emergency that requires immediate attention. You must contact your Kelsey-Seybold physician within 48 hours. You can reach your Kelsey-Seybold doctor’s office or the Kelsey-Seybold doctor on call, 24/7, by calling 713-442-0000. You can also speak to Kelsey-Seybold registered nurses after 5 p.m. and on weekends and holidays when you call our After-Hours Nurse Hotline at 713-442-0000. Our nurses have access to your confidential medical record and can page your doctor when needed.

9. What options does the Kelsey-Seybold Greater Houston Plan offer me when I need care after regular business hours?

Through the Kelsey-Seybold Greater Houston Plan, you have many options for after-hours care. Your resources include:

  • The Kelsey-Seybold After-Hours Nurse Hotline at 713-442-0000, available after 5 p.m. weekdays and on weekends and holidays. A Kelsey-Seybold registered nurse will advise and assist you, page your physician when needed and even schedule appointments for you. Kelsey-Seybold After-Hours nurses have access to your confidential medical record. A consultation with a Kelsey-Seybold After-Hours Nurse is FREE.
  • See a Kelsey-Seybold Doctor on Saturdays When You Are Ill. Appointments for both children and adults are available from 9 a.m. to 2 p.m. at four regional Kelsey-Seybold locations: Clear Lake Clinic in the Bay Area, Tanglewood Clinic near the Galleria, Spring Medical and Diagnostic Center in the Spring/FM 1960 area, and Fort Bend Medical and Diagnostic Center in Sugar Land. Call Kelsey-Seybold's 24-hour Contact Center at 713-442-0000 after 5 p.m. on Friday or on Saturday morning for a Saturday appointment. Your plan copay for an appointment with a Kelsey-Seybold Primary Care Physician on Saturday is $25.
  • If you or a family member have an immediate care need after 5 p.m., contact the Kelsey-Seybold After-Hours Nurse Hotline at 713-442-0000 for quality medical advice at no charge. Your Kelsey-Seybold After-Hours Nurse can access your confidential medical record and page physicians. Through Cigna, you also have access to participating Urgent Care Centers throughout Greater Houston. Call the Cigna Customer Service Line at 1-855-279-1509 to find a facility near you. Urgent Care Centers treat conditions that need immediate attention, but are not life-threatening, like broken bones, fractures, cuts, lacerations, sprains/strains, fevers, and minor infections. Your copay for an Urgent Care visit is $50.
  • Go to the nearest emergency room (ER) when you believe you or a family member may be experiencing a life-or-limb threatening medical situation. Emergency care services 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. Your plan copay for an Emergency Room visit is $200.

  • 10. What happens when I need to go to the hospital?

    The Kelsey-Seybold Greater Houston Plan and Kelsey-Seybold physicians partner with top hospitals in the Texas Medical Center and surrounding communities. A partial list of the hospitals preferred by Kelsey-Seybold physicians includes:

    • CHI St. Luke’s Health – Baylor St. Luke’s Medical Center, Texas Medical Center, Sugar Land Hospital and The Woodlands
    • Texas Children’s Hospital – Texas Medical Center and West Campus
    • Houston Methodist – Sugar Land and Willowbrook
    • HCA Clear Lake Regional Medical Center
    • HCA The Woman’s Hospital of Texas
    • Memorial Hermann – Memorial City

    11. Are emergencies covered outside of Houston if I am traveling?

    Yes, emergencies are covered worldwide. If you become ill while you are traveling outside of the area, please seek care at a participating Urgent Care Center or, in the case of a serious life-or-limb threatening emergency, seek care at the nearest Emergency Room. Contact Cigna directly through the Customer Service Line at 1-855-279-1509 for more information about participating Urgent Care Centers outside of the Greater Houston area. After receiving care, you must notify your Kelsey-Seybold doctor as soon as possible. Please note that in the Kelsey-Seybold Greater Houston Plan, when you are traveling out of the area, appointments with a doctor in the doctor’s office are not covered without prior authorization from Kelsey-Seybold.

    Behavioral Health Related Services (Mental Health/Substance Abuse Care)

    12. If I am currently enrolled in Shell’s HSM plan and receiving behavioral health services, will I need to find a new provider if I decide to switch to the Kelsey-Seybold Greater Houston Plan?

    The Kelsey-Seybold Greater Houston Plan offers behavioral health (mental health/substance abuse) benefits for covered services received from providers who participate in Cigna’s Behavioral Health network. To see if your current provider is participating in the network, contact Cigna directly through the Customer Service line at 1-855-279-1509. If you find that your current provider is not participating in Cigna’s network, and you have concerns about changing providers, Transition of Care may be authorized for the current practitioner to complete treatment and/or prepare you to transition to a Cigna Behavioral Health network practitioner. Cigna will review each case on an individual basis. If your situation is approved for Transition of Care benefits, you will be able to continue seeing your current provider for a specified period of time until the safe transfer of care to a Cigna Behavioral Health provider can be arranged. Please call the Customer Service Line at 1-855-279-1509 or ask your healthcare professional to call on your behalf to initiate the Transition of Care process. You or your provider must call within the first 30 days of your enrollment in the Kelsey-Seybold Greater Houston Plan.

    13. If I am currently enrolled in the Cigna HMO plan and receiving care from a Behavioral Health provider participating in the Cigna Behavioral Health network, will I need to find a new provider if I decide to switch to the Kelsey-Seybold Greater Houston Plan?

    No. The Kelsey-Seybold Greater Houston Plan offers behavioral health (mental health/substance abuse care) in partnership with Cigna so you can continue receiving care from your current Cigna behavioral health provider. However, you will need to provide your physician a copy of your new medical ID card to ensure that your claims are processed correctly.

    Living or Traveling Out of the Area

    14. I have a college student attending school outside of the Houston area. Will my child be covered under the l Kelsey-Seybold Greater Houston Plan?

    Under the Kelsey-Seybold Greater Houston Plan, you have access to the Cigna Guest Privileges Program. This program provides coverage for dependents, including college students, who reside in an area where the Guest Privileges Program is offered. Cigna’s Guest Privileges Program offers benefits for routine care, as well as urgent and emergent treatment needs. Contact Cigna directly through the Be Well @ Shell Kelsey-Seybold Health Plan Member Services line at 1-855-279-1509 for more information. If the Cigna Guest Privileges Program is not available in the area where your dependent resides, he/she will have access to only emergency and urgent care benefits under the plan. All non-urgent/routine care must be delivered/coordinated through a Kelsey-Seybold physician.

    15. My child resides with his/her other parent outside of the Houston area. Will my child be covered under the Kelsey-Seybold Greater Houston Plan?

    Under the Kelsey-Seybold Greater Houston Plan, you have access to the Cigna Guest Privileges Program. This program provides coverage for dependents who reside in an area where the Guest Privileges Program is offered. Cigna’s Guest Privileges Program offers benefits for routine care, as well as urgent and emergent treatment needs. Contact Cigna directly through the Customer Service Line at 1-855-279-1509 for more information. If the Cigna Guest Privileges Program is not available in the area where your dependent resides, he/she will have access to only emergency and urgent care benefits under the plan. All non-urgent/routine care must be delivered/coordinated through a Kelsey-Seybold physician.

    16. If I am traveling outside of Houston and become ill or suffer an accidental injury, what should I do if I am enrolled in the Kelsey-Seybold Greater Houston Plan?

    Depending on the severity of your situation, you should: (1) contact your Kelsey-Seybold physician during normal business hours, or (2) contact the Kelsey-Seybold After-Hours Nurse Hotline, available toll free at 1-800-231-6421, or (3) seek care from one of the participating Urgent Care Centers available across the country, or (4) go to the nearest emergency room for serious and immediate medical treatment needs. Kelsey-Seybold’s After-Hours registered nurses have access to your Kelsey-Seybold electronic medical record and can counsel you on appropriate care and next steps. The nurse can page your physician and have medications called into a local pharmacy, as necessary, to treat your condition.

    Appointments, Doctors, and Locations

    17. How can I make an appointment?

    Call Kelsey-Seybold Appointment Scheduling at 713-442-0000, 24 hours a day, seven days a week. You can also request and schedule appointments online through two options: (1) via MyKelseyOnline.com, your secure online connection to your Kelsey-Seybold doctors (login and password required), and (2) via AppointmentsNOW, where you can select Family Medicine, Internal Medicine, or Pediatrics and see doctors and available appointments (no login or password required). To schedule online with AppointmentsNOW, go to kelsey-seybold.com/NOW.

    18. How do I go about choosing a primary care physician? Is there help available to me in making a choice?

    Your primary care physician is your personal physician who knows your medical history and can act as your expert navigator through the healthcare system. Your Kelsey-Seybold physician will prompt you to get needed preventive care and, when illness occurs, will engage specialists, care managers, and other experts to manage the situation as needed. You are not required to designate a Kelsey-Seybold physician as your primary care physician to participate in the Kelsey-Seybold Greater Houston Plan. If you do decide to choose a personal primary care physician, Kelsey-Seybold can assist you. Call your Kelsey-Seybold Concierge at 713-442-7455 or toll-free at 1-844-729-1219. You can also view biographies and search for physicians here.

    19. Is there a Kelsey-Seybold Clinic location near me?

    Kelsey-Seybold Clinic offers 24 locations throughout the Greater Houston area. For personalized assistance in finding a location close to you, call the Kelsey-Seybold Concierge at 713-442-7455 or toll-free at 1-844-729-1219. For detailed information, including physician biographies, videos, and driving instructions to a Kelsey-Seybold locations, click here. Please note that Kelsey-Seybold Greater Houston Plan participants can get care at any Kelsey-Seybold location and schedule appointments with any Kelsey-Seybold physician – no restrictions and no referrals needed to see a Kelsey-Seybold specialist.

    20. Does the Kelsey-Seybold Greater Houston Plan offer all the specialists I need?

    The Kelsey-Seybold Greater Houston Plan includes 400+ Kelsey-Seybold primary care and specialist physicians, as well as over 4,000 Kelsey-Seybold “affiliate specialists.” Affiliate specialists are selected by Kelsey-Seybold for their medical expertise and ability to deliver high-quality care. A major advantage of the Kelsey-Seybold Greater Houston Plan is the coordinated care you receive from your Kelsey-Seybold physicians as they guide your treatment and organize specialists and resources specific to your needs. Kelsey-Seybold affiliate specialists – like Kelsey-Seybold staff physicians – are among Houston’s top doctors and include physicians from Texas Heart Institute, Baylor College of Medicine, Texas Children’s Hospital, UT Health, and leading private practitioners. Referrals are required to visit one of these affiliate specialists.

    Are Referrals Needed?

    21. Do I need a referral to see a specialist with the Kelsey-Seybold Greater Houston Plan?

    A: You do not need a referral to see an in-house Kelsey-Seybold specialist. You can make an appointment with any Kelsey-Seybold specialist at any location, with no referral needed. Kelsey-Seybold offers more than 400 doctors who practice in more than 55 medical specialties. Non-emergency treatment received outside of Kelsey-Seybold requires a pre-authorized referral for benefits to be considered under the plan. Your Kelsey-Seybold doctor will coordinate your care and engage “affiliate specialists” (see QA #20) based on your specific treatment needs. It’s all part of the “coordinated, accountable care” promise.

    Your Kelsey-Seybold Concierge

    22. What is the Kelsey-Seybold Concierge?

    The Kelsey-Seybold Concierge is a special, complimentary service designed to help you with questions and needs along the way. It is available exclusively to Kelsey-Seybold Greater Houston Plan members.

    Call the Kelsey-Seybold Concierge at 713-442-7455 or toll-free at 1-844-729-1219, 8 a.m. to 5 p.m., Monday through Friday.

    Here are just some of the special services available to plan members:

    • Personalized assistance in scheduling appointments and selecting physicians.
    • Assistance in finding nearby clinic locations.
    • Expert guidance regarding specific services available at each clinic location.
    • Expert help in resolving your questions regarding the Kelsey-Seybold Greater Houston Plan.

    Online Services Available to You

    23. Where can I find online information about the Kelsey-Seybold Greater Houston Plan?

    Go to kelsey-seybold.com/shellplan2021 to access:
    • Plan information and the conveniences you’ll experience.
    • Important phone numbers and other contact information.
    • Answers to Frequently Asked Questions.
    • Information about covered services and exclusions under the plan.
    • Online physician search.
    • After-hours services, urgent care, and emergency partner hospitals.

    24. What is MyKelseyOnline?

    MyKelseyOnline offers patients a personalized and secure way to communicate with their doctors, access most test results, schedule and request appointments, and even access portions of their medical records. You can sign up at MyKelseyOnline.com or call 713-442-6565 for set-up assistance or for help with your account. Here are just a few of the conveniences available through MyKelseyOnline:

    • E-mail your doctor’s office.
    • Schedule an office visit or preventive exam with a Kelsey-Seybold physician.
    • View most test results and comments from your physicians.
    • Pay bills online.
    • Request a prescription refill at a Kelsey Pharmacy.
    • View your medical records, including test results, medications, allergies, and immunizations. (Parents or legal guardians can view pediatric test results and immunization records if they set up a proxy account for their child.)

    Prescriptions

    25. Do I have prescription drug benefits under the Kelsey-Seybold Greater Houston Plan?

    CVS/Caremark will administer prescription drug benefits for the Kelsey-Seybold Greater Houston Plan through their national retail pharmacy network. The Kelsey-Seybold pharmacies located within the Kelsey-Seybold Clinic locations are a part of the CVS/Caremark network. Your Kelsey-Seybold doctor will ask you where you’d like your prescriptions filled and electronically transmit prescriptions to the pharmacy of your choice. Members also have access to the CVS/Caremark mail pharmacy service for greater convenience and savings on maintenance medications.

    Kelsey-Seybold Greater Houston Plan members will receive a separate prescription drug card to present to their pharmacy when picking up prescriptions.

    26. I am currently getting one or more prescriptions filled through CVS/Caremark Mail Order service. Will I experience any disruption of service if I switch from my current medical plan to the Kelsey-Seybold Greater Houston Plan?

    No. Nothing will change with your mail-order medications. They will continue to be filled on the same schedule unless you elect to move your medications to a Kelsey Pharmacy. If you have additional questions, please contact the CVS/Caremark Customer Care number at 1-866-221-4207.

    About My Plan ID Cards

    27. Will I receive an ID/insurance card when I enroll in the Be Well @ Shell Kelsey-Seybold Health Plan?

    Yes. You and each covered dependent will receive a Health Plan ID/insurance card. You will also receive a separate CVS/Caremark ID card to present to your pharmacy for prescriptions, including refills.

    28. Will my Social Security number appear on my membership identification card?

    No. Each member will be issued a unique identification number.

    29. How do I request a duplicate/replacement ID card?

    You can request a duplicate or replacement Be Well @ Shell Kelsey-Seybold Health Plan Insurance ID card here. You will submit an online form and your request will be processed within seven to 10 business days. You may also call your Kelsey-Seybold Concierge at 713-442-7455 or toll-free at 1-844-729-1219, 8 a.m. to 5 p.m., Monday through Friday. To request a duplicate or replacement CVS/Caremark ID card, please contact the CVS/Caremark Customer Care number at 1-866-221-4207.

    About Retirees

    30. Are retirees eligible for the Kelsey-Seybold Greater Houston Plan?

    A: Non-Medicare-eligible retirees in the Greater Houston area are eligible to enroll in the Kelsey-Seybold Greater Houston Plan. Medicare-eligible retirees have the option of joining the KelseyCare Advantage plan. Members in these plans will get their medical care from the Kelsey-Seybold Clinic network of physicians.

    Need Help?

    Contact us using our short form and one of our representatives will be in touch within one business day or call 713-442-SHLL (7455) and select option 2.