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How to Enroll
Forms & Documents
City of Houston
Coastal Water Authority
Episcopal Diocese of Texas
Rating is from U.S. News and World Report, a leading publisher of annual authoritative rankings including Best Medicare Plans. Our plan does not have a direct relationship with U.S. News. This award was not given by Medicare. Our overall rating from Medicare for 2019 is 5.0. Our plan’s official CMS Star Rating can be found at
City of Houston
Welcome to KelseyCare Advantage’s City of Houston web portal—a web page dedicated exclusively to City of Houston Medicare-eligible retirees enrolled in KelseyCare Advantage. It is a privilege to bring you high quality, affordable health care and we look forward to providing you with excellent customer service for years to come.
Click on the links below to access important benefit documents for 2019.
Link to the City of Houston HR Benefits
You can reach the City of Houston HR Benefits team by
Important Note About Your Pharmacy Network:
This network consists of any Kelsey-Seybold Pharmacies, Wal-Mart/Sam's pharmacies, HEB Pharmacies, and all CVS Pharmacies
. If you fill your prescription at these pharmacies, you may pay lower cost sharing than at other pharmacies. Download
City of Houston 2019 Pharmacy Directory (Coming Soon)
KelseyCare Advantage Preferred 2019
2019 Application (Required)
2019 COH Medicare Plan Election Form (Required)
2019 Evidence of Coverage
2019 Annual Notice of Changes
2019 Summary of Benefits
2019 Comprehensive Formulary
2019 Formulary Addendum
Drug Search - See if your drug is covered
to search the 2019 City of Houston KelseyCare Advantage Formulary.
Schedule of Copayments for Prescription Drugs
Your pharmacies with preferred cost-sharing include
Kelsey-Seybold pharmacies, Walmart/Sam’s pharmacies, H-E-B and all CVS pharmacies
. If you fill your prescription at these pharmacies, you may pay lower cost sharing than at other pharmacies.
Have questions about KelseyCare Advantage?
Call our Concierge Team at
, 8:00 a.m. to 5:00 p.m., Monday through Friday. Or, click on the “Request Assistance” button above to request a phone call from a KelseyCare Advantage Concierge Representative.
Provider Directory Request
If you would like a Provider Directory mailed to you here are your options:
and request a paper copy be mailed to you
Send an email to
Request a copy
KelseyCare Advantage is offered by KS Plan Administrators, LLC, a Medicare Advantage HMO with a Medicare contract. Enrollment in KelseyCare Advantage depends on contract renewal. You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Understand Medicare Advantage
Compliance and Fraud
How to Enroll
Cost Sharing, Copayments,and Deductibles
Appeals / Grievances
Part D Coverage Determination
©2015 KelseyCare Advantage. All rights reserved.