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BSWH Member Plan

Medical Information Center

Welcome

This site is a one-stop online headquarters for employees and dependents covered by Baylor Scott & White Health medical plans. To learn more about your medical coverage and other benefits, visit BSWHealth.com/Benefits.

Member Portal Tutorial: Watch a video tutorial about navigating the Member Portal to learn about the tools and resources available to help you manage your health plan benefits.

Online Connections

News and Alerts: Important Notices

BSWH Employee Plan Custom Site

Watch a video tutorial about navigating the Member Portal to learn about the tools and resources available to help you manage your health plan benefits.

Out-of-Area (OOA) Coverage - Only available with the PPO and HSA plans

Provides a modified Tier 2 benefit coverage for employees and covered dependents who live 40 or more miles from the nearest Tier 1 acute care hospital and visit Tier 2 providers for inpatient and outpatient care. The modified benefit is - 80% vs. 50%, after Tier 2 deductible. To ensure claims process correctly, employees and dependents must notify our Customer Advocacy Center at 844.843.3229 prior to receiving care.

Baylor Scott & White Quality Alliance (BSWQA) HealthAccess

Need help finding Tier 1 providers and scheduling appointments? Assistance is just an email or phone call away:

Summary of Benefits and Coverage

Summary of Benefits and Coverage (SBC) is an easy-to-understand summary about each medical plan option offered by Baylor Scott & White Health. This summary makes it easy for you to compare coverage between all three network tiers and how different services and procedures are covered.

Learn more about the plans with the NEW overview guides tailored to how each plan works. Explore the guides at BSWHealth.com/benefits.

Pharmacy Information

Because prescription drugs are a major driver of overall healthcare spending, we've developed programs that bring you high-quality care that's efficient and cost effective.

Our benefits site has details on your prescription drug benefits. A few additional resources are listed below:

The following tier information applies to your pharmacy benefit for all BSW plans (EQA, SEQA, PPO and HSA). Using lower tier or preferred medications can help you pay your lowest out-of-pocket cost. Please note: If you have a high deductible plan, the tier cost levels will apply once you meet your deductible.

Drug Tier Includes Helpful Tips
Tier 0 Preventive Tier 0 drugs may be available at a $0 cost share based on Health Care Reform regulations.
Tier 1 Preferred Generics Use Tier 1 drugs instead of brand-name drugs to help reduce your out-of-pocket costs.
Tier 2 Preferred Brand Tier 2 drugs will generally have lower co-payments than non-preferred brand-name drugs.
Tier 3 Non-preferred Brands and Generics Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.
Tier SP1 Specialty Preferred Generics Specialty drugs are sometimes used to treat complex and chronic conditions and may require special monitoring and handling. Use preferred options in SP1 and SP2 when available.
Tier SP2 Specialty Preferred Brands Specialty drugs are sometimes used to treat complex and chronic conditions and may require special monitoring and handling. Use preferred options in SP1 and SP2 when available.
Tier SP3 Specialty Non-preferred Brands Specialty drugs are sometimes used to treat complex and chronic conditions and may require special monitoring and handling. Use preferred options in SP1 and SP2 when available.

Preventive Care Medications

Under the Affordable Care Act, also known as the healthcare reform law, BSWHP covers some preventive care medications at 100% without charging a copay, coinsurance or deductible. The following list of drugs and products require a prescription (including over-the-counter medications) and filled at a network pharmacy to be covered at no cost share.

Baylor Scott & White Pharmacy Information

To learn about the services provided by Baylor Scott & White Pharmacies and their locations, visit:

Health and Wellness Programs

Treating yourself right isn't a fad, it's a good habit. And it's a habit anyone can pick up. Let our Wellness programs improve the areas of your life that could use a boost.

Preventive Care

A lifetime of good health starts with quality medical care throughout your life. Thanks to the Affordable Care Act (ACA), this care is now within the reach of all Americans. ACA requires health plans to eliminate cost sharing and cover preventive care services recommended by the U.S. Preventive Services Task Force (USPSTF), guidelines specifically issued for women and adopted by Health Resources & Services Administration (HRSA), the Advisory Committee on Immunization Practices and the Bright Futures Guidelines of the Academy of Pediatrics.

The following recommendations are general guidelines for all ages and should not dictate the care you receive. Your doctor will let you know what tests and exams you may need based on your specific risk factors and overall health.

  • Guidelines may change throughout the year based on new or revised laws and/or regulations and additional guidance.
  • Services must be billed with a primary diagnosis of preventive, screening, counseling or wellness, if applicable, to qualify and other restrictions may apply.
  • Your benefits plan may contain additional preventive care benefits, exclusions and limitations. Check your plan documents for a complete description of benefits, exclusions, limitations and condition of coverage.
  • Grandfathered plans (a plan that hasn't changed since 2010) may have costs. See your plan documents to find your specific coverage and costs.
  • Talk to your healthcare provider about a proper schedule of check-up visits.

Preventive Care versus Diagnostic Care

Preventive Care

Comprehensive evaluation to prevent health problems; you do not have symptoms or other abnormal studies suggesting abnormalities

Diagnostic Care

Medical care to treat or diagnose a problem, to monitor existing problems, or follow up on abnormal test results.

 

Disease Management

Get free assistance with chronic health and access to care.

Managing a health condition can be challenging. To make it a little easier, Baylor Scott & White Health offers employees and dependents of Baylor Scott and White Health Plan disease management services through the Baylor Scott & White Quality Alliance Comprehensive Care Management team.

As a part of your care team, a care manager can support you in managing your health, prescriptions, and your doctor's appointments. Care managers may communicate with your physician to help facilitate conversations about your health concerns.

A care manager may reach out to you if you've been identified as having a chronic health condition such as asthma, diabetes, COPD, or a variety of other conditions that benefit from focus care. You can contact your care manager at your convenience by calling the HealthAccess Center at 844.279.7589.

The HealthAccess Center can also help you find Tier 1 providers and schedule appointments.

Participation is voluntary. There is no additional cost to members for this program.

Complex Case Management

This program is for members who have chronic conditions or complex care needs. A nurse care manager will work with members, families, and the providers to create a plan to meet the member's ongoing complex care needs. Care managers advocate for members and assist them with setting goals and making a personal plan to improve their health as well as assist with arrangements for necessary services. Care managers answer questions and provide education to help members have a better understanding of their condition and plan of care.

The purpose of the program is to help members get the best possible results and the greatest value from their health plan. Participation is voluntary. There is no additional cost to members for this program.

For more information, please request a screening to see if Complex Case Management is the right program for you.

Healthy Pregnancy Information

We are pleased to offer a maternity program for expectant Baylor Scott & White Health Plan members. Focused on helping expectant mothers enjoy a healthy pregnancy journey, members can benefit from diverse program features for the duration of their pregnancy and one year postpartum.

Sign up by calling the customer service number on the back of your ID card or send an email to: HPMaternityCaseManagement@BSWHealth.org.

BSW Maternity Care Management

BSW Maternity Care Management members receive helpful tips and assistance during pregnancy and after delivery. Benefits include:

Contact Information

Have question about your benefits, coverage, pay or any healthcare needs? Contact us at 844.843.3229 and follow the prompts based on your specific needs:

  • For eligibility, benefits information or claims details using the self-service IVR, press 1
  • For assistance finding a Tier 1 provider or scheduling an appointment, press 2
  • For the 24/7 Patient Advisory Nurse line, press 3
  • For prior authorization requests, press 4
  • For assistance or questions about your pay, benefits, paid time off, disability or leave, press 5
  • To speak with a Customer Advocate about medical or pharmacy related questions, press 6 or you can also send us a secure message via our Member Portal

If you need to enroll in benefits or update your contact information, please log in to myPeoplePlace.com.

Other Resources

BSWH Benefits

Visit your benefits website to review your plan options, find side-by-side plan overviews and watch quick videos explaining how the plan works.

Thrive

Thrive is Baylor Scott & White Health's comprehensive, award-winning wellness program. All employees—full time, part time and PRN—and their spouses are eligible to participate. And you don't have to be enrolled in a Baylor Scott & White medical plan to take part. To learn more about Thrive or get answers to specific questions, visit thriveforwellness.com or email thrive@bswhealth.org.

MyBSWHealth

Is a one-stop online patient portal tool to help patients manage their health and access MyChart. It also provides access to other features including access to Baylor Scott & White Health Plan for users with an active account. You can access MyBSWHealth online or by downloading the MyBSWHealth App from the App Store or Google Play.

Member Portal Tutorial

Watch a video tutorial about navigating the Member Portal to learn about the tools and resources available to help you manage your health plan benefits.

Virtual Care: eVisits and Video Visits

Get care from a Baylor Scott & White Health provider any day of the week without leaving your home or office. Simply schedule an eVisit or Video Visit through your computer or mobile device. Receiving virtual care through MyBSWHealth.com or the MyBSWHealth app also allows your visit to be connected to your medical health records (with BSWH providers).

eVisits
  • Complete a short survey about yourself and your symptoms on the MyBSWHealth app. It takes about five minutes, depending on your condition.
  • A care team member will review your answers, make a diagnosis and recommend treatment.
  • You will receive your diagnosis and recommended treatment in an online response.
  • Prescriptions will be sent immediately to your preferred pharmacy.

Clinicians are available 8 AM to 8 PM daily. If you finish an interview after 8 PM, you will receive a response by the next day.

NEW! Behavioral eVisits are now available and you will receive a response Monday through Friday from 8 AM to 4:30 PM. Please note this option does not support prescriptions or medication refills.

Video Visits
  • Schedule a same-day appointment through the MyBSWHealth app
  • Receive setup instructions prior to the visit
  • Begin virtual doctor appointment

Video visits are available 8 AM to 8 PM daily.

To learn more about these services, access additional information here. If you have questions about eligibility or need technical support, call 855.760.7625. For benefit questions, contact Baylor Scott & White Health Plan at 844.843.3229.

Health Savings Account

Manage your Health Savings Account through Optum Bank.

BSWHP Informed Member Communications

2022


2021


2020

December

September

July Update

  • Early refills of your medications are extended through Sept. 30, 2020.
  • Prior authorizations for most prescription medications are extended for an additional 90 days. This applies to authorizations that are set to expire on or before Aug. 31, 2020.
 
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