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BSWH Employee Medical Plan


This is the online health plan headquarters for Baylor Scott & White Health employees and their dependents who are covered by Baylor Scott & White Health Plan medical plans.

For additional information about your medical coverage and other benefits, visit

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Important Notices

New networks!

Tier 1 is now BSW Premier HMO and Tier 2 is now UnitedHealthcare Options PPO.

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

Employees and covered dependents who live out of state or 40 or more miles from the nearest Tier 1 acute care hospital are eligible to receive a modified benefit when they visit Tier 2 providers for inpatient and outpatient care. The modified benefit is 80% plan paid (vs. 50%), after Tier 2 deductible is met.

  • Out-of-state employees and covered dependents are automatically flagged for the out-of-area coverage (no action required).
  • Employees and dependents that live 40 or more miles from the nearest Tier 1 acute care hospital must contact BSWHP Care Connect Center at 844.843.3229 and request the out-of-area coverage prior to receiving care.
  • If you or your dependent had the out-of-area coverage activated but no longer live out of state or 40 or more miles from a Tier 1 acute care hospital, contact BSWHP to deactivate this coverage.

Baylor Scott & White Quality Alliance (BSWQA) Care Navigation

Need help finding Tier 1 providers (PPO and HSA plans) / in-network providers (SEQA and EQA plans) and scheduling appointments? Assistance is just an email or phone call away:

Summary of Benefits and Coverage

A Summary of Benefits and Coverage (SBC) is an easy-to-understand summary about each medical plan option offered by Baylor Scott & White Health. These documents make it easy for you to see how different services and procedures are covered in different medical plans and compare coverage between the three network tiers in our HDHP and PPO plans. Baylor Scott & White Health offers the following medical plan options

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

Pharmacy Information

Our goal is to provide high-quality pharmaceutical care at the lowest possible cost to you. For example, generic medications can be significantly lower in cost compared to their brand-name counterparts. What are the differences between them? Find out in Save Money with Generic Medications.

Our benefits site has details on your prescription drug benefits. Additional resources are listed below:

A formulary is a list of selected medications covered by your plan as part of your health benefit in consultation with a team of health care providers. The BSWHP Group Value Formulary is driven by the Pharmacy and Therapeutics Committee (P&T) physicians and pharmacists who review the safety, efficacy and costs of each medication.

The tier information in the chart below applies to pharmacy benefits for all BSWH employee plans (SEQA, EQA, PPO and HSA). Using lower tier or preferred medications can help you pay the lowest out-of-pocket cost. Please note: If you have a high deductible (HSA) 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 Healthcare 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 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

Our health and wellness programs offer tools and resources aimed at one purpose: Empowering you to work towards your well-being goals in ways that work for you.

A refreshed wellness site makes it easier to access the array of programs designed to support your mind, body and spirit. Visit to explore our well-being resources to see all the ways we can support you.

All employees — full-time, part-time and PRN — are eligible to participate. And you don't have to be enrolled in a Baylor Scott & White medical plan to take part.

When we are physically ill, we go to a doctor, we take medicine, we rest - we don't think twice about taking steps to feel better. Yet many of us don't treat our mental health the same way. When you're stressed, you have options—probably more than you think. A healthier, happier life is possible with these support and treatment options offered to our employees.

Not convinced these options are right for you? See three reasons medical professionals hesitate to seek behavioral health treatment...and the facts behind why they shouldn't.

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 vs. 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.

Care Management

Get free assistance with chronic health and access to care.

Living with a health condition can be challenging. To make it a little easier, the Baylor Scott & White Quality Alliance Comprehensive Care Management team provides care management services to employees and dependents of Baylor Scott and White Health Plan.

Through care management, there is a multidisciplinary team available to support you in managing your health, assisting with navigation and coordination of care. Additionally, care managers work with members, families and providers to create plans to meet the ongoing complex care needs specific to each member. Care managers advocate for members, answer questions, provide education and assist members with setting goals.

A care manager may reach out to you if you have been identified as having a chronic health condition such as asthma, diabetes, COPD or a variety of other conditions that benefit from focused care. Care managers may communicate with your physician to facilitate conversations about your health concerns. At the core of care management is the goal to improve members’ health and quality of life in addition to getting the greatest value from their health plan.

Participation in care management is voluntary and offered at no cost to you. For more information, please email

Baylor Scott and White Quality Alliance's Care Navigation team is available to connect you to a care manager, locate tier one providers within your benefit plan and assist with appointment coordination. Care Navigation can be reached at 844.279.7589.

Baylor Scott & White Quality Alliance Comprehensive Care Management has a dedicated team for supporting our members between the age of newborn and 18. Since raising kids does not come easy, our interdisciplinary team is here to help! We are available to support both the pediatric member and their caregiver(s) across a range of needs. Services include education on preventive care specifically for the pediatric population, support for high-risk conditions, support for transition from pediatric to adult provides and more.

For more information on Pediatric Care Management services, please email

All pregnant medical plan participants can receive additional support from RN and/or SW Care Managers including a comprehensive assessment, coordinated care and resources to promote a healthy pregnancy and full-term birth. There is no additional cost to members for this program. Benefits include:

  • Education and support during pregnancy and after delivery
  • In-home support for high-risk conditions (such as diabetes, high blood pressure and severe nausea)
  • Screening for early identification of perinatal depression
  • Newborn health education
  • Breastfeeding best practices

Digital Care Journey

All medical plan participants can take part in a free program through MyBSWHealth for expecting moms, which includes information, resources and support for every step of pregnancy including education on fetal growth and development, self-care, breastfeeding and planning for baby's care after birth. Members can be enrolled by any BSWH provider. To learn more about or sign up for Maternity Care Management and/or the Health Pregnancy Digital Care Journey send an email to with you name, date of birth and estimated due date.

All members automatically have maternity benefits. To learn more about your benefits:

  • Log into the MyBSWHealth member portal to view your benefit information.
  • Call the customer service number on the back of your ID card.

NOTE: Welcoming a new child is an exciting time with many things to remember, but there is one important step you should take as soon as possible after delivery - add your newborn to your benefits within 30 days of birth. Visit and log into to submit a life event and add your newborn to your benefits.

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

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.

MyBSWHealth member portal

Our one-stop online patient portal tool helps you manage your health and access MyChart. It also offers access to Baylor Scott & White Health Plan for users with an active account, virtual care options, and much more. 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.

You can access MyBSWHealth online or by downloading the MyBSWHealth App from the App Store or Google Play.

Health Savings Account

Manage your Health Savings Account through Optum Bank.

Better tools
make it easier

We all have different healthcare needs. Handle them your way with the MyBSWHealth app. Download the app today and take a hands-on approach to your healthcare.

Text BETTER to 88408
QR code - scan to download the my bsw health app
My health. My Way.
Schedule Appointments
Video visit with your doctor
Message your doctor
Get test results
Manage your family's health

24/7 Virtual Care: eVisits and Video Visits

Members have access to board-certified doctors, pediatricians, licensed therapists and more using your smartphone, tablet or desktop computer.

MyBSWHealth Virtual Care

my bsw health mobile app

Receive care from the comfort of your home, or anywhere in Texas, 24/7. Simply log into or download the app.

Conduct an eVisit for common medical conditions and get care fast

  • Complete a short, online interview about your symptoms.
  • Receive a response from a Baylor Scott & White Health provider within one hour.
  • Select your preferred pharmacy to send prescriptions (if needed).

Schedule a same-day Video Visit with a provider, face to face

  • Schedule your appointment.
  • Talk with a Baylor Scott & White Health provider live about your symptoms.
  • Visits length varies, based on your needs. Often as quick as 10 - 15 minutes.
  • Provider will send prescription (if needed) to your preferred pharmacy.
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