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Health plan tools at your fingertips, 24/7: Did you know you can send questions through the secure messaging feature of the MyBSWHealth member portal and we'll get back to you, usually within 1-2 business days? You can also view your ID card, find a provider and much more. Access guide

Welcome, TRS-ActiveCare Participants

Thanks for stopping by! If you're new to Baylor Scott & White Health Plan, it's nice to meet you.

Not sure if you're in the right region to choose this plan? Check the BSWHP-TRS Service Area Map.

Learn more about us in the 2023-24 TRS Member Presentation →↓

Provider Search

You can see providers anywhere in our 141-county service area, no matter where you live. You do not need a referral to see an in-network provider — even specialists.

In plan year 2023-24, Baylor Scott & White Health Plan members continue to be on the BSW Premier HMO network. If you're new to Baylor Scott & White Health Plan, be sure to check and see if your providers are part of this network.

Did you know? As a BSWHP member you pay...

  • $0 copay for your first primary care sick visit
  • $0 copay for primary care for dependents under age 19

Online Tools

MyBSWHealth App

Access health plan information from any computer, tablet or smartphone device. To download:

 
 

Or text "BETTER" to 88408

Show your card

Always show your new Member ID card to your provider, even if your coverage has not changed.

A new plan year may mean you have a new Member ID number, or a phone number may have changed. Your provider will need this information to confirm your coverage and process your claims.

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

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.

The WebMD digital wellness platform encourages members to be healthy, while providing personal health support for various health conditions and health risks.

Well-being Assessment - Take an online health assessment to access recommendations and daily habits to improve your health and well-being. The well-being assessment is a simple digital health survey that helps you take steps towards a healthier and more vibrant life.

Digital Wellness Coaching – Stay engaged, track progress and accomplish well-being goals by utilizing Daily Habits. Daily Habits offers you a personalized set of activities based on your health information and personal interests.

  • Nutrition
  • Sleep
  • Stress
  • Physical Activity
  • Tobacco

Digital Health Library – The Resource card offers articles, videos, recipes and motivational apps to support a healthier life. You can search for condition-specific information or explore other health topics of interest.

From Your Health Plan – Find the latest information on additional wellness offerings available through the health plan.

Wellness Challenges – Join a wellness challenge for the motivation to go the extra mile. Wellness Challenges encourage sustainable, healthy habits through competition and accountability. Gamify drinking water, taking the stairs and other activities that challenge and boost your well-being.

  • Physical Activity: Ready! Set! Move!
  • Nutrition: Five to Thrive
  • Stress: Stressless
  • Sleep: Seize the Zzzz
  • Water: Rethink Your Drink

Nurses are available to our members 24/7. Our nurses can give you information about how to take care of yourself at home or can help you decide if an appointment, an urgent care visit or an emergency room visit is best for your symptoms. If you want to talk to a nurse, call 877.505.7947

This program is for members who have chronic conditions or complex care needs. A nurse case manager will work with members, families and the physician to create a plan to meet the member's ongoing complex care needs. Case managers advocate for members and assist them with setting goals and making a personal plan to improve their health. They also can assist with arrangements for necessary services. Case 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, request a screening to see if Complex Case Management is the right program for your needs.

Are you expecting? You can receive helpful tips and assistance during pregnancy and for one year after birth.

Benefits include:

  • Access to a nurse 24/7 during pregnancy
  • In-home support for high-risk conditions (such as diabetes, hypertension and severe nausea)
  • Depression screening following delivery
  • Parental education for newborn health during the first year
  • Immunization reminders
  • Planning for returning to work.

Sign up by calling the customer service number on the back of your ID card.

Finding help just got easier. findhelp is a Texas-based platform created to connect all people in need with programs that serve them. You can search for local resources like medical care, food, job training, transportation and more. Organizations in your community are ready to help.

findhelp is free, private, and easy to use. Search and connect at:

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.

Have you ever wondered why some people can eat the foods they love and not gain weight? Wondr Health reveals the secret sauce behind then unexpected concept through behavioral science.

Pharmacy Information

If you are eligible for a Medicare Part D prescription drug plan, please read this:

Pharmacy/prescriptions resources

2024

2023

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 must be filled at a network pharmacy to be covered at no cost share.

2023

2022

BSWHP Specialty Pharmacy Drug Program

The BSWHP Specialty Pharmacy Drug Program offers the choice of two specialty care pharmacies to help manage and access specialty drugs.

BSWHP Medications Restricted to Pharmacy or Medical Benefit

BSWHP has certain medications that are restricted to the Pharmacy or Medical Benefit. For more information on these medications, visit the link below:

Pharmacy information and locations

Member Support

Let us help you with any questions. We're here serving Texans, so call us weekdays between 7 AM and 7 PM to speak live to another Texan.

Customer Service Center: 844.633.5325 (TTY: 800.735.2989)

Temple (Headquarters)

1206 W. Campus Drive
Temple, TX 76502
254.298.3000
888.633.5325

Following CDC guidelines for COVID-19, at this time we do not have in-person customer service. Our Customer Service Representatives will be happy to help you by phone at the numbers above. You also have access to your 24/7 Self-Service portal.

Nurse Advice Line

Nurses are available to members 24/7. Our nurses can give you information about how to take care of yourself at home or can help you decide if an appointment, urgent care visit or emergency room visit is best. To talk to a nurse, call 877.505.7947.

Language Line

If you need assistance and your primary language is not English, call 888.210.0744 and tell the BSWHP Customer Service Coordinator. An interpreter from AT&T will assist you in completing your call.

Other TRS Benefits

Provider Information

Baylor Scott & White Health Plan doesn't require members to select a primary care physician (PCP). You have the flexibility of using any of our network providers. However, if you choose to select a PCP, you can. In fact, everyone on your plan can select their own PCP.

Languages Spoken by Physician/Provider:

You may search for doctors who speak a certain language using our online Provider Search. Enter requested information into the form and click "Search." In the "Customize Results" field, select "language." You may also select gender, group affiliation, hospital affiliation, board certification and accepting new patients.

Hospital-Based Physicians

Some professional services provided by physicians at an BSWHP-participating facility or hospital might be considered out of network (OON). These may include services provided by specialists such as anesthesiologists or radiologists. You may be responsible for payment of all or part of the fees for those professional services that are not paid or covered by the member's health benefit plan. BSWHP has established a fee schedule for out-of-network (OON) hospital-based providers. BSWHP will reimburse the out-of-network provider up to the amount on the fee schedule, minus any applicable co-payments, co-insurance and/or deductibles.

To confirm whether or not your hospital utilizes participating physicians such as anesthesiologists or radiologists, please contact BSWHP customer service at 844.633.5325.

See a list of in-network and out-of-network hospital based providers for select commercial plans.

Urgent Care and Extended Hours Clinics

If you or a family member has an urgent health matter or needs to see a physician after hours, urgent care centers are listed in our provider search tool.

Referrals and Prior Authorizations

Certain services require prior authorization by Baylor Scott & White Health Plan.

All services must be medically necessary and appropriate and meet Baylor Scott & White Health Plan coverage criteria where applicable. If your plan does not offer an out-of-network benefit, all services must be rendered by in-network physicians/providers (unless otherwise authorized in advance) in order to be eligible for payment.

Board Certification

After completing residency training in their specialty, a physician needs to pass an exam and meet certain requirements established by their Board to become Board Certified. Learn more about Board Certification or check the Board Certification status of a provider.

Tools and Resources

Find all important documents and forms below:

Member Resources and Information

Transition of Care

For enrollees new to BSWHP who are in active treatment for medical conditions with non-BSWHP network providers, BSWHP may grant up to 90 days to transition care from non-BSWHP providers to BSWHP providers, based on individual case review.

Please fill out the Transition of Care form and either submit it to BSWHP at:

Baylor Scott & White Health Plan
1206 W. Campus Drive
Temple, TX 76502
Attention: Member Relations

Claims

Baylor Scott & White Health Plan doesn't require members to select a primary care physician (PCP). You have the flexibility of using any of our network providers. However, if you choose to select a PCP, you can. In fact, everyone on your plan can select their own PCP.

All claims are processed at the Baylor Scott & White Health Plan headquarters in Temple, Texas. When a Baylor Scott & White Health Plan member is covered by more than one insurance or medical plan, we coordinate benefits paid by BSWHP to avoid duplicate coverage and payment. A copy of the other insurance Explanation of Benefits (EOB) must accompany any claims submitted to Baylor Scott & White Health Plan for secondary coverage determination.

Subrogation

Subrogation refers to cases when another person or insurance company is responsible for payment of medical services. Injuries on someone else's premises and motor vehicle accidents are the most common examples. Baylor Scott & White Health Plan expects to be reimbursed for expenses paid for care if a third party is responsible.

Bratton Firm acts as our representative in subrogation claims. If Baylor Scott & White Health Plan has already paid medical expenses, Bratton Firm will investigate. For questions regarding possible subrogation claims, please contact Bratton Firm at 512.477.8772.

Workers Compensation

Injuries related to on-the-job circumstances should be filed directly with the Workers Compensation carrier or the employer involved. Baylor Scott & White Health Plan does not pay for work-related injuries.

More Claims Information

For questions related to claims issues, including claims submissions, payments, denials and adjustments, call us at a href="tel:+18446335325">844.633.5325 and ask for the claims department.

Appeals and Grievances

Baylor Scott & White Health Plan recognizes that an enrollee, physician, provider or other person designated to act on behalf of an enrollee may encounter an event in which performance under this agreement does not meet expectations. It is important that such an event be brought to our attention. We are dedicated to addressing problems quickly, managing the delivery of health care services effectively and preventing future complaints or appeals.

The Medical Director of the Baylor Scott & White Health Plan has overall responsibility for the coordination of the complaint and appeal procedure. Download the complete Baylor Scott & White Health Plan Complaint and Appeal Procedure.

Authorizations and Referrals

To receive the maximum benefit from your Baylor Scott & White Health Plan (BSWHP) medical plan, you will need to use BSWHP-approved doctors, hospitals, pharmacies, and other providers of medical services that are covered by your plan. In the event of an emergency, it is important that you go to the nearest hospital that can provide the best care for your needs. In this case, you may use doctors or hospitals outside the BSWHP network.

When you need non-emergency medical services you always have the choice of using out-of-network providers. However, you will not receive the benefits of your BSWHP medical plan, and you will be responsible for the full cost of any medical services you receive.

Most services you need are available through the Baylor Scott & White Healthcare system. Referrals are no longer required by BSWHP, however, some specialists may require it. Some services may also require your physician to ask BSWHP for prior authorization. If you want to be sure BSWHP will pay for this service, you will need prior authorization before these procedures are performed. When authorization is given, BSWHP will provide coverage for these services based on the terms of your specific plan.

All services must be medically necessary and appropriate and meet Baylor Scott & White Health Plan coverage criteria where applicable. If your plan does not offer an out-of-network benefit, all services must be rendered by in-network physicians/providers (unless otherwise authorized in advance) in order to be eligible for payment.

If you have questions about referrals or prior authorizations, please contact our Customer Advocacy Team at 844.633.5325 or submit a request for assistance online.

Resources for Benefits Administrators

Welcome, New and Returning Baylor Scott & White Health Plan Administrators!

You'll find everything you need for a successful Annual Enrollment below. If you don't find what you need, please let us know. We're here for you.

Not sure if you're in the right region? Check the BSWHP-TRS Service Area Map.

Announcements and Information

Self-Service Employer Portal

Here's where you'll find access to the District Dashboard, member search, ID cards and much more. Plus, you can give your District Benefits Administrators access to BSWHP membership data. Be sure to bookmark the link so you can find it easily: BSWH Employer Self-Service.

Provider Search

BSWHP TRS members can see providers anywhere in our service area, no matter where they live. Our open access HMO means members are free to see any network provider without a referral.

Employer Portal

The Employer Portal is here. Be sure to bookmark the link so you can find it easily:

Forms & Requests

Customer Service

Call 844.633.5325 to speak to a Customer Service Advocate. Your Client Management team will still be available at their current numbers, found on the Client Management Contact Sheet.

2023-24 Plan Year Benefits Information

General Plan Information

Materials

Presentations

2022-23 Plan Year Benefits Information

General Plan Information

Materials

Presentations

Frequently Asked Questions

Accessing Care

BSWHP will provide benefits for medically necessary emergency care whether you are temporarily out of the service area or within the service area. Emergency care is defined as the sudden and unexpected onset of a condition of such a nature that a prudent layperson, possessing an average knowledge of medicine and health, believes their health could be jeopardized if they do not get immediate treatment. BSWHP will approve or deny the requested post-stabilization treatment within one hour if contacted by the provider or facility. Some examples of emergency conditions include the following:

  • Unusual or excessive bleeding
  • Broken bone
  • Acute abdominal or chest pain
  • Loss of consciousness
  • Suspected heart attack
  • Sudden persistent pain
  • Serious burn
  • Poisoning
  • Convulsions
  • Difficulty in breathing

In all emergency situations, you are encouraged to seek care with the nearest BSWHP-approved provider; however, if the time needed to reach a BSWHP-approved provider might endanger your health, go to the nearest emergency room. Medically necessary emergency care is covered. If you are hospitalized as a result of the emergency, you should contact the BSWHP Health Services Division within 24 to 48 hours of any admission at 888.316.7947. Coverage for continued treatment is assured when approval is obtained from the BSWHP Medical Director through the Health Services Division. Emergency care in a hospital emergency room requires a copay, which will be waived if hospital admission occurs within 24 hours.

While a medical emergency is considered a life-threatening condition, urgent care is considered less severe than an emergency, but requiring care more quickly than elective care. Urgent care includes, but is not limited to, sudden illnesses and injuries, lacerations and fever. BSWHP encourages you to access one of its Urgent Care Clinics if you find yourself needing urgent care after hours. If you do not know when to access an Urgent Care Clinic, please contact a BSWHP nurse through our Nurse Advice Line at 877.505.7947.

To make a routine appointment, contact your physician's office. To help the staff schedule your appointment quickly, please refer to the following.

  • If it is your first appointment, tell the appointment clerk.
  • Have your identification card ready for any required information.
  • Periodic examinations (e g. annual Pap smears or history and physical) may need to be scheduled 8 to 12 weeks in advance. Other routine appointments are scheduled according to the urgency of the problem.
  • If you cannot keep the appointment, notify your physician's office as quickly as possible.

You may access any of our contracted physicians. Your copay is based on whether the physician is a primary care physician or specialist. PCPs include:

  • Family Practice — treats all age groups from newborns to the elderly. They provide routine medical care, referrals to specialists, some minor surgical procedures and obstetrics/gynecology services.
  • Community Internal Medicine — treats patients 16 years old and older. They provide routine medical care, gynecology services and referrals to specialists.
  • Pediatrics — treats children up to age 18 and provides routine care as well as referrals to specialists.
  • OB/GYN — specializes in women's health and family planning.

For a list of physicians visit Find A Provider or call the number on the back of your card.

All non-emergent medical care must be provided by BSWHP network providers. You may see a network specialist without a referral. Behavioral health services and elective hospital admissions require prior authorization through BSWHP Care Coordination Department.

After-hours telephone calls or emergency requests are routed to the Baylor Scott & White Memorial Hospital operator. The Health Services Department is contacted for authorizations for inpatient admissions and emergency surgeries and procedures.

If you are enrolled in Baylor Scott & White Health Plan and are ill or injured, you can contact the Nurse Advice Line at 877.505.7947 (TTY: 711). The Nurse Advice Line is staffed 24 hours a day, every day of the year. Our nurses can give you information about how to take care of yourself at home or can help determine if an office visit, an urgent care visit or an emergency room visit is most appropriate for your symptoms. It is free, completely voluntary and confidential. However, this service is not meant to replace a doctor's care.

Baylor Scott & White Health Plan is an Open Access HMO. This means that a member can go to any network provider without a referral. Members may choose a network primary care physician (PCP) if they would like to designate one, but PCPs are not required by Baylor Scott & White Health Plan.

Benefits

Refer to your Evidence of Coverage (EOC) available through the Member Portal at MyBSWHealth.com under Plan Documents. You may also call Customer Service at 844.633.5325.

Refer to your Evidence of Coverage (EOC) available through the Member Portal at My.BSWHealth.com under Plan Documents. You may also call Customer Service at 844.633.5325.

Refer to your Evidence of Coverage (EOC) available through the Member Portal at My.BSWHealth.com under Plan Documents. You may also call Customer Service at 844.633.5325.

Out-of-pocket maximums are not mutually exclusive from other out-of-pocket limits. This means that a member's total out-of-pocket maximum could contain a combination of coinsurance and/or copayments (For example, a member could pay up to $6,450 in copayments alone if there was no coinsurance paid throughout the year. If a member met the $2,000 coinsurance out-of-pocket maximum, he/she would pay $4,450 in copayments, totaling $6,450 in overall out-of-pocket expense).

Claims

You must access services through a Baylor Scott & White Health Plan network provider unless you have received prior authorization through BSWHP Health Services Division. Members do not have to file a claim for covered services provided by BSWHP network providers. The participating provider will file the claims on your behalf. Just make sure you present your member ID card at the time of service.

In the event you are treated by an Out-of-Network (OON) provider, and they will not file a claim on your behalf; you're paying the provider directly; and you have an OON benefit, please submit a claim for a Direct Member Reimbursement.

  • Insured Medical Claim Form

Call Customer Service at 844.633.5325.

When your medical claims are processed by Baylor Scott & White Health Plan, you can view your Explanation of Benefits statement online through the Member Portal. The EOB outlines the disposition of your claim, including the amount paid. You must be registered for the Member Portal to view your electronic EOBs. Click the "Log In" button at the top of the page to register. You will need your member ID card to complete registration. (If you already have a member account, you can click "Log In" to view your claims information and EOBs.)

Receiving EOBs electronically ensures that benefit information is available when and where it is needed. Electronic EOBs also reduce administrative costs and demonstrate environmental awareness by reducing paper usage. Your EOBs will be delivered electronically through the portal unless you specifically request to receive paper EOBs in the mail. To request paper EOBs, log into the portal and select “Update Preferences

Customer Service

You can reach Customer Service at 844.633.5325 from 7 AM to 7 PM weekdays.

For services provided by non-participating providers, you will need to file a claim for reimbursement directly to BSWHP at the following address:

Baylor Scott & White Health Plan
Attn: Claims Dept.
1206 W. Campus Drive
Temple, TX 76502

In an effort to improve communication with non-English speaking members, BSWHP uses the interpretive services of AT&T (CQ Fluency). When calling a BSWHP representative, you can request to be linked to a highly-trained interpreter. Let Customer Service know your primary language and the call will be completed with the help of an AT&T interpreter. You do not have to call a special line for this service.

BSWHP also has several interpreters available through Customer Service at 844.633.5325.

BSWHP is dedicated to addressing your grievances and resolving them promptly. If there is ever a time when you are not satisfied with the performance of BSWHP or one of its providers, you should contact a Customer Service Advocate at 844.633.5325 immediately. All grievances are documented and thoroughly investigated. BSWHP encourages your input and will not discriminate against you, refuse coverage or engage in any other retaliation if you choose to file a complaint or request an appeal of a decision.

BSWHP's definition of a complaint is an oral or written form of dissatisfaction that is not able to be resolved promptly to your satisfaction. When you call Customer Service to express dissatisfaction, he/she will immediately document your issues and send you a complaint form (as required by the Texas Department of Insurance) to complete and send back to BSWHP. This form does not go into your medical record; it simply helps BSWHP address your complaint with the appropriate person or department. BSWHP responds to the oral and written complaints in the same manner and informs you of a resolution within 30 calendar days of receipt of the complaint.

BSWHP's definition of an appeal is a request for BSWHP to reverse a previous adverse decision. All appeals are presented to a panel, which is held within 30 calendar days after receipt of the request. You have the right to appear before the panel and to present written or oral information in support of your request to reverse the previous decision. The BSWHP will permit and pay for an immediate appeal to an independent review organization in the event the decision rendered was an Adverse Determination (denial of coverage based on medical necessity determination) to the complainant and the request was presented to the BSWHP within 180 days of the previous decision. For more information on your appeal rights, please contact a Customer Service Advocate at 844.633.5325.

Miscellaneous

If you are an active employee, contact your Benefits Coordinator.

BSWHP has a process whereby a group of physicians and other healthcare professionals evaluate requests for coverage of new technological procedures or treatments. The Technical Assessment Committee receives from a requesting doctor, a proposal to BSWHP that outlines a new or currently uncovered medical or behavioral procedure, devices or treatments, the perceived advantages over current therapy, criteria for utilization and supporting papers from peer-reviewed scientific journals.

The Technical Assessment Committee then meets to evaluate the physician's request for coverage. The recommendations of the Technical Assessment Committee are presented to the BSWHP Quality Improvement Committee for a final approval determination. If you have a request for coverage of a new medical or behavioral procedure, device or treatment, please contact your physician or the Health Services Division at 888.316.7947.

Out-of-Network

As a member of BSWHP, you are covered worldwide for any true emergency that occurs. Incidents such as heart attacks, deep lacerations, loss of consciousness, breathing difficulties, broken bones and other critical conditions that require immediate treatment are covered with your emergency room copay/coinsurance. If you have a medical problem that is urgent but is not an emergency, you are encouraged to contact our Nurse Advice Line at 877.505.7947. This is a 24-hour line you can access from anywhere in the world for medical advice and assistance in managing your illness.

When seeking treatment in an out-of-network emergency room, provide your member identification card. This will speed up the processing and payment of your bill by BSWHP. This will also allow the treating physician to discuss your emergency care with your network physician, if necessary.

BSWHP will cover any emergency that occurs while away at school. It will be important to plan for routine medical needs while the student is away. If your child is attending school within the State and will be located near one of our provider clinics, your child can receive care at the facility. If the student is attending school out of the BSWHP service area, it may be necessary to consider supplementary coverage for routine medical care. The student may want to use the college dispensary for his/her routine medical care. The student can also access our Nurse Advice Line at 877.505.7947 at any time for medical advice and assistance.

BSWHP is a Health Maintenance Organization (HMO) and your care has been prepaid and prearranged for within the BSWHP network. If you would like BSWHP to pay for the doctor visit, you must see a BSWHP physician. You may continue to see the physician outside the BSWHP network, but BSWHP will not pay for the visit. You may want to get copies of your medical care records from the outside doctor so that your BSWHP physician can continue care.

BSWHP network is a large, multi-specialty network and, in most cases, can meet the majority of your medical needs. If you develop a medical condition that your BSWHP network physicians cannot care for, you will need a recommendation from your BSWHP network physician and the approval of the BSWHP Medical Director before any out-of-plan services can be covered. A formal review of your case will be provided and you will receive a letter outlining clearly what BSWHP will or will not cover with the outside physician.

For more information on referrals, see the Referrals and Prior Authorizations page.

Please have someone call BSWHP within 24-48 hours of your admission so that we can begin coordinating your care as soon as possible. The instructions for reporting an out-of-plan admission are printed on the back of your member identification card. Simply use the toll-free line.

If you are hospitalized while traveling with others, we suggest that you always have someone else within your group know what to do in case you are unable to speak for yourself.

Pharmacy

Refer to the Formulary Management document for information about pharmaceutical management procedures.

If you have any questions about Baylor Scott & White Health Plan, please call Customer Service at 844.633.5325.

Providers

If you would like to know the professional qualifications of a BSWHP network physician, visit our Find A Provider page or call Customer Service at 844.633.5325. You can inquire about your physician's medical school, residency, board certification status and any other information you may need to choose a practitioner in the network

Baylor Scott & White Health Plan is an Open Access HMO. A member can go to any network provider without a referral.

Members may choose a network primary care physician (PCP) if they would like to designate one, but PCPs longer required by the Baylor Scott & White Health Plan.

If you would like to select a PCP, please refer to our online directory. Each person listed on your plan may select a PCP from the following physicians:

  • Family Practice treats all age groups from newborns to the elderly. They provide routine medical care, referrals to specialists, some minor surgical procedures and obstetrics/gynecology services.
  • Internal Medicine physicians treat patients 16 years and older. They provide routine medical care, gynecology services and referrals to specialists.
  • Pediatricians treat treats children up to age 18 and provide routine care as well as referrals to specialists.
  • OB/GYNs specialize in women's health and family planning.

When selecting a PCP, consider which clinic would be most convenient to meet your own needs. Each person listed on your plan can select his or her own doctor.

If you would like specific information about any of the PCPs, click on Find A Provider or contact Customer Service. Once you select a PCP, you can make an appointment with that physician. If your PCP is unavailable, you can see any other physicians of the same specialty that work with the clinic.

You can change your PCP anytime.

No covered person is required to designate a PCP. If they wish to do so, each person listed on your plan can select his or her own doctor.

Member Portal

You can go straight to the Member Portal at My.BSWHealth.com. You can also navigate to the portal by clicking the "Log In" button in the upper right corner of each page on this site. You will need your member ID, Social Security Number and date of birth to register initially to the secure site.

On the Member Portal, you can:

  • View and print ID cards
  • View benefits and coverage
  • See claims and Explanations of Benefits (EOBs)
  • View deductibles and out-of-pocket accumulators
  • Take a wellness assessment
  • Send an email to customer service advocates through secure messaging feature

The Member Portal also features a cost estimator and a provider search based on your specific health plan.

For our Individual and Family Plan members, the Member Portal will help you learn how to:

  • Make payments online
  • Set up recurring payments
  • Access forms
  • Check to see if payment was received
  • Make demographic changes (address, phone, etc.)

Your account will automatically be unlocked 30 minutes after the last failed login attempt. After 30 minutes, click "Forgot Password" and reset your password.

Accounts are automatically locked after five failed attempts to prevent other programs from cracking members' passwords.

First, verify your username is correct. All usernames are an email address specified by the member upon registering for the Member Portal. If you have multiple email addresses, try a different one.

You should contact Customer Service at 844.633.5325. They can help you with many issues. If they can't help, they will take your contact information and forward it to a subject matter expert. In most cases you will get a resolution in a couple of hours via email or a return phone call. Also, check your Spam folder.

If you didn't get an email, try again to reset your password and double-check the email address that you type in is correct. If you mistype even one letter, you will not receive the password reset email.

It could be that you typed in your email address incorrectly when you first registered. If you suspect this is the problem, contact Customer Service at 844.633.5325 and they can verify your email address or submit a correction request, which should be completed in a few hours.

A Social Security Number is not required to apply for coverage with Baylor Scott & White Health Plan. So if you didn't provide an SSN during your application process, we do not have your SSN on file. You will therefore not be able to use it to register. Instead, if you have it, use your member ID number and date of birth. If you do not know your member ID number, please contact Customer Service at 844.633.5325.

First, verify that you're typing in the correct member ID number. If you are, contact Customer Service at 844.633.5325. It's possible that your date of birth is incorrect in our system. If you are a new member, it's possible your application has not yet been processed. As soon as your application is processed, you should be able to register for the Member Portal online.

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  • Edge
  • IOS Safari for iPad (there is a known bug about viewing your Medical Card)

Note: Internet Explorer and browsers on phones are not supported.

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