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​​Medical Questions

  1. What's Scott and White Health Plan's role in my medical plan?
    Scott and White Health Plan (SWHP) administers all three Baylor Scott & White Health medical plans - the HRA, HSA and PPO - for employees in Central and North Texas. Baylor Scott & White funds its employee medical coverage. That means the System assumes the financial risk of providing medical benefits to its employees and their covered dependents. Baylor Scott & White contracts with SWHP to manage claims, deliver customer service and provide overall administration of its medical plans. 
  2. When should I expect to receive my new ID card?
    Medical ID cards will be mailed to your home address or mailing address if one is on file and it's different than your home address. The target date to have a medical ID card to you is by Jan. 1.
    You can also log in to the SWHP Member Portal to request additional medical ID cards or print and save a temporary copy of your medical ID card. Employees may need to create an account if new hire or has not set up a Member Portal account. You can also view your medical ID card on MyBSWHealth app. To log in, use the same user name and password you use for the SWHP Member Portal.  For additional ID card inquiries, call SWHP Customer Advocacy at 844-843-3229.
  3. What's the SWHP Customer Advocacy phone number?
    SWHP has set up a dedicated customer service number for Baylor Scott & White employees: 844-843-3229.

    The customer advocates can answer a wide range of questions and check with a subject matter expert on questions they can't resolve. SWHP Customer Advocacy Department hours are 7 a.m. - 8 p.m. CT, Monday - Sunday. ​

  4. Which procedures need to be pre-authorized by my provider?
    Prior authorization is the process of checking with SWHP to make sure a service, treatment, medication or piece of durable medical equipment is medically necessary before you receive it. You'll find a complete Prior authorization list on the SWHP website for Baylor Scott & White employees at From the Menu Bar (upper left corner of the screen), select Tools and Resources to get to the Prior authorization list. Make sure you and your doctor review the list to confirm if Prior authorization is needed before you contact SWHP.
  5. Why doesn't my doctor show up when I use the provider search tool?
    The provider search tool refreshes every 2 to 4 weeks. Some doctors may still be in the contracting process with SWHP. While most doctors in the Baylor Scott & White Quality Alliance (BSWQA) are contracted with SWHP, some aren't. Even if your doctors are part of the BSWQA, check the provider search tool via to be sure they participate in our Tier 1 Preferred Network or Tier 2 National Network.

  6. What should I do if my doctors show up in the provider search results but say they are not part of the network?
    Your provider's office staff may not be aware they are part of the network for Baylor Scott & White medical plans - either through direct contracts with SWHP or Cigna, our Tier 2 National Network. If this situation arises with one of your doctors, please ask them to call our Provider Services at 844-769-3994 to verify their network participation for Baylor Scott & White Employee Plan. 

  7. How do I make sure the doctors who care for me in the hospital will be in network?
    Hospital-based physicians (radiologists, anesthesiologists, pathologists, emergency providers, neonatologists and hospitalists) will not be part of the searchable provider options as they may be independent contractors. If you receive care from any of these physicians at any Tier 1 facility, they will be paid at the Tier 1 benefit level of the usual and customary rate.
  8. What if I have dependent children out of state on my plan?
    Employees and dependents who live 40 or more miles from the nearest Tier 1 hospital may visit Tier 2 providers and receive a higher benefit (80% vs. 50%, after deductible).  You can determine your proximity to Tier 1 network hospitals by using the provider search tool at  If you or one of your dependents lives 40 or more miles from a Tier 1 hospital, notify the SWHP Customer Advocacy Center at 844-843-3229.  To ensure your claims process correctly, please notify them prior to accessing services.  Or if you or your dependent had the OOA coverage activated but no longer live 40 or more miles from a Tier 1 hospital, contact SWHP to deactivate this coverage.

  9. When I need urgent care, which facilities are covered by our plan?
    Our provider networks include many urgent care locations in the Tier 1 and Tier 2 Networks. In addition, many HealthTexas Provider Network (HTPN) clinics have extended hours. Tier 1 providers include Concentra, Methodist Urgent Care, PrimaCare, Cook Children's Urgent Care, MedPost Urgent Care, NextCare Urgent Care, Scott and White Urgent Care, Scott and White Pediatric Urgent Care, etc. All of our urgent care providers are listed in the provider search tool. We're continuing to review and expand our urgent care network as needed. Please use the provider search tool for a complete list.​

  10. Which lab services are part of the Tier 1 Preferred Network?
    SW Medical Center – Temple, LabCorp, Quest Diagnostics, ClearPoint Diagnostic, Central Texas Pathology, etc. are in Tier 1. In addition, some HTPN clinics have their own in-house lab services and are considered Tier 1. Many providers have arrangements with multiple lab services and may be able to send your lab work to LabCorp, Quest, and ClearPoint if you request it. Lab tests that are part of preventive care services are always covered at 100% in Tier 1 and Tier 2 – must be billed with a preventive care diagnosis.  

  11. Why aren't my HRA or HSA dollars available?
    If you're a new member of the Baylor Scott & White HRA plan, you can log in to the SWHP Member Portal at to review your HRA balance. You can also view your HRA balance on MyBSWHealth app. To log in, use the same user name and password you use for the SWHP Member Portal to review the HSA balance, log in to the HSA portal from the Online Connections.

  12. How do I submit a claim to SWHP for reimbursement?
    In-network providers should submit claims to SWHP on your behalf. If you visited a Tier 3 provider and they refused to submit a claim to SWHP on your behalf, request an itemized bill from them. You can submit a claim to SWHP for processing/payment. Fill out a medical claim form, include proof of payment and your itemized bill. The medical claim form can be found at, under the Menu Bar (upper left corner of the screen), select Tools and Resources.
    In-network pharmacies should submit claims to SWHP electronically. If you used a non-contracted pharmacy and paid out-of-pocket for covered prescription drugs, submit your claim to SWHP for reimbursement. A pharmacy claim form can be found at Under the Menu Bar (upper left corner of the screen), select Tools and Resources.  You'll need to include your pharmacy receipt and prescription label/information provided by the pharmacy.
    Follow instructions on the respective claim form you are using, include proof of payment, itemized bill or pharmacy receipt and mail it to Scott & White Health Plan Attn: Claims Dept. 1206 West Campus Drive Temple, TX 76502. For medical claims, we'll send you an acknowledgement letter within 15 days of receiving your claim and to let you know if we need any additional information. We process most medical and pharmacy claims within 30 days.  

  13. How are ED/radiologists paid at a Baylor Scott & White facility versus Tier 2 or Tier 3?
    If you received care by any of these physicians at a Tier 1 facility, their claims will process/pay at the Tier 1 benefit level of the usual and customary rate if the physician is Tier 3. If you received care from any of these physicians at a Tier 2 or Tier 3 facility, Tier 2 physicians are paid at a contracted rate and Tier 3 physicians are paid at the usual and customary rate. Tier 3 physicians may balance-bill you for chages not reimbursed by the plan. 
  14. For preventative screening, how do we know if anesthesia providers are covered?
    If the provider bills as preventative services and they meet the criteria for preventative services, the services are paid at 100% for Tier 1 and 2.​

  15. Are all Baylor Scott & White facilities and affiliated entities covered under Tier 1?
    All Baylor Scott & White facilities are considered Tier 1.  For those affiliated entities they must be contracted with Scott and White Health Plan to be considered Tier 1.  Employees are encouraged to use the Find a Provider search tool at​ to confirm provider network status prior to accessing services.

  16. How will the new medical premium paycheck deductions impact "salary" employees?
    All employees contain an hourly rate within the HR system.  As of 10/23/17, this rate will be used to determine premium paycheck deduction for the next calendar year.  New rates are effective for the plan year that begins 1/1/18.

  17. Because Tier 1 is limited geographically, do we receive a deeper discount on services?
    Tier 1 provides a higher quality of care and the plan covers a greater share of the cost for facilities/providers.

  18. Is Cigna still going to be the network for Tier 2?
    Yes, Cigna will still be our Tier 2 National Network.

  19. How are EMS services billed and why don't we get to choose which Tier the provider comes from? Or is there a more efficient way to get emergency transport?
    EMS services are processed/paid at the Tier 1 benefit level of the usual and customary rate. It is an industry standard that EMS providers are normally not contracted with any insurance company. If provider does not agree with the payment they receive from SWHP and you are balance billed, contact SWHP Customer Advocacy at 844-843-3229 and let them know you are being balance billed. SWHP will work with the provider to try and negotiate a single case agreement. 
  20. Are contracted services, such as ED physicians and radiologist, working in a Baylor Scott & White facility covered by Tier 1?
    If you receive care at a Tier 1 facility, the benefit is setup to process hospitals-based physicians' claims at Tier 1 benefit level. If the provider is out-of-network, we process claims at Tier 1 benefit level of the usual and customary rate. This information can be found on page 113 of the Summary Plan Description (SPD). Below is the link to the SPD for your convenience.  If you are balance billed, contact SWHP Customer Advocacy at 844-843-3229 and let them know you are being balance billed. SWHP will work with the provider to try and negotiate a single case agreement.
  21. What access to coverage do we have for travel outside of Texas?
    Tier 2 is a national network - we have access to providers through the Cigna network, and coverage is based on the services you need and the plan you elect. Example, if you are in the PPO and you visit an urgent care, your copay is $100. Below is the link to the coverage and cost for your convenience. SWHP is the administrator of the plan and providers are required to file claims to SWHP for processing and/or payment.​
  22. For a "routine" preventative care procedure – a colonoscopy – will it be covered free of cost if a previous one (done three years ago) was routine but resulted in a procedure (polyp removal)? Preventive screening for Sigmoidoscopy is every five years, for colonoscopy if every 10 years, and fecal occult blood test (FOBT) is every year starting at age 50 years and continuing until age 75 years. If screening resulted in a procedure (polyp removal) the claim can also result in a medical diagnostic, which means, deductible and co-insurance will apply. 
  23. Are there any changes to the Tier 2 benefit level?
    Tier 2 modified benefit of 65% after deductible across all medical plans is being eliminated to align to Tier 2 standard coverage of 50% after deductible for the following services – acupuncture, diagnostic labs and x-rays, DME, prosthetic devices, basic and comprehensive infertility, oral surgery and private duty nursing.
  24. If I elect the HRA plan in 2018 will my HRA continue to send my check for urgent care and emergency room copays?
    No, Discovery Benefits will pay providers directly for all eligible medical costs in 2018.

  25. Do the new HRA copays apply to the deductible?
    No; however, the copays do apply to the out of pocket maximum though.

  26. What happens to my HRA dollars if I move to the HSA?
    If you switch plans, the HRA dollars will be forfeited.

  27. Is the change to ER visits one visit for my entire family, or one visit per covered person in my family?
    Under the HRA and PPO plans, the first visit to the ER for each covered individual is $250.  When a covered individual goes to the ER for a second visit and beyond, those visits will be subject to deductible and coinsurance.  If you have the HRA plan, your HRA dollars from Baylor Scott & White can help to pay for these expenses.

    On the HSA plan, ER visits are subject to deductible and coinsurance.  Copays are not part of this plans design per IRS rules and regulations.

​Dental & Vision Questions

  1. I am currently under contract with Aetna DMO for my orthodontic provider.  What if this provider is not contracted with MetLife PPO?  Is the coverage different?
    Even if the current provider is not contracted with MetLife, there are out of network benefits available with the MetLife PPO Plus dental Plan.  Orthodontic services are paid on a quarterly basis to the provider and length of coverage is generally established at time braces are placed.  
  2. Does MetLife PPO Plus cover local dentists? 
    This network is quite expansive and includes many dentists between NTX and CTX.  To locate dental providers in the MetLife network, go to, enter your ZIP code and chose the PDP network.
  3. What is the dental maximum for the PPO plan vs. the PPO Plus plan with MetLife?
    Under the PPO plan, the annual maximum is $1,000.  On the PPO plus plan, the annual maximum is $2,000.  The Plus plan includes coverage for implants and orthodontia.
  4. Is there a max age for orthodontia on the PPO Plus plan?
    Orthodontia is offered to both children and adults on the Plus plan.  There is a $2,000 lifetime maximum for this benefit.

  5. How are implants covered on the PPO Plus plan?
    Implants are covered as a major service.  Deductible would apply first, then the plan would pay 50% up to the annual maximum is reached for the year.

  6. For SuperiorVision, what is covered and what local optometrists?  
    Please use this link for more details on what is covered by the vision plan:

General Questions​

  1. Is it possible to buy different plans for different family members? 
    No, it is not possible to purchase different plans for different family members.  Whichever plan you select as an employee is the plan your family will have.

  2. I didn't sign up for short term disability during my new hire period.  What do I need to do to elect this benefit during Annual Enrollment?
    You should elect this benefit during the annual enrollment process, and complete an Evidence of Insurability form. 
  3. Is Ask ALEX available to help me decide which plan is right for me and my family?  
    Alex is live now at​.

  4. Is it possible to purchase different plans for different covered dependents?
    No, the employee (staff) would be enrolled in the same plan as covered dependent.  However, for example, the employee may choose to enroll in medical only but select family coverage for dental.​​