sw.swhp.orgBSWH Employees | Baylor Scott & White Health Plan

BSWH Employees | Baylor ScottWhite Health Plan') . Please upgrade . 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: HealthAccess@bswhealth.org 844.843.3229 , option 2 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 ScottWhite 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 ScottWhite Health offers the following medical plan options 2024 Benefits Information BSWH Select Exclusive Quality Alliance (SEQA) BSWH Exclusive Quality Alliance (EQA) BSWH High Deductible Health Plan (HDHP) BSWH Preferred Provider Organization (PPO) 2023 Benefits Information BSWH Select Exclusive Quality Alliance (SEQA) BSWH Exclusive Quality Alliance (EQA) BSWH Health Savings Account (HSA) BSWH Preferred Provider Organization (PPO) 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 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: 2024 BSWHP Group Value Formulary 2023 BSWHP Group Value Formulary 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 (PT) 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. 2024 Chronic and Preventive Medication List Quantity Limits-Group Value and Group Choice 2023 Chronic and Preventive Medication List Quantity Limits-Group Value and Group Choice Monthly Group Value Formulary Changes Drug Requests - Prior Authorizations, Exceptions and Appeals 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. 2024 Group Value and Group Choice Preventive Medication List 2023 Group Value and Group Choice Preventive Medication List Baylor ScottWhite Pharmacy information To learn about the services provided by Baylor ScottWhite Pharmacies and their locations, visit: Baylor ScottWhite Pharmacy Online Pharmacy Mail Order Form ToolsResources Member Resources Member Forms Member Brochures Provider Directories Complex Case/Disease Management Program Coordination of Benefits Review Formulary and Pharmaceutical Management Glossary Members Right and Responsibilities Members Right and Responsibilities Notice of Privacy Practices Notice of Privacy Practices Prescription Fills and Refills Preventive Care List Prior Authorization List (Medical Benefit) Quality Improvement Program Quick Reference Guide Technology Assessment Program Utilization Management Program MyBSWHealth Authorization to Release PHI (Protected Health Information) Authorization to Release PHI (Protected Health Information) Medical Claim Form Pharmacy Claim Form Transition of Care Form Transition of Care Form Maternity Care Management Member Portal Brochure Telehealth 2024 Directories BSW Premier HMO Tier 1 Behavioral Health BSW Premier HMO Tier 1 Pediatrics BSW Premier HMO Tier 1 Enhanced Access at Children's Medical Center BSW Premier HMO Tier 1 West Texas 2023 Directories BSWQA Tier 1 Behavioral Health BSWQA Tier 1 Pediatrics BSWQA Tier 1 Enhanced Access at Children's Medical Center BSWQA Tier 1 West Texas 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. Live Well A refreshed wellness site makes it easier to access the array of programs designed to support your mind, body and spirit. Visit...