This Plan is a health maintenance organization (HMO). OPM requires that FEHB plans be accredited to validate that plan operations and/or care management meet nationally recognized standards. Baylor Scott & White Health Plan holds the following accreditation: National Committee for Quality Assurance (NCQA). To learn more about this plan’s accreditation, please visit the following website: www.ncqa.org.
We require you to see specific physicians, hospitals, and other providers that contract with us. These Plan providers coordinate your health care services. We are solely responsible for the selection of these providers in your area. Contact us for a copy of our most recent provider directory. We give you a choice of enrollment in a Standard Option and a Basic Option plan.
HMOs, emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury. Our providers follow generally accepted medical practice when prescribing any course of treatment.
When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You pay only the copayments, coinsurance, and deductibles described in this brochure. When you receive emergency services from non-Plan providers, you may have to submit claim forms.
You should join an HMO because you prefer the plan’s benefits, not because a particular provider is available. You cannot change plans because a provider leaves our Plan. We cannot guarantee that any one physician, hospital, or other providers will be available and/or remain under contract with us.
General features of our Standard and Basic Options
We have Open Access benefits
Our HMO offers Open Access benefits. This means you can receive covered services from a participating provider without a required referral from your primary care provider or by another participating provider in the network.
How we pay providers
We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure. These Plan providers accept a negotiated payment from us, and you will only be responsible for your cost-sharing (copayments, coinsurance, deductibles, and non-covered services and supplies).
Health education resources and account management tools
Health education resources and account management tools are available on our website at htttps://bswhealthplan.com/fehb.
- Wellness programs are available online or by calling Customer Service at 844-633-5325.
- You can access your claims and explanations of benefits (EOBs) by visiting https://bswhealthplan.com/fehb and logging in to the BSWHP member portal.
- You can view, display and order ID cards.
Your rights and responsibilities
OPM requires that all FEHB plans provide certain information to their FEHB members. You may get information about us, our networks, and our providers. OPM’s FEHB website www.opm.gov/healthcare-insurance/ lists the specific types of information that we must make available to you. Some of the required information is listed below.
- Baylor Scott & White Health Plan began operation in January of 1982 as a not-for-profit Health Maintenance Organization (HMO).
- Baylor Scott & White Health Plan is a privately owned, not-for-profit community-based health maintenance organization and does not include any partners.
You are also entitled to a wide range of consumer protections and have specific responsibilities as a member of this Plan. You can view the complete list of these rights and responsibilities by visiting our website, www.bswhealthplan.com/fehb.
If you want more information about us, call 844-633-5325, or write to Baylor Scott and White Health Plan, 1206 West Campus Drive, Temple, TX 76502. You may also visit our website at https://bswhealthplan.com/fehb.
By law, you have the right to access your protected health information (PHI). For more information regarding access to PHI, visit our website at https://bswhealthplan.com/fehb to obtain our Notice of Privacy Practices. You can also contact us to request that we mail a copy regarding access to PHI.
Your medical and claims records are confidential
We will keep your medical and claims records confidential. Please note that we may disclose your medical and claims information (including your prescription drug utilization) to any of your treating physicians or dispensing pharmacies.
Service Area:
The Standard Option utilizes the BSW Premier HMO Network.
The Basic Option utilizes the BSW Premier HMO Network.
Standard Option Eligibility Area
To enroll in this Option, you must live in or work in one of the counties listed below. This is where our provider's practice. Baylor Scott & White Health Plan has two service areas for the FEHB program. Our service area includes Central, North and West Texas.
The following counties comprise our Central Texas service area for this option:
Austin, Bastrop, Bell, Bexar, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coke, Coleman, Comal, Concho, Coryell, Crockett, Falls, Fayette, Freestone, Grimes, Guadalupe, Hamilton, Hays, Hill, Houston, Irion, Kimble, Lampasas, Lee, Leon, Limestone, Llano, Madison, Mason, McCulloch, McLennan, Menard, Milam, Mills, Reagan, Robertson, Runnels, San Saba, Schleicher, Sterling, Sutton, Tom Green, Travis, Walker, Waller, Washington and Williamson.
The following counties comprise our North and West Texas service area for this option:
Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Brown, Callahan, Carson, Castro, Childress, Cochran, Collin, Collingsworth, Comanche, Cottle, Crane, Crosby, Dallam, Dallas, Dawson, Deaf Smith, Denton, Dickens, Donley, Eastland, Ector, Ellis, Erath, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Grayson, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Hood, Howard, Hutchinson, Johnson, Jones, Kent, King, Knox, Lamb, Lipscomb, Loving, Lubbock, Lynn, Martin, Midland, Mitchell, Moore, Motley, Navarro, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reeves, Roberts, Rockwall, Scurry, Shackelford, Sherman, Somervell, Stephens, Stonewall, Swisher, Tarrant, Taylor, Terry, Throckmorton, Upton, Ward, Wheeler, Winkler, and Yoakum
Basic Option Eligibility Area
To enroll in this Plan, you must live in or work in one of the counties listed below. This is where our provider's practice. Baylor Scott & White Health Plan has two service areas for the FEHB program. Our service area includes Central, North and West Texas.
The following counties comprise our Central Texas service area for this option:
Austin, Bastrop, Bell, Bexar, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coke, Coleman, Comal, Concho, Coryell, Crockett, Falls, Fayette, Freestone, Grimes, Guadalupe, Hamilton, Hays, Hill, Houston, Irion, Kimble, Lampasas, Lee, Leon, Limestone, Llano, Madison, Mason, McCulloch, McLennan, Menard, Milam, Mills, Reagan, Robertson, Runnels, San Saba, Schleicher, Sterling, Sutton, Tom Green, Travis, Walker, Waller, Washington and Williamson.
The following counties comprise our North and West Texas service area for this option:
Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Brown, Callahan, Carson, Castro, Childress, Cochran, Collin, Collingsworth, Comanche, Cottle, Crane, Crosby, Dallam, Dallas, Dawson, Deaf Smith, Denton, Dickens, Donley, Eastland, Ector, Ellis, Erath, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Grayson, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Hood, Howard, Hutchinson, Johnson, Jones, Kent, King, Knox, Lamb, Lipscomb, Loving, Lubbock, Lynn, Martin, Midland, Mitchell, Moore, Motley, Navarro, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reeves, Roberts, Rockwall, Scurry, Shackelford, Sherman, Somervell, Stephens, Stonewall, Swisher, Tarrant, Taylor, Terry, Throckmorton, Upton, Ward, Wheeler, Winkler, and Yoakum
Ordinarily, you must get your care from providers who contract with us. If you receive care outside our service area, we will pay only for emergency care benefits. We will not pay for any other healthcare services out of our service area unless the services have prior plan approval.
If you or a covered family member move outside of our service area, you can enroll in another plan. If your dependents live out of the area (for example, if your child goes to college in another state), you should consider enrolling in a fee-for-service plan or an HMO that has agreements with affiliates in other areas. If you or a family member move, you do not have to wait until Open Season to change plans. Contact your employing or retirement office.