Providers Being Added to PPO and HSA Tier 1 Network
Effective March 18, 2019, new providers will be added to the PPO and HSA Tier 1 Network. These providers are currently displaying as Tier 2 in the Find a Provider search tool but their network status will change to Tier 1 by March 18. A list of providers is available here.
Health Reimbursement Account (HRA) Plan
The HRA plan will be retired effective January 1, 2019 and replaced with a new single-network plan designed with affordability and predictability in mind. If you are currently enrolled in the HRA plan and do not enroll in a new plan, you will be automatically enrolled in the PPO plan for 2019.
You can still use remaining HRA dollars, subject to 2018 rollover limits, to pay for care if you enroll in the Select Exclusive Quality Alliance (SEQA)/Exclusive Quality Alliance (EQA) plan or the PPO plan, and receive care from a Tier 1 provider (except in cases of urgent/emergency care). Learn more about rollover limits and payment eligibility at BSWHbenefits.com.
Group Value Formulary
Prescription drugs are a major driver of overall healthcare spending. Effective Jan. 1, 2019 the Baylor Scott and White Health Employee plan will have a new drug list called the Group Value Formulary.
Out-of-Area (OOA) Coverage
Effective Jan. 01, 2019 this modified coverage will only be available for the PPO and HSA plans. OOA coverage provides a modified Tier 2 benefit for employees and covered dependent(s) who live 40 or more miles from the nearest Tier 1 acute care hospital and visit Tier 2 providers. The modified benefit is 80% (vs. 50%), after deductible.
Prior Authorization and new eviCore program
Prior authorization for certain services is required for all plans. Refer to the Tools and Resources section of our website to make sure you know what services might require prior authorization. Plan ahead: the standard time needed to receive a prior authorization is fifteen days (except in an emergency). Learn more about the eviCore Prior Authorization Program.
Baylor Scott & White Quality Alliance (BSWQA) HealthAccess
Need help finding Tier 1 providers and schedule appointments? Contact BSWQA HealthAccess at 1-844-279-7589 for assistance.