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Preferred Provider Organization (PPO) Plan

Available to all benefits-eligible employees

How it works
PPO Plan
Provider network
All three networks are available with this plan; however, the Tier 1 BSWQA Network is always the best value!
Deductible
This plan has a lower deductible than the HSA Plan: $1,000 for employee or $2,000 for family (Tier 1). Your deductible will vary based on how many dependents you are covering. Once your deductible is met, you pay coinsurance until you reach your out-of-pocket maximum. Inpatient and outpatient expenses, lab work, imaging, durable medical equipment expenses, private duty nursing, hearing aids, skilled nursing, home health and hospice and any other non-copay expenses apply.
Coverage
There's no cost for preventive visits and MyBSWHealth app video visits and e-visits.
Copays
This plan offers copays for some services, including a $1,200 bundled maternity copay when you see a Tier 1 provider.
Tax-free savings account
You can open a general-purpose flexible spending account to pay for eligible healthcare expenses. The funds do not rollover and use-it-or-lose it applies.

Learn more about tax-free savings accounts.
Leftover HRA dollars?
You can use remaining employer funded dollars to pay for eligible medical expenses in the Tier 1 BSWQA Network up to the $1,000 rollover maximum. Urgent/emergency care received in Tiers 2 and 3 is also covered. As you receive care from eligible providers, the plan will automatically pay the provider on your behalf. Any remaining funds after Dec. 31, 2020, will be forfeited.

Deeper Dive

View coverage and costs

Our network tiers

Tier 1 BSWQA Network is always the best value

All of our medical plans are administered by Scott and White Health plan, with coverage through different networks. Depending on the medical plan you choose, you'll have access to one or more networks, also called coverage tiers.

Watch to learn more about our network tiers and discover why keeping your care within the Baylor Scott & White family is great for your health and your wallet!

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Still wondering what plan is right for you?

Ask ALEX!

Special delivery

Two new enhancements to support expectant moms

Bundled maternity copay

PPO Plan enrollees pay a $1,200 bundled maternity copay for all expenses related to maternity/delivery care and baby’s postnatal services.

Expecting the Best® Maternity Program

On or after Jan. 1, 2020, expectant moms covered by a BSW medical plan and seeing a Tier 1 BSWQA Network provider may enroll.

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Frequently asked questions | PPO

How much do I pay for preventive care?
Preventive care*, such as physicals, screenings, immunizations and more, are provided at no cost when you use a Tier 1 BSWQA Network or Tier 2 Cigna National Network provider. Preventive eye exams are not included as part of our medical plans. If you or a covered dependent need routine eye care, our vision plan can help make glasses and contacts more affordable.

How much do I pay for non-preventive care?
You’ll pay fixed copays for doctor visits and nearly all prescriptions without having to meet your deductible. The amount you pay depends on the physicians and pharmacies you use. If you chose a provider in the Tier 3 network, you’ll first have to meet your deductible before coinsurance kicks in.

How much do I pay for prescription drugs?
There is no deductible for prescription drugs. You pay copays or coinsurance from day one. Prescription costs do count towards your out-of-pocket maximum. Click here to learn more about our prescription drug benefits.

How much is the out-of-pocket maximum?
Your out-of-pocket maximum will vary based on how many dependents you are covering. All plans have an embedded out-of-pocket maximum so that no one in the family pays more than the individual maximum. A separate out-of-pocket maximum applies for services provided under each tier.

  • Tier 1 BSWQA Network medical expenses count toward meeting the Tier 2 Cigna National Network out-of-pocket maximum, but not vice-versa
  • Costs of all drugs filled at Baylor Scott & White Health pharmacies or contracted pharmacies apply to Tier 1 BSWQA Network and Tier 2 Cigna National Network
  • There is no out-of-pocket maximum for the Tier 3 Network
  • Amounts paid for Tier 3 do not apply to Tier 1 BSWQA Network or Tier 2 Cigna National Network out-of-pocket maximum
  • Limited drug distribution filled at contracted pharmacies are subject to the Tier 1 out-of-pocket maximum

Will I have out-of-pocket protection?
Yes. Once you pay your out-of-pocket maximum in Tier 1 Network BSWQA or Tier 2 Cigna National Network, the plan will pay 100% of the cost of additional eligible care expenses in that tier.

*Services will be covered at 100% when billed with a preventive diagnosis code.

NEW! Same-day video visits

Free for PPO Plan enrollees

Get care where and when you need it. Access video visits or eVisitsVideo visits via the MyBSWHealth app. Starting on Jan. 1, 2020, video visits are available 8 a.m. to 8 p.m. seven days a week. To be eligible, employees must have a MyBSWHealth account.

When I had a sinus infection the video visit was a lifesaver. I didn’t have to wait long or miss work time to travel. It felt the same as video chatting with a friend. Plus, the prescription was ready for me by the end of the day.  

Amanda Lincer, Executive Assistant

Download the MyBSWHealth app

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This site summarizes the programs and benefits available to employees and their eligible dependents. Official plan documents, policies and certificates of insurance that contain the details, conditions, maximum benefit levels and restrictions on benefits govern our benefits program and are available on this site. In case of a conflict between this site and the official documents, the official documents prevail. The information on this site isn't a guarantee of benefits. Baylor Scott & White reserves the right to modify or terminate its employee benefit plans and programs at any time for any reason.

Click here if you have feedback on the website or need to report an issue. All other questions and issues, please contact the corresponding resource on the Need Help page.

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