Plan year 2020 benefits highlights swhp org

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Plan Year 2020 Benefits

HIGHLIGHTS

Texas Employees Group Benefits Program

SWHP_7/2019

Employees Retirement System of Texas

WELCOME TO A FULLY INTEGRATED APPROACH TO CARE

Every day, Scott and White Health Plan (SWHP) works in unison with doctors, hospitals, and clinics to meet the needs of our members. How do we do that? Here's one example: we teamed up with Baylor Scott & White Quality Alliance (BSWQA) to form Baylor Scott & White Preferred, an integrated health plan solution.

Baylor Scott & White Preferred providers belong to the BSWQA Accountable Care Organization (ACO). They are contracted with SWHP to provide care for you.

WHAT IS AN ACO?

ACOs are formed from a group of doctors that are committed to being accountable to patients and payers for the quality, appropriateness and efficiency of healthcare services. They are healthcare organizations that tie payments to quality measures and the cost of care. In our ACO, doctors, hospitals, SWHP, post-acute care facilities and others work together to make sure you get the right care at the right time and at the right cost.

HOW DOES AN ACO WORK?

Your primary care doctor leads a care team that may include physician assistants, medical assistants and registered nurses. They ensure

your preventive services are up-to-date and help manage your care if you have been diagnosed with a complex illness.

Your primary care doctor uses electronic health records to help keep you and your care team on the same page. These records are shared securely with other doctors and care managers in the system to track your health history, your medicines, and your test results--all in real time. This also helps your doctor spot any gaps in your care.

Find a Provider

Our provider search tool at ers. allows you to: ? Search by name, specialty and/or ZIP code ? Add filters for gender, board certification, accepting new patients and more ? See practice locations, contact information and maps ? Get details, including network participation and hospital affiliations ? Customize your own profile

Go to ers. and scroll down the page to "Find a Provider" and you will be on your way.

Need more help? Call the Baylor Scott & White Quality Alliance

Health Access Line: (844) 279-7589

As a member of a health plan working with an ACO, YOU CAN EXPECT CARE THAT IS:

HIGH-QUALITY. You should expect the care you receive to be safe, timely, effective, efficient, equitable and patient-centered.

COORDINATED. Your doctor acts as the quarterback for care, guiding your care team and coordinating appropriate services across all sites of care that might include a specialist's office, the hospital, or laboratory and imaging services.

CONVENIENT. Many of our doctors and facilities offer same-day appointments, extended hours, and onsite laboratory and imaging services. Urgent care centers and retail care clinics like Walgreen's and CVS are in the BSW Preferred network.

COMPREHENSIVE. The BSW Preferred network of primary and specialty care doctors and facilities is broad. We are confident we can meet your care needs.

COST-EFFECTIVE. Copays and out-of-pocket expenses are kept in check when your care needs are delivered inside the BSW Preferred network (doctors, hospitals, laboratory, imaging and post-acute care.) All other providers are considered out-of-network and no benefits are available for services other than emergency situations.

Plan Year 2020

N

Eligibility Map Employees Retirement System of Texas

Parker

Denton

Collin

Tarrant

Dallas

Rockwall

W

E

S

If you live or work in one of the green counties, you will be eligible to participate in the Texas Employees Group Benefits Program (GBP) administered by SWHP for Plan Year 2020.

Callahan Eastland

Erath

Hood

Johnson

Somervell

Coleman

Comanche Brown

Mills

Bosque Hamilton

Hill McLennan

Ellis Navarro

Henderson

Anderson Freestone Limestone

McCulloc h San Saba

Mason

Llano

Lampasas Coryell

Burnet

Bell Williamson

Falls Milam

Gillespie

Blanco

Travis

Lee

Kendall

Hays Comal

Bastrop Caldwell

Leon

Houston

Robertson

Madison

Trinity

Brazos Grimes

Burleson

Walker

San Jacinto

Montgomery Washington

Waller

Harris

Guadalupe Gonzales

Colorado

Fort Bend

Wharton

Scott and White Health Plan offers a variety of programs designed to

meet your health and wellness needs, regardless of where you may be on the continuum of care. Through a comprehensive suite of effective

resources and tools, we offer a tailored experience built on the demands of our members. It is our mission to

promote a healthy lifestyle and empower our members to become an active

participant in their healthcare team.

WE L L N E S S ASSESSMENT

The Wellness Assessment is a simple, digital health survey that helps you take steps toward a more vibrant and healthier life. The Wellness Assessment asks questions about your life and delivers customized action steps from our Lifestyle Management program. Modules are self-paced, available online, and convenient for promoting physical and mental health -- all things to help you feel your best. ers.health

Nurse Advice Line

The SWHP Nurse Advice Line is here for you 24 hours a day, every day of the year. Our nurses will discuss your symptoms to help you take care of yourself wherever you are. They will also help you determine if you need an appointment, or a visit to urgent care, or an emergency room.

To talk to a nurse, call toll free

(877) 505-7947.

EXTRA ASSISTANCE WHEN YOU NEED IT

Complex Case Management

If you have chronic conditions or complex care needs, our nurse case managers will work with you, your family, and your physician to create and manage your care plan. Case managers advocate for you and assist with setting goals and making a personal plan to improve your health. They also can assist with arrangements for necessary services and make referrals to, and incorporate, Disease Management programs as applicable. Case managers answer questions and educate you so you have a better understanding of your condition and plan of care.

The purpose of the program is to help you get the best possible results and the greatest value from your health plan. Participation is voluntary, and there is no additional cost to you for this program. To see if Complex Case Management is right for you, request a screening by completing the Case Management referral form at .

Disease Management

Disease Management programs are designed to improve the health of members with chronic conditions and reduce associated costs from avoidable complications. These goals are accomplished by identifying and treating chronic conditions more quickly and more effectively, slowing the progression of those diseases.

Disease Management is a system of coordinated heath care interventions tailored to your conditions where self-care efforts can be implemented.

Working with your healthcare providers, Disease Management empowers you to manage the disease and prevent complications.

SWHP ERS members can access the program by calling the Health Access Line (844) 279-7589 or through our online Member Information Center.

ers.disease-and-conditionmanagement

Maternity Topics and MOMS Program

Following the birth of a baby, moms and dads can get important information and resources through our MOMs program, that supports families with personal phone calls from licensed professionals.

A MOMS program professional can be reached toll-free at (888) 316-7947.

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