State of Texas and Higher Education
Employees, Retirees and their Dependents
Frequently Asked Questions
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How do I select a Primary Care Physician (PCP) and what happens if I do not like him/her after I have made a decision? Is it necessary that all our family members use the same physician?
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What kind of coverage will I have when I go out of town or go on vacation? When I travel abroad, is it necessary to purchase additional insurance for foreign travel?
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What kind of coverage will my college-age child have while he/she is away at school?
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I am currently seeing a doctor outside of Scott & White; can I continue to see that doctor?
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How do I get a referral outside the SWHP network when you cannot provide the services that I need?
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What happens if I am hospitalized outside the service area?
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What should I do if I get a bill that should have been paid by SWHP?
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How can I add/delete someone from coverage under my plan?
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What if I need additional identification cards, a copy of my policy, or any other materials?
1. How do I select a Primary Care Physician (PCP) and what happens if I do not like him/her after I have made a decision? Is it necessary that all our family members use the same physician?
To select a Primary Care Physician (PCP), please refer to our online directory. Each person listed on your plan may select a PCP from the following physicians:
- Family Practice treats all age groups from newborns to the elderly. They provide routine medical care, referrals to specialists, some minor surgical procedures, and obstetrics/gynecology services.
- Community Internal Medicine physicians treat patients 16 years and older. They provide routine medical care, gynecology services, and referrals to specialists.
- Pediatrics treats children up to age 18 and provides routine care as well as referrals to specialists.
In selecting a PCP, consider which clinic would be most convenient to meet your own needs. Each person listed on your plan can select his or her own doctor from any of the three panels.
If you would like specific information about any of the primary care physicians, just contact your Customer Service Coordinator at a Scott & White Health Plan (SWHP) office near you. Once you designate a physician, you can make an appointment with that physician or, if he/she is unavailable, any of the other physicians of the same specialty that work with the clinic. You can change your PCP online or by simply contacting your Customer Service Coordinator at a SWHP office near you.
2. What kind of coverage will I have when I go out of town or go on vacation? When I travel abroad, is it necessary to purchase additional insurance for foreign travel?
As a member of SWHP, you are covered world wide for any bona fide emergency that occurs. Incidents such as heart attacks, deep lacerations, loss of consciousness, breathing difficulties, broken bones, and other critical conditions that require immediate treatment are covered with your Emergency Room copayment. If you have a medical problem that is urgent but is not an emergency, you are encouraged to contact our Nurse Advice Line at (800) 975-6612. This is a 24-hour line that you can access from anywhere in the world for medical advice and assistance in managing your illness.
In traveling abroad, SWHP provides coverage for all emergencies. (For definitions, please refer to the Urgent and Emergency Care section.) If you anticipate an extended stay, you may want to consider additional coverage for routine medical care.
3. What kind of coverage will my college-age child have while he/she is away at school?
SWHP will cover any emergency that occurs while away at school. (For a definition of an emergency, please refer to the Urgent and Emergency Care section.) It will be important to plan for routine medical needs while the student is away. If your child is attending school within the State and will be located near one of our provider clinics, your child can receive care at the facility. If the student is attending school out of the SWHP service area, it may be necessary to consider supplementary coverage for routine medical care. The student may want to use the college dispensary for his/her routine medical care. The student can also access our Nurse Advice Line at (800) 975-6612 at any time for medical advice and assistance.
4. I am currently seeing a doctor outside of Scott & White; can I continue to see that doctor?
SWHP is a Health Maintenance Organization (HMO) and your care has been prepaid and prearranged for within the SWHP network. If you would like SWHP to pay for the doctor visit, you must see a SWHP physician. You may continue to see the physician outside the SWHP network, but SWHP will not pay for the visit. You may want to get copies of your medical care records from the outside doctor so that your SWHP PCP can continue care.
5. How do I get a referral outside the SWHP network when you cannot provide the services that I need?
SWHP network is a large multi-specialty network and, in most cases, can meet the majority of your medical needs. If you develop a medical condition that your PCP and specialists cannot care for, you will need (1) recommendation from your SWHP network physician and (2) the approval of the SWHP Medical Director before any out of plan services can be covered. A formal review of your case will be provided and you will receive a letter outlining clearly what SWHP will or will not cover with the outside physician.
6. What happens if I am hospitalized outside the service area?
Please have someone call SWHP within 24-48 hours of your admission so that we can begin coordinating your care as soon as possible. The instructions for reporting an out-of-plan admission are printed on the back of your member identification card. Simply use the toll-free line.
If you are hospitalized while traveling with others, we suggest that you always have someone else within your group who knows what to do in case you are unable to speak for yourself.
7. What should I do if I get a bill that should have been paid by SWHP?
As soon as you receive the bill, please contact a SWHP Claims Representative at a SWHP office near you for assistance.
8. How can I add/delete someone from coverage under my plan?
If you are covered on your employer's plan, simply contact your employer. If you are covered under an individual plan, please call a SWHP office near you.
9. What if I need additional identification cards, a copy of my policy, or any other materials?
You may request an identification card online. To receive additional contracts, identification cards, summaries of benefits, or any other material, contact a Customer Service Coordinator at a SWHP office near you.
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