Page 8 - 2020 McLennan County Benefits Enrollment Guide
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Frequently Asked Questions Regarding the
Health Plan
What is a formulary drug?
A prescription drug formulary is a comprehensive list of prescription drugs deemed safe and effective with acceptable or
superior financial value. The formulary is an evolving process as existing and new drugs are evaluated by the Scott &
White Health Plan Pharmacy and Therapeutics Committee (P&T). You can view the McLennan County Employee Health
Plan formulary at https://swhp.org/Portals/0/Files/Forms/Formulary/McLennan-Group-Value-Formulary-2019.pdf
What is a deductible and when does it reset?
The deductible is the amount you pay for covered health care services before your insurance plan starts to pay. With a
$1,000 deductible, for example, you pay the first $1,000 of covered services yourself. Your deductible amount runs
through a calendar year meaning the dollar amount accrued resets to zero January 1 .
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How do I find a physician in my area?
You can use the website, https://portal.swhp.org/#/search?networkCode=HMO&hideOptions=true , to find the health
care provider you need, or call Customer Service at 1-800-299-8640. We do not require that you have a Primary Care
Physician (PCP), so you can choose anyone from our network at any time.
On the website you will see a symbol with a “+” under the provider’s name. If the symbol is green, that provider is
accepting new patients. If the symbol is orange, approval is required by that provider to accept a new patient. The
website is updated when notification is received, but sometimes there are delays in notifications. There will always be
providers coming in and out of network and new patient acceptance may change periodically.
The network of physicians has recently expanded to include the North Texas Region Hospitals (Fort Worth, Dallas, etc.)
In order to identify in-network physicians in this area, please adjust the zip code to one within 100 miles of these city
locations. If you enter a McLennan County area zip code, you are limited to a 100 mile radius of Waco and some of
these North Texas hospitals are beyond that radius.
Where can I access information about my benefits, plan, claims, EOBs (Explanation
of Benefits) or other important information?
My Benefits (https://portal.swhp.org/#/login) is available online 24/7 to assist you in verifying member eligibility and
benefits, checking claim status and many other options. For further assistance, you can contact Customer Service at 1-
800-299-8640.
What should I do if I get a bill that should have been paid by the McLennan County
Employee Health Plan?
As soon as you receive the bill, please contact a Claims Representative at 1-800-321-7947. They will research the bill to
determine if a payment has already been made and will work with your provider to resolve the situation.
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