BSW SeniorCare Advantage Rx (HMO-POS), BSW SeniorCare Advantage (PPO), Covenant Health Advantage Rx (HMO)

Important Message About What You Pay for Vaccines

Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Customer Service for more information.

Important Message About What You Pay for Insulin

You won’t pay more than $35 for a one-month supply of each Insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

For More Information

For more detailed information about your drug coverage, please review your Evidence of Coverage and other plan materials.

For other questions, please contact Baylor Scott & White Health Plan Customer Service at 1-866-334-3141 (TT: 711). Covenant Health Advantage members may contact Baylor Scott & White Health Plan Customer service at 1-833-442-2405 (TTY: 711); October 1 through March 31 from 7 a.m. – 8 p.m., seven days a week (excluding major holidays); and April 1 through September 30 from 7 a.m. – 8 p.m., Monday through Friday (excluding major holidays); or visit BSWHealthPlan.com/Medicare.

If you have general questions about Medicare prescription drug coverage, please call Medicare at 1-800- MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048. Or, visit https://www.medicare.gov.

How to Request an Exception

You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:

You can ask us to cover your drug even if it is not on our formulary.

You can ask us to waive coverage restrictions or limits on your drug.

You can ask us to provide a higher level of coverage for your drug.

You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescribing physician’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 72 hours after we get your prescribing physician’s supporting statement.