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2025 Review • Goals for 2026
Items to review
2024 Utilization meeting with Wilsonart –When will this be available for us to work with Wilsonart to schedule a meeting in early June?
New programs being offered by BSW to WA in 2025 and 2026 Communication strategy Impact to members
Renewal timeline and review ALL anticipated plan design changes Wilsonart will need to take in 2026
When will the renewal be available? Expected renewal: we meet with Wilsonart, late July or early August (we will need this sooner than we received the 2025 renewal).
Utilization meeting Early June
Renewal timeline –working with underwriting for late July or early August
Plan design changes for 2026
Updates: Benefits in review
Riders
• Hearing Aid Rider – in network same as DME
• Vision Eyewear - $10 exam $0 eyewear ($200 Allowance) PPO and HMO
Additional benefits
• COBRA
• Dental – MetLife
• STD/LTD –MetLife
• Basic Life and AD&D – MetLife
Integrated patient/member experience
• Provider search returns health plan provider network results
• Claims information in real-time, with deductible and OOP
• Member ID card, benefit documents and benefit details
• Single sign-on to wellness and pharmacy benefits
• Integrated member support with health plan service center
• Agent and AI-supported chat
• Real-time cost estimation
• Family account management
• EviCore and OncoHealth – Cancer Treatment Program and cutting-edge Analytics
Member Support
Member Guide
• Resources available on BSWHP website (formulary, find a pharmacy, etc)
Specialty and mail order contact information
NEW!
Open Enrollment/Portal Tools
• Find a pharmacy
• Formulary look-up functionality (preferred drugs/tiering/utilization management requirements)
• Price medications
Current Members
• Patient tools integrated with MyBSWHealth
• Rx Smart Save - Provides members with clinically appropriate, low-cost alternative medications in real time.
Members receive a message within the member portal
Wellness Programs
The WebMD digital wellness platform provides resources and tools to encourage members to be healthy, while providing personalized support for various health conditions and health risks.
Wondr Health
Wondr Health is a digital weight loss program available at no additional cost to fully insured commercial members.
• Developed to improve the health of Type 2 diabetics and reduce overall healthcare costs
• Available for large group plans starting 1/1/25 (excluding HDHP plans)
• Offers $0 copays for diabetes medications and supplies while meeting program criteria
• Works in tandem with BSW Be Well Coaching to offer a streamlined member experience
• BSWHP custom program, offering more flexibility to meet group needs vs vendor
• Led by pharmacist with over 20+ years of BSWH system experience – Established relationships with regional PCPs and Specialists
Webinars
Connect, learn, and get answers to some of your questions from doctors and other leading health experts.
Join us the 1st Wednesday of every month, from 11 AM - 11:30 AM. Each webinar will feature a new topic to help you live healthier.
• Three health coaching programs available:
Nutrition Management
Stress Management
Tobacco Cessation
• Additional program available by referral, BSW Be Well with Diabetes.
This program is a partnership with the Pharmacy team.
BSWHP Group Value (GV) Formulary Tiering
• Positive changes may occur monthly
• Monthly changes can be viewed on the BSWHP website
• Formulary drug lists are updated quarterly on the BSWHP website
• Negative changes to the formulary occur typically bi-annually on 7/1 and 1/1
• Members taking chronic medications are notified of negative changes 60 days in advance, which includes preferred alternative options if applicable.
Prior Authorization
A member, an authorized representative, or a prescriber can submit a request for an exception to the formulary
• Request can be submitted electronically, by fax, mail, or phone
Members and prescribers are notified of the determination in writing
• If denied, information on how to appeal is included
PA resources available at:
Pharmacy Resources for Providers | Baylor Scott & White Health Plan (bswhp.org)
Medication Adherence: Pilot Outcomes
Proportion of Days Covered (PDC)
’24-’25
Broker Bonus Program
• Sell a NEW GROUP, earn a bonus.
• RENEW an existing group, earn a bonus.
(Must have 300 or more current BSWHP members)
The amount you earn will be based on covered members. For the group effective dates July 1, 2024 – June 30, 2025, you will earn
• $35 for each fully insured member on new group
• $12 for each self-funded member on new group
• $10 for each fully insured member on renewed group
• $3 for each self-funded member on renewed group
If you sell:
• One fully insured group with 150 members ($35x150 = $5,250)
• One self-funded group with 250 members ($12x250 = $3,000)
If you renew:
• Fully insured group with 400 members ($10x400 = $4,000)
• Self-funded group with 250 members
($3x250 = $750) You earn $13,000!