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Frequently Asked Questions

Do I only have access to Baylor Scott & White providers & facilities?
The DFW ConnectedCare plan utilizes the Baylor Scott & White Quality Alliance, a preferred network of providers that consists of Baylor Scott & White providers and facilities along with associated independent providers and select providers and facilities from Methodist health system, Cook Children’s, and Children’s Health.
Do you need to go through a primary care provider (PCP) to see a specialist with DFW ConnectedCare?
No, there is no referral required to see a specialist, but you will need to make sure the specialist is a part of the Baylor Scott & White Quality Alliance.
How does the coverage work when traveling either for business or pleasure?
When traveling, you will have access for urgent care needs through providers and facilities in the Aetna Signature network. The website for Aetna will be on the back of the medical ID card, or you can call the DFW ConnectedCare center for help in finding a provider when traveling if you need care.
Also, emergent care while traveling is covered. If truly an emergency, you should go to any emergency room to seek care. Additionally, you will have access to telemedicine, similar to the other medical plan options, through the Baylor Scott & White Quality Alliance or Doctor on Demand after hours.
How much do I have to pay if I accidentally go to an out of network PCP or Specialist? Does the cost incurred count towards my max out of pocket?
There is no coverage for out-of-network primary care physician or specialist services so you would be 100% responsible and it will not count towards your out-of-pocket maximum.
How does this work if my dependent child is away at college in another state?
If you have dependents away in college, this is likely not the right plan for you/your family. The network of doctors and facilities is local here in the DFW area.
How are diagnostic tests (x-ray, labs) and imaging (CT, PET, MRI) scans covered on the DFW ConnectedCare plan?
If you have a service done at the doctor’s office, there is no cost for diagnostic tests as it is a part of your primary care or specialist copay. Diagnostic tests performed in an outpatient setting have a $50 copay. Imaging scans performed in the doctor’s office or at a freestanding facility have a $100 copay. If the service happens at a hospital facility, imaging scans have a $400 copay.
What about preventative care/screening/immunizations?
Covered at 100% if recommended based on age & gender.
How are infusions covered?
Chemotherapy, radiation, and infusions are subject to a 20% co-insurance.
If I am traveling, are emergencies covered and in what instances?
True emergency services while traveling are covered as if they are in-network. There is a $300 copay for true emergencies (copay waived if admitted). $300 copayment + 40% coinsurance for non-emergent services rendered in an emergency room.
What about international travel?
Emergencies while traveling internationally are also covered as part of the plan. As with most medical plans, members would be responsible for the upfront cost then would submit proper documentation to be reimbursed for expenses incurred.
What if I have a non-emergent issue such as the cold, flu, urinary tract infection, etc. while traveling?
Team members will have access to eVisits (7 days a week from 8a-8pm CST) & video visits (M-F 8a-8pm CST) through the MyBSWHealth app, Doctor on Demand (24/7 access), CVS minute clinics, and American onsite clinics. You can also access urgent care facilities in the Aetna Signature Administrators network.
What happens if I have an emergency in the DFW area and I am taken by ambulance to an out of network hospital or emergency room?
Emergency room services will be covered the same if in-network or out-of-network. $300 copay for true emergent situations (copay waived if admitted). $300 copayment + 40% coinsurance for non-emergency. Emergency medical transportation is covered at 100%.
If there is a zero dollar deductible, why is there an out-of-pocket maximum? What counts towards it?
The out-of-pocket maximum is the most you will pay in a year for covered services. Copayment and coinsurance amounts DO count toward your out-of-pocket maximum. In families of 2 or more members, if family out-of-pocket maximum is met cumulatively, expenses are payable at 100% for all family members even if the individual out-of-pocket maximum haven’t been met by each member. Non-covered or excluded expenses you pay for DO NOT count toward your out-of-pocket maximum.
Is it true that American team members on the DFW ConnectedCare plan will get priority access to same or next day visits at certain Baylor Scott & White primary care practices?
Yes, it is true. DFW ConnectedCare members will have priority when making appointments at select provider practices. Please feel free to take advantage of same or next day appointments, extended hours including nights and weekends, along with onsite lab and imaging services.
If I have funds in a Health Savings Account (HSA) am I able to use them while enrolled in this plan?
Yes, you are able to use funds already contributed to your HSA to pay for eligible medical expenses. While, enrolled in this plan, you are not allowed to make new contributions to an HSA account.
What about Flexible Spending Accounts (FSA) and Health Reimbursement Accounts (HRA)?
The DFW ConnectedCare plan has the option for team members to utilize a FSA and/or HRA to pay for eligible medical expenses. The FSA is funded by the team member with pre-tax dollars up to $2700 in 2020. DFW ConnectedCare members are also eligible for a HRA that is funded by American when team members complete certain wellness reward initiatives.
Who is WebTPA?
WebTPA is the claims administrator for the DFW ConnectedCare plan effective January 1, 2020. They will issue your medical ID card(s), send your explanation of benefits (EOB), and complete your claims processing.
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