FirstCare Health Plans – Here With You Through COVID-19
FirstCare Health Plans and Baylor Scott & White Health are continuing to monitor COVID-19 developments and are working together to ensure members get the care and coverage they need, when they need it most. You can expect claims processing, customer service by phone and member portal, and other operations to remain as usual.
To protect our members and also our health plan employees, we are temporarily suspending in-person visits to our health plan offices. This does not apply to Baylor Scott & White Health medical facilities.
We hope to welcome you back to our offices very soon. We have more information on COVID-19 and how to keep your loved ones safe at
BSWHealth.com.
Over-the-Counter At-Home COVID-19 Tests
Need to know your options for over-the-counter (OTC) at-home COVID-19 tests? View the information below to see what may be available to you.
Health Plan Coverage
Beginning Jan. 15, 2022, and until further notice, Baylor Scott & White Health Plan will cover at-home over-the-counter (OTC) COVID-19 diagnostic tests authorized by the U.S. Food and Drug Administration (FDA).
Federal guidance requires coverage for OTC COVID-19 tests for fully insured individual health plans. Guidance for members enrolled in Medicaid plans is published by Health and Human Services Commission (HHSC).
Who is covered for at-home COVID-19 tests?
OTC COVID-19 tests are covered for members of FirstCare fully insured individual health plans.
OTC COVID-19 tests are not covered for employment purposes. For example, tests are not covered if your employer requires that you test yourself multiple times per week as a condition of employment or for pre-employment screening.
Which tests are covered?
Covered tests include at-home COVID-19 test kits authorized by the FDA and do not require an order from a medical provider. The most common are BinaxNOW
™, CLINITEST
®, Flowflex
™, i-Health
®, InteliSwab
™, Ellume, On/Go
™, QuickVue
® and At-home test kits (Roche). Look for an FDA Emergency Use Authorization label on the package.
Is there a limit to how many tests will be covered?
Yes. Members can get up to eight (8) tests per month for no additional out-of-pocket cost under your pharmacy benefit. (e.g., a family of 4 would be eligible for 32 tests a month).
Note that coverage is per test. If you buy a box/kit containing two (2) tests, it counts as two (2) tests.
How can I get a test kit?
Pay $0 at a preferred network pharmacy.
Visit the pharmacy counter at a preferred network pharmacy:
Baylor Scott & White Pharmacies, Walmart, Sam’s Club, Walgreens, Kinney Drugs or Rite-Aid (includes Bartell Drugs). Present your member ID card and ask to have your OTC at-home COVID-19 test kit(s) submitted to OptumRx, the administrator of your pharmacy benefit. You can get up to eight (8) tests per month for no additional out-of-pocket cost under your pharmacy benefit.
Purchase a test kit and be reimbursed up to $12.
Purchase an FDA-authorized OTC COVID-19 test kit at other stores or online retailers not listed above. You will be reimbursed up to $12 per test for up to eight (8) tests per covered member per month without a prescription. Keep your receipt(s) and the name of your at-home test kit(s). You'll need that information to submit a claim for reimbursement.
Order a test kit to be mailed to your home.
Log in to the
MyBSWHealth member portal. Click “Baylor Scott & White Health Plan” under the Dashboard on the left, then “Plan Benefits,” then “Please click here to view your Pharmacy Claims.” This brings you to the OptumRx site where you will scroll down and select “Get at-home COVID-19 tests with $0 copay.” Follow the directions as prompted to receive test kits in the mail. Important note: Members are limited to eight (8) tests (4 kits)
per household per calendar month for mailed test kits.
Please note: Some pharmacies and other stores are experiencing supply shortages for these test kits.
How do I submit a claim for reimbursement?
If you paid out-of-pocket for an FDA-authorized OTC COVID-19 test kit on or after Jan. 15, you can submit your claim within one year of your purchase date. Reimbursement will be available through the end of the federal emergency health period. A separate claim must be submitted for each member.
To receive the quickest possible reimbursement,
submit a claim online. You can also
print and complete a mail-in form
What if I have questions?
Call the Customer Service number on the back of your member ID card.
More information about OTC COVID-19 testing:
Learn More
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COVID-19 Vaccine Update
The U.S. Food and Drug Administration (FDA) issued Emergency Use Authorizations for COVID-19 vaccines by Pfizer, Moderna and Johnson & Johnson/Janssen. We want to answer a few of your questions about this exciting development in the fight against COVID-19.
Learn more about vaccine safety and how to get a vaccine.
What does the COVID-19 vaccine cost?
The COVID-19 vaccine is available to health plan members at zero out-of-pocket cost.
Potential Schemes Related to COVID-19
Scammers are using telemarketing, text messages, door-to-door visits as well as social media to conduct their fraudulent activities. These individuals are offering COVID-19 tests, grants and prescription cards in exchange for personal information to benefit themselves and harm the public.
Ways to protect yourself from fraud, waste and abuse schemes:
- Never share information to unknown individuals. This should include date of birth, Social Security number, Medicaid or Medicare numbers, health care details, financial or other personal identifiable information. Sharing this type of information can lead to identity theft.
- Review your Explanation of Benefits (EOB) or MyBSWHealth for suspicious activity or claims.
- Ignore offers or advertisements for COVID-19 testing or treatments on social media.
- Never post photos of your COVID-19 vaccination cards on social media.
- Do not open links in text messages from unknown individuals.
- Do not trust any unexpected calls or visitors offering COVID-19 tests or supplies.
- Do not pay anyone to speed up your vaccine eligibility.
- Report suspected fraud to health plan helpline: 1-866-399-8161
Learn More
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Benefit Updates: COVID-19 Testing and Treatment
Effective July 1, 2021, and until further notice:
- FirstCare Health Plans continues to waive all member cost-sharing for COVID-19 testing and vaccinations.
- Member cost-sharing is no longer waived for outpatient office visits and inpatient hospital stays.
- Refer to your plan documents for:
- Telehealth services coverage
- Copayment information
- Other plan details
This applies to fully insured Commercial Group and Individual policies. Members of self-insured groups should contact their Human Resources Department regarding coverage.
What to Do if You're Sick
The COVID-19 virus and its variants are still circulating in the community. Even individuals who are fully vaccinated should remain watchful of their health.
If you feel sick with fever, cough, or have difficulty breathing and have traveled to high-risk locations or were in close contact with someone with COVID-19 in the 14 days before you began to feel sick, seek medical care.
Option 1: Stay home and visit a doctor virtually.
FirstCare Health Plans has teamed up with MDLIVE to provide access to board-certified doctors 24 hours a day, seven days a week.
To visit with a doctor:
- Log into your member portal;
- Download the MDLIVE mobile app; or
- Call and speak to an MDLIVE representative at 1-800-718-5082
After your visit, prescriptions (if needed) will be sent immediately to your preferred pharmacy.
Option 2: Find a doctor, clinic or hospital near you.
When you schedule your visit, share your concerns about your COVID-19 symptoms or exposure. Your doctor’s office, clinic or hospital will have instructions for your visit.
Option 3: If you are experiencing a medical emergency, call 911.
Notify the operator if you have COVID-19 or need to be seen for COVID-19 symptoms. If available, put on a face mask before the ambulance arrives.
We're Here to Help
FirstCare Health Plans is dedicated to providing ongoing access to quality healthcare services for members impacted by public health emergencies. We will follow federal and state guidance while working with hospitals, drug stores and other providers to ensure our members get the care and medications they need.
Helpful Tips & Phone Numbers