Baylor Scott & White Health Plan

What Baylor Scott & White Health Plan does

Baylor Scott & White Health Plan (BSWHP), legally operating as Scott and White Health Plan, is a Texas state-licensed not-for-profit health maintenance organization founded in 1982 and headquartered at 301 N. Washington Ave., Dallas, with a secondary compliance office in Temple, Texas. The company is the payer arm of the broader Baylor Scott & White Health delivery system and serves four primary lines of business: Medicare Advantage plans under the BSW SeniorCare Advantage brand (HMO and PPO), Individual & Family ACA Marketplace plans across Gold, Silver, and Bronze metal tiers, Employer Group plans (HMO, PPO, EPO, POS) covering 141+ Texas counties, and government programs including STAR Medicaid (Central Texas) and CHIP (West Texas through the FirstCare subsidiary). Additional wholly owned subsidiaries include Baylor Scott & White Care Plan for HMO products and Baylor Scott & White Insurance Company for insured PPO and EPO products.

The technology stack centers on the MyBSWHealth member portal and mobile application (iOS and Android), which consolidates claims, benefits, scheduling, prescriptions, provider messaging, eVisits, video visits, and billing into a single consumer interface. Underlying interoperability is built on FHIR (Fast Healthcare Interoperability Resources) standards with OAuth 2.0 / Open ID Connect authentication delivered through Microsoft identity infrastructure and exposed via an Inovalon-hosted Developer Portal to comply with the CMS-9115-F Patient Access Final Rule and CMS-0057-F Prior Authorization Final Rule. A Provider Portal handles claims, billing, and digital prior authorization, and a Medical Cost Estimator tool provides member-facing cost transparency. Pharmacy benefit management is delivered through Judi Rx (formerly Capital Rx), and digital advance care planning is integrated through the MyDirectives platform. The plan holds NCQA Health Plan Accreditation and full HIPAA compliance.

Revenue is generated primarily through recurring monthly insurance premiums across all lines (individual, Medicare Advantage, employer group, Medicaid managed care, and CHIP), supplemented by administrative fees from third-party administration of self-funded employer plans (named clients include AbbVie, Covenant Health, and Hendrick Health). Distribution combines direct-to-consumer enrollment (Marketplace, Medicare AEP campaigns), licensed agent/broker networks accessing dedicated agent portals, and a dedicated employer services team for large group sales. The plan has 849 employees, was recognized as a Top 10 best overall Medicare Advantage plan in Texas by U.S. News & World Report for 2026, and has announced the wind-down of Individual Plans (on and off Marketplace) effective December 31, 2026, pending regulatory approval, signaling a strategic portfolio refocus.

Name

Baylor Scott & White Health Plan

Legal name

Scott and White Health Plan

Website

https://bswhealthplan.com

Company type

Private

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Baylor Scott & White Health Plan is a Texas not-for-profit health insurer offering Medicare Advantage, ACA Marketplace, Employer Group, Medicaid STAR, and CHIP plans through the Baylor Scott & White Health delivery system, supported by the MyBSWHealth digital platform and FHIR-based interoperability APIs.

Ownership category

akta.pro rank

Product category

Managed Health Insurance Plans

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Medicare Advantage (MA) Plans (FSAIAGAA)

akta.pro secondary industries

Small Group Health Insurance (2–50/100) (FSAIAFAD), Off-Exchange Individual Major Medical Plans (FSAIAEAB), Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB)

Keywords

• Health insurance plans
• Medicare Advantage plans
• Employer group coverage
• Medicaid managed care
• Health plan administration

Headquarters

HQ city

Dallas

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Health Insurance Premiums: The primary revenue stream comes from collecting insurance premiums from members (individual plans, Medicare Advantage) and employers (group plans). Premium revenue is generated through monthly subscription-like payments based on plan tier and coverage type.
2. Government Program Revenue: Revenue from federal and state programs including Medicare Advantage (BSW SeniorCare Advantage), Medicaid STAR, and CHIP through subsidiary FirstCare Health Plans.
3. Third-Party Administration: Scott and White Health Plan serves as a third-party administrator for self-funded employer-sponsored plans, earning administrative fees.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels6 records

Core offering

Baylor Scott & White Health Plan is a Texas not-for-profit health insurance company that sells Medicare Advantage, ACA Marketplace individual and family, and employer group health plans (HMO, PPO, EPO, POS), and administers STAR Medicaid and CHIP government programs through its subsidiary FirstCare Health Plans. Members access benefits through the MyBSWHealth member portal and mobile app, provider portal, virtual care services, and an integrated care delivery network tied to the Baylor Scott & White Health system.

Product overview

Baylor Scott & White Health Plan (BSWHP) is a Texas-based health insurance provider offering a comprehensive portfolio of health plans and digital health management tools. The core product portfolio includes MyBSWHealth Member Portal (web and mobile app) for members to access claims, benefits, and healthcare services; Medicare Advantage plans (BSW SeniorCare); Marketplace/ACA Individual & Family plans; Employer Group plans for small and large businesses; and Medicaid/CHIP plans through subsidiaries. The digital ecosystem is complemented by Virtual Care/telehealth services (eVisits and video visits), a Provider Portal, Find a Doctor/Pharmacy search tool, Medical Cost Estimator, 24-Hour Nurse Advice Line, and Advance Care Planning tools. The company operates interoperability APIs using FHIR standards for third-party integrations and is NCQA accredited.

Differentiator

Problem solved

Functional benefit

Products and services

• BSW SeniorCare Advantage Medicare Plans Medicare Advantage plans offered in Texas including HMO and PPO options, recognized as a Top 10 best overall Medicare Advantage plan in Texas by U.S. News & World Report for 2026.
• Marketplace Individual & Family Plans ACA Marketplace individual and family health plans including Gold, Silver, and Bronze tier options such as BSW Elite Gold HMO and BSW Prime Silver HMO.
• Employer Group Plans Small and large group employer-sponsored health plans including HMO, PPO, EPO, and POS options with various coverage tiers, sold across 141+ Texas counties. Includes both fully-insured and self-funded plan administration.
• Virtual Care / Telehealth Telemedicine services including eVisits (5-10 minute symptom questionnaire with 1-hour provider response) and 24/7 video visits with on-call providers (10-15 minute appointments).
• MyBSWHealth Member Portal Secure member portal for Medicare Advantage, Marketplace, and Employer Group members to access health plan information, claims, benefits, billing, and member ID cards.
• MyBSWHealth Mobile App Mobile application available on iOS and Android enabling members to manage healthcare needs including lab results, appointments, prescriptions, medical records, eVisits, video visits, messaging providers, and insurance billing.
• STAR Medicaid Plans Medicaid STAR program for low-income families, children, and pregnant women offered in Central Texas through Scott and White Health Plan.
• FirstCare Health Plans (Subsidiary) Wholly owned subsidiary offering STAR Medicaid and CHIP plans in West Texas and Lubbock areas.

Quantifiable outcome

• Prior authorization approval rates: 90.12% for BSW SeniorCare Advantage HMO non-urgent requests
• +2 more outcomes

Named customers5 records

Segments5 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

AI capability1 record

Feature4 records

Partnerships

Four partnerships are on record, tiered core.

• FirstCare Health PlanscoreStrategic or Co-development PartnerSubsidiary company of Scott and White Health Plan that administers STAR Medicaid and CHIP plans in West Texas. FirstCare operates as a separate health plan brand providing coverage for children and families in the West Texas and Lubbock areas.
• Scott and White Health PlancoreStrategic or Co-development PartnerParent organization and operating entity for Baylor Scott & White Health Plan. Provides the integrated healthcare delivery system network and administrative infrastructure.
• Judi Rx (formerly Capital Rx)coreTechnology or IntegrationPharmacy benefit administrator (PBA) providing prescription drug benefit management. Name changed from Capital Rx to Judi Rx for Commercial, ACA Individual Coverage and Medicare members. Members' pharmacy benefits and service remain the same.
• Inovalon (Developer Portal)coreTechnology or IntegrationTechnology partner providing the Interoperability API Developer Portal for third-party application registration and access to BSWHP data pursuant to CMS Interoperability and Patient Access Final Rule.

Scale indicators4 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• UnitedHealthcare: UnitedHealthcare is the largest U.S. health insurer and dominant Medicare Advantage carrier in Texas. It directly competes with BSWHP across MA, employer group, and individual segments, with broader geographic reach and deeper marketing investment.
• Cigna Healthcare: Cigna competes with BSWHP in Texas across individual ACA Marketplace plans, employer group coverage, and Medicare Advantage. Cigna has stronger national carrier scale and global brand recognition.
• Aetna (CVS Health): Aetna, owned by CVS Health, competes with BSWHP across individual Marketplace, employer group, and Medicare Advantage products in Texas, with parent-company integration advantages (CVS Caremark, MinuteClinic, Oak Street Health).

Direct peers

• Humana: Humana is a Medicare Advantage-focused carrier with significant Texas presence. It competes directly with BSWHP's BSW SeniorCare Advantage HMO/PPO plans for senior enrollment during AEP and on Stars-driven quality positioning.
• Blue Cross and Blue Shield of Texas: BCBS Texas is the incumbent statewide carrier and competes with BSWHP across PPO/HMO individual, employer group, and Medicare Advantage segments with deeper brand recognition and broader provider networks.
• Centene Corporation:

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/bswhealthplan

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries3 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Baylor Scott & White Health Plan