Compliance, Privacy & Legal Notices

We've gathered our compliance and legal information in one place for you to access. Here you'll find policies governing the use of this website, information about the Health Insurance Portability and Accountability Act (HIPAA), privacy, non-discrimination, language assistance, security and more.

About Our Plans

Our Health Maintenance Organization (HMO) products are offered through Scott and White Health Plan dba Baylor Scott & White Health Plan, and Scott & White Care Plans dba Baylor Scott & White Care Plan. Insured PPO and EPO products are offered through Baylor Scott & White Insurance Company. Scott and White Health Plan dba Baylor Scott & White Health Plan serves as a third-party administrator for self-funded employer-sponsored plans. Baylor Scott & White Care Plan and Baylor Scott & White Insurance Company are wholly owned subsidiaries of Scott and White Health Plan. These companies are referred to collectively in this section of the website as Baylor Scott & White Health Plan ("BSWHP").

When "Plan" is mentioned, this is referring to BSWHP.

Fraud and Abuse Concerns

Fraud is knowingly and willfully executing, or attempting to execute, a scheme to obtain financial or personal gain (Example: billing for services not provided). The term does not include unintentional technical, clerical or administrative errors.

Abuse is any action that may result in one or more of the following: unnecessary costs to the healthcare system, improper payment for services, payment for services that fail to meet professionally recognized standards of care and services that not medically necessary (Example: billing excessive charges for services or supplies).

Fraud Protection and Prevention

The Plan’s Special Investigations Unit (SIU) utilizes fraud detection software for medical and prescription claims, investigates any suspicious claims and reviews concerns from members and other sources regarding possible fraud and abuse.

Common concerns from members are suspicious phone calls and bills for services not received.

Suspicious Phone Calls

Example: You receive a call from someone claiming to be from the Plan and they ask for personal information like your social security number or financial information.

If you suspect a call may be a scam, do not give any personal or financial information.

Here are a few ways you can protect yourself against future calls:

• Enroll in the National Do Not Call Registry – donotcall.gov or 888.382.1222
• Enroll in the Texas Do Not Call list – TexasNoCall.com
• Report these numbers as suspected scam – texasattorneygeneral.gov (under Consumer Protection section of the website) or call 800.621.0508
• Report these numbers to the Federal Trade Commission – reportfraud.ftc.gov or 877.382.4357

Bills for Services You Did Not Receive

Example: You see a service on your Explanation of Benefits (EOB) or get a bill for something you did not receive.

If you receive a bill for services you do not recognize, it is best to contact your provider first. It may be a simple error that can be easily corrected. If you still suspect fraudulent activity after speaking with your provider, you can contact the Plan using one of the following:

HelpLine
The HelpLine is a confidential means of reporting.

Compliance Officer

You may also contact the Texas Department of Insurance (TDI) using one of the following:

Here are a few ways you can identify services billed to the Plan:

• Review your Health Plan Explanation of Benefits (EOB) to ensure accurate dates of service, name(s) of providers and services billed.
• Review bills and EOBs on the MyBSWHealth app: App Store | Google Play.

Potential Schemes Related to COVID-19

Scammers are using telemarketing, text messages and 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 and abuse schemes:

• Never share information with unknown individuals. This should include date of birth, social security number, Medicaid or Medicare numbers, healthcare details, financial or other personal identifiable information. Sharing this type of information can lead to identity theft.
• Review your explanation of benefits (EOB) or claims/billing information in 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 the plan HelpLine: 888.484.6977

Delegated entities (Delegates) otherwise known as Vendors, Subcontractors and First Tier, Downstream and Related Entities (FDRs)

This page provides education, important links and resources to guide our Delegated Entities through Compliance Program requirements.

Baylor Scott & White Health Plan (BSWHP) and its wholly owned subsidiaries maintain a process to monitor delegated functions and responsibilities so that we are able to validate compliance with Federal and State laws, as well as contractual regulations. Guidelines indicate that vendors, subcontractors and delegated entities (delegates), including First Tier, Downstream and Related Entities (FDRs) who partner with us should follow the same compliance guidelines as BSWHP while working on BSWHP business.

The Why

Our organization is responsible for fulfilling the terms and conditions of our contracts with Federal and State agencies. The Centers for Medicare and Medicaid Services (CMS) and Federal and State regulators ultimately hold us responsible for delegate activities and performance. Our Delegates are also responsible for complying with these requirements and must ensure their Downstream Entities comply with such applicable laws and regulations.

The How

Code of Conduct

Adopt our organization’s Code of Conduct or distribute your own to your employees within 90 days of hire and annually thereafter, or when the Code of Conduct is updated. Our Code of Conduct is designed to promote honest, ethical, and lawful conduct by employees, officers, directors, Delegates, including agents and brokers. These standards of conduct should clearly define expectations of professional behavior.

• Include the expectation that employees and Delegates act in an ethical and compliant manner.
• Ramifications of failure to comply with applicable statutory and regulatory requirements.
• Encourage employees and Delegates to report violations of the law and policies, including providing guidance on how reporting can occur.

Training and Education

Delegates are expected to make sure that applicable employees of the entity receive General Compliance and Fraud, Waste and Abuse (FWA) education, either through the entity’s processes or through training materials provided by a regulatory agency. Training should occur within 90 days of hire or contracting and annually thereafter.

Training programs are expected to meet the following requirements.

• Education will include general compliance information, FWA and HIPAA training materials.
• FWA training includes the risks associated with the function being performed by the Delegate.
• Training is provided to Delegates' employees who have involvement in the administration or delivery of benefits on behalf of our organization.
• Training materials should be reviewed and revised, as appropriate, no less than annually and whenever there are material changes in regulations, policy or guidance.
• Training is documented and maintained appropriately, including training materials, sign-in sheets, certificates of completion, test results, etc.
• Delegates will attest to meeting these training requirements as part of the Annual Attestation.

Exclusion and Identity Screening

Delegates must, at a minimum, utilize the following government sources to screen their employees and Downstream Entities prior to hire or contract and monthly thereafter. Regulators prohibit our organization from hiring, employing or making payments to any person or entity excluded or debarred from Federal or State healthcare programs: Our Delegates are paid in whole or in part from Federal funds.

• Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE)
• System for Awards Management (SAM), formerly the Excluded Parties List System (EPLS)
• Texas State Level Excluded Parties Lists
• Office of Personnel Management (OPM) Debarment
• Office of Foreign Assets Control (OFAC) Specially Designated Nationals (SDN) and Bureau of Industry and Security (BIS) consolidated lists (USA Patriot Act)
• Social Security Administration Death Master File (SSA-DMF) (MEDICAID Delegates ONLY)
• National Plan and Provider Enumeration System (NPPES)
• Centers for Medicare and Medicaid Services (CMS) Preclusion List (MEDICARE ADVANTAGE Delegates ONLY)

Helpful Links

• Code of Conduct
• exclusions.oig.hhs.gov
• oig.hhs.gov/exclusions/exclusions_list.asp
• sam.gov
• oig.hhsc.state.tx.us/oigportal2/Exclusions
• home.treasury.gov/policy-issues/financial-sanctions/sanctions-list-search-tool
• ssa.gov/dataexchange/request_dmf.html
• npiregistry.cms.hhs.gov

Compliance Concerns and FWA Reporting Mechanisms

Our organization has designated a Compliance & Ethics HelpLine as a confidential and secure reporting mechanism. Delegates are encouraged to report potential Compliance or FWA concerns to our organization without fear of retaliation. Delegates are encouraged to have such reporting mechanisms for their employees and delegates.

Audit and Monitoring

Delegates must perform routine monitoring of delegated functions. Monitoring activities include using performance-based metrics, or scorecards, that are repeatedly measured in the normal course of operations. Results over time may identify systemic issues that require corrective action. Delegates are responsible for providing monitoring results that impact our organization on an ongoing basis.

Areas of focus can include but are not limited to:

• Risks identified through Delegate’s risk assessment process
• Operational performance standards
• Delegate and Downstream service levels
• Complaint rates and trends
• Quality measures
• Industry best practices
• Risks identified through FWA, Compliance and Ethics Helpline

Such monitoring efforts enable our organization to detect failures in the Compliance Program, recommend or require corrective action plans, and confirm corrective actions result in ongoing compliance.

Communication and Regulatory Change Management

Delegates are expected to adhere to regulatory and program changes received from Federal and State agencies, including but not limited to CMS HPMS and Qualified Health Plan (QHP) memos, fraud alerts, and policy updates, as applicable. Any changes or concerns related to such updates must be reported to our organization immediately.

Annual Attestation

Our organization requires an Annual Attestation of compliance from its Delegates. At a minimum, the Delegate attests to meeting all requirements outlined above. Signed attestations (digital signatures acceptable) following the completion of a contract year should be emailed to HPCompliance@BSWHealth.org.

Terms of Use

We are delighted to welcome you to Baylor Scott & White Health Plan (“BSWHP”, “we” or “us”). Our websites and services are provided to visitors and members (“you,” or “visitor”), conditioned upon their acceptance, without modification, of the terms, conditions and notices contained or identified herein (“Terms”).

Your use of these websites and services constitutes your acceptance and agreement to all such Terms. If you do not agree to the Terms, you may not access or otherwise use the websites or services.

We retain the right, at our sole discretion, to deny access to the services and websites, to anyone, at any time and for any reason, including but not limited to, for violation of these Terms.

1. Special Notice Regarding Dispute Resolution

These Terms contain provisions that govern how legal claims you and BSWHP may have against each other are resolved (see Section 16 below), including an agreement and obligation to arbitrate disputes, which, subject to limited exceptions, will require you to submit claims you have against us to binding arbitration, unless you opt out in accordance with Section 16(E).

Unless you opt out of arbitration: (a) you will only be permitted to pursue legal claims against us on an individual basis, not as part of any class or representative action or proceeding; and (b) you will only be permitted to seek relief (including monetary, injunctive, and declaratory relief) on an individual basis.

2. Definitions

• "Content" means the webpages, data, messages, text, images, photographs, graphics, audio or video recordings, product descriptions, pricing and other information or material available from or through the Platform.
• "Intellectual Property Right" means copyright, patent, trademark, trade secrets and all other intellectual property rights, including moral rights.
• "Member" means an individual who is allowed to access a Self-Service portal.
• "Partner" includes any sponsor, advertiser, supplier, service provider, licensor and/or other entity that contributes to, or provides services for, the development, financing, and operation of the Platform.
• "Platform" means all Content, Services, Site, Social Media, Self-Service Portal, and software or other technologies underlying the operation of the Site or the Services.
• "Self-Service Portal" means an area of the Platform that may be accessed only by Members. Access to a Self-Service Portal requires a valid and current username and a password.
• "Services" means the social media, blogs, messaging, and other functionalities or services available from or through the Platform, and in connection with which a visitor can upload, download, post, publish, transmit, access, make available, or share Content with BSWHP or with others.
• "Site" means the website located at BSWHealthPlan.com and, in the case of Members, the Self-Service Portal.
• "Social Media" means the Baylor Scott & White Health Plan presence on social media, including but not limited to Facebook, Twitter or LinkedIn.
• "Submission" means any information, comment, rating, data, message, text, image, photograph or similar material submitted to, or uploaded to any part of the Platform by any visitor. Health insurance claims and other similar materials that are submitted as confidential or private materials in furtherance of the Services provided by BSWHP to a Member are not deemed “submissions” for the purpose of these Terms.
• "Visitor" means any Members, agents, employers, providers and the public or other person who is able to access any part of the Platform other than the Self-Service Portals.

BSWHP may make improvements and/or changes on the Platform at any time. All definitions above are intended to apply to the then-current version of the Platform.

3. Modifications

BSWHP may change, suspend or discontinue any aspect of the Platform, terminate or suspend the availability of any feature, database or content at any time without notice. We may also impose limits on certain features and services or restrict access to parts or all of the Platform without notice or liability.

These Terms may be modified from time to time. BSWHP will post a notice of such changes on the Platform in accordance with applicable laws. The revised Terms will be effective as indicated in the notice.

CONTINUED USE OF THE PLATFORM AFTER MODIFIED TERMS HAVE BECOME EFFECTIVE WILL INDICATE YOUR AGREEMENT TO BE BOUND BY THE MODIFIED TERMS WITH RESPECT TO ALL DATA THEN IN OUR CUSTODY OR CONTROL.

Certain provisions of these Terms may be superseded by expressly designated terms located on particular pages of the Platform. In such circumstances, the expressly designated legal notice or term will be deemed to be incorporated into these Terms and to supersede those provision(s) of these Terms that are designated as being superseded for the particular type of activity or for all activities.

4. Minors May Not Use the Platform

As a condition of your use of the Platform, you warrant that you are not a “minor” as such term is defined in your state or country of residence, and that you possess the legal authority to enter into a binding legal contract.

5. Access to the Platform

A. Ownership; Reservation of Rights

Unless otherwise stated in these Terms, as between you and BSWHP, the Platform (including its structure and arrangement) is BSWHP's sole property. BSWHP and its Partners retain all rights, title and interest in the Platform, including all Intellectual Property Rights therein.

Except as otherwise required or limited by applicable law, any reproduction, distribution, modification, public display, public performance, retransmission, or publication of any part of the Platform is strictly prohibited without BSWHP’s express written consent.

B. License and Use Limitations

BSWHP grants each visitor a limited, personal, non-exclusive, non-transferable, non-sublicensable license to access and use the Platform only to the extent that the visitor complies with all provisions of these Terms. BSWHP reserves all other rights or licenses not expressly granted.

The license granted to the visitors of the Platform who are not “Members” is limited to access to the general audience website and does not include the use of the Self-Service Portal.

The Platform is provided for each visitor’s personal and non-commercial use. You may use, access, download, store, display on your device (computer, smart phone, tablet), view, listen to, play, share and print any Content that is made available on or through the Platform, only for your personal, informational, noncommercial purposes and subject to the following:

You may not modify, copy, distribute, transmit, display, perform, reproduce, publish, license, create derivative works from, transfer or sell any information, software, products or services obtained from this Platform, except as follows:

• You may not modify, copy, distribute, transmit, display, perform, reproduce, publish, license, create derivative works from, transfer or sell any information, software, products or services obtained from this Platform, except as follows:
• You may download and make copies of the Content and other downloadable items displayed on the Platform for personal, non-commercial use only, provided that you maintain all copyrights, trademark and other notices contained in such Content. Copying or storing of any Content for other than personal, non-commercial use is expressly prohibited without prior written permission from BSWHP, or the copyright holder identified in this individual Content copyright notice.
• You may not harvest, collect, use, or store information about other visitors;
• You may not reproduce, redistribute, modify or alter any aspect of the Platform;
• You may not create derivative works of, reverse engineer, or exploit any aspect of the Platform;
• You may not use the Platform for any purpose that is unlawful or prohibited by these Terms;
• In any permitted copy of the Content, you must conspicuously display all BSWHP’s (or BSWHP’s Partners') copyright or other Intellectual Property Right notices as they appear on the Platform;
• You may not remove, deface, or overprint any logo, any copyright or trademark notice, or other notice of ownership from any originals or copies of the Platform or any third party’s material that you access on or through the Platform.

6. Self-Service Portals

A. Terms Applicable to the Self-Service Portals

Access to, or use of, any Self-Service Portal may be subject to additional rules, guidelines, license agreements, user agreements or other terms and conditions (collectively “Special Terms”). You agree to these Special Terms when using the particular elements of the Platform to which these Special Terms pertain. These Special Terms (to the extent that they apply to a specific visitor) are incorporated into these Terms by this reference, when applied to that visitor. If there is a conflict or inconsistency between the Special Terms for a specific area of the Platform and the remainder of these Terms, the Special Terms will have precedence with respect to access and use of that area of the Platform.

B. User ID and Passwords

Access to the Self-Service Portal requires the use of a password and a username. As a condition of your use of the Self-Service Portal, you agree that:

• You are responsible for maintaining the confidentiality of your username and password;
• You will not share your username and/or password, or provide access to the Platform to any other person;
• You are responsible for all activities that occur through the use of your username and password; and
• You will notify BSWHP immediately of any use of your username or password(s) or account information that you did not authorize or that is not authorized by these Terms.

We reserve the right to require that you change your password or restrict your access to the Platform as we deem reasonably necessary.

C. Self-Service Portal Functionality

Self-Service Portal Members have the ability to access a variety of services through their member account. BSWHP may change, suspend or discontinue any of the services at any time. BSWHP may also impose limits on the use of, or access to, certain features or portions of the Platform, in any case without notice or liability.

Some services offered on the Self-Service Portal may include cost estimators, provider reviews, quality data, health and wellness information, and/or medical terms/definitions. This information is provided for general comparison or information only. This information may change from time to time, including for reasons outside the control of BSWHP.

In some cases, BSWHP may not have received the latest update. Therefore, BSWHP cannot guarantee that the information displayed on the Self-Service Portal will always be complete, accurate or up-to-date, or that it reflects the actual cost, quality, procedure, or insurance coverage related to the particular medical service(s) or providers researched. Nor does BSWHP, by providing access to such services, guarantee that the medical conditions or services researched will be "Covered Services" as that term is defined under your specific benefits agreement with BSWHP.

Information and services accessed through your Member account is not a substitute for the medical advice of your physician and/or provider. The information on the Platform, including but not limited to any Content provided, including any comparison data, is for informational and educational purposes only, and is not intended as a substitute for medical professional help, advice, diagnosis or treatment.

Information on the Platform is not provided in the course of a professional relationship between a healthcare provider and a patient and is not intended to create any physician-patient relationship, nor should it be considered a replacement for consultation with a healthcare professional. You always should seek the advice of your physician or another competent medical professional to address any questions or concerns you may have regarding your medical care.

D. Errors, Pricing & Ratings

We do not guarantee the accuracy of any part of the Platform. We reserve the right to correct any error, including any pricing errors on the Platform. If you have made a purchase under an incorrect price, we will offer you the opportunity to keep your purchase at the correct price or we will cancel your purchase without penalty.

Product ratings displayed on the Platform are intended as only general guidelines; we do not guarantee the accuracy of the rating.

E. No Confidentiality

If you wish to transmit any information that you consider confidential to you or your household (for example, personal health information or financial information), you should use only those means that BSWHP makes available to you for such purpose. This includes only the (a) online forms posted on BSWHP website, (b) Self-service portal and (c) BSWHP direct enrollment portal.

Except for the receipt of information transmitted through our online forms, service portal or direct enrollment portal, BSWHP does not want to receive confidential information from any user, Registered User or any third party, through or in connection with any part of the Platform.

Notwithstanding anything that you may note or state when sharing your Submissions, any Submission will be received and treated as non-confidential and unrestricted.
We do not make any representation that any means of communication with BSWHP other than those specifically identified by BSWHP (online questionnaires, service portal or direct enrollment) are confidential or secure. For example, any posting on social media is likely to be shared with other visitors of the social media platform.

BSWHP WILL NOT TAKE, AND WILL NOT BE REQUIRED TO TAKE, ANY STEPS TO SAFEGUARD THE CONFIDENTIALITY OF ANY INFORMATION THAT YOU SHARE THROUGH MEANS OTHER THAN AS SPECIFIED IN BSWHP'S PRIVACY POLICY.

7. Warranties, Liability & Damages

A. Disclaimer of Warranty

BSWHP reserves the right to change the Platform at any time, at its discretion. The Platform is in constant evolution and is modified, adapted, reformatted or rewritten with very limited time for testing or quality assurance. There may be errors, omissions, deficiencies or inconsistencies. Your use of the Platform is at your own discretion and risk.

We disclaim any warranty that (a) the Platform is free of viruses or other harmful component: (b) the Platform will meet your requirements; (c) the Platform will be available without interruptions, will be timely, secure, or error-free; (d) defects will be corrected; (e) the results that may be obtained from the use of the Platform will be accurate or reliable; or (f) the quality of any Content or Service will meet your expectations.

THE PLATFORM AND THE SUBMISSIONS ARE PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS AND WITHOUT ANY WARRANTY OF ANY KIND, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, AND ALL WARRANTIES, INCLUDING WITHOUT LIMITATION IMPLIED WARRANTIES, CONDITIONS OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE AND NON-INFRINGEMENT, ARE EXPRESSLY DISCLAIMED.

BSWHP MAKES NO REPRESENTATION ABOUT THE SUITABILITY OF THE CONTENT, INFORMATION, SOFTWARE, MATERIALS, PRODUCTS OR SERVICES CONTAINED OR DISCUSSED ON THIS PLATFORM FOR ANY PURPOSE.

BSWHP DOES NOT REPRESENT OR ENDORSE THE ADVICE, OPINION, STATEMENT OR OTHER INFORMATION DISPLAYED OR DISTRIBUTED THROUGH THE PLATFORM. YOU ACKNOWLEDGE THAT ANY RELIANCE UPON SUCH CONTENT, OPINION, ADVICE, STATEMENT OR INFORMATION SHALL BE AT YOUR SOLE RISK.

BSWHP RESERVES THE RIGHT, IN ITS SOLE DISCRETION, TO CORRECT ANY ERRORS OR OMISSIONS IN ANY PORTION OF THE PLATFORM.

B. User and Third-Party Submissions

Submissions posted on the Platform have been developed by visitors. These visitors are independent entities, and are not our agents or representatives. The inclusion of any Submission on the Platform does not constitute any endorsement or recommendation of the visitor or his/her submission.

THE SUBMISSIONS ARE PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS, AS A CONVENIENCE TO VISITORS, AND WITHOUT ANY WARRANTY OF ANY KIND.

BSWHP DOES NOT AND CANNOT REVIEW ALL SUBMISSIONS OR THE RESPONSES TO THESE SUBMISSIONS, AND BSWHP IS NOT RESPONSIBLE FOR ANY SUCH SUBMISSIONS OR RESPONSES.

BSWHP RESERVES THE RIGHT AT ALL TIMES TO DISCLOSE ANY SUBMISSION, INFORMATION, OR MATERIALS, AS NECESSARY TO SATISFY ANY LAW, REGULATION OR GOVERNMENT REQUEST, OR TO EDIT, REFUSE TO POST OR TO REMOVE ANY SUBMISSION, INFORMATION OR MATERIALS, IN WHOLE OR IN PART, THAT IN ITS SOLE DISCRETION IT BELIEVES ARE OBJECTIONABLE OR IN VIOLATION OF THESE TERMS.

C. Disclaimer of Liability

BSWHP disclaims any liability for the acts, errors, omissions, representations, warranties, breaches or negligence caused by or related to any Submissions shared by visitors.

BSWHP disclaims any liability for the acts, errors, omissions, representations, warranties, breaches or negligence caused by or related to any Content or any other aspect of the Platform, or any Submission, and any liability for any damage to any device or network, or for loss of data that may result from access to, or use of any part of the Platform.

Information published on the Platform may refer to products, programs, or services that are not available in your region.

D. Limitation of Damages

IN NO EVENT SHALL BSWHP, ITS PARTNERS AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, OR AGENTS (COLLECTIVELY, "BSWHP PARTIES") BE LIABLE FOR ANY DIRECT, INDIRECT, PUNITIVE, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE PLATFORM, OR WITH ANY SUBMISSION, DELAY, USE OR INABILITY TO USE THE PLATFORM, OR FOR ANY INFORMATION, MATERIALS, SOFTWARE, PRODUCTS AND SERVICES OBTAINED THROUGH THE PLATFORM, OR OTHERWISE ARISING OUT OF THE USE OF THIS PLATFORM FOR ANY PRODUCTS OR SERVICES OR HYPERTEXT LINKS TO THIRD PARTIES OR FOR ANY BREACH OF SECURITY ASSOCIATED WITH THE TRANSMISSION OF ANY INFORMATION THROUGH THE PLATFORM OR ANY LINKED PLATFORM. WHETHER BASED ON CONTRACT, TORT, STRICT LIABILITY OR OTHERWISE, EVEN IF BSWHP HAS BEEN ADVISED OR THE POSSIBILITY OF DAMAGES.

IF, NOTWITHSTANDING THE LIMITATION ABOVE, BSWHP IS FOUND LIABLE UNDER THESE TERMS, IN NO EVENT SHALL SUCH LIABILITY EXCEED $10 PER VISITOR, AND IN THE CASE OF MEMBERS, THE SUMS PAID BY THE MEMBER FOR THE BSWHP SERVICE DURING THE SIX-MONTH PERIOD PRECEDING THE EVENT THAT CAUSED THE DAMAGES.

E. Exclusions and Limitations

Some jurisdictions do not allow the disclaimer or exclusion of certain warranties or the disclaimer, exclusion or limitation of certain liabilities, therefore, some of the above limitations may not apply to you. To the extent that they are held to be legally invalid, disclaimers, exclusions and limitations set forth in these Terms, including those set forth in sections “Disclaimer of Warranty” and “Limitation of Liability” do not apply and all other provisions shall remain in full force and effect.

To the extent, the BSWHP Parties may not, as a matter of applicable law, disclaim any implied warranty or limit its liabilities, the scope and duration of such warranty and the amount of the BSWHP Party's liability shall be limited to the minimum amount permitted under such applicable law.

8. Visitors' Obligations

A. No Unlawful or Prohibited Use

As a condition of your use of this Platform, you warrant and represent to BSWHP that you will not use this Platform for any purpose that is unlawful, violates any third party's rights, or is prohibited by these terms, conditions and notices.

B. Visitors' Security Obligations

We use reasonable technical, physical and other measures to protect the availability and integrity of the Platform.

We expect you to use the Platform responsibly. Among other things, you agree not to:

• Access or use the Platform in any manner that could damage, disable, overburden or impair any of the computer systems, networks or databases that form or operate the Platform;
• Attempt to gain access to any Member accounts or any parts of the Platform, or its computer systems, networks or databases or other than your Member account;
• Interfere or attempt to interfere with the proper working of any Member account or the Platform or its computer systems, networks or databases;
• Use any robot, spider, scraper or other automated means to access any Member account or the Platform or its computer systems, networks or database.

You agree to notify BSWHP immediately of any unauthorized use of your account or password, or any other breach of security.

C. Self-Service Portals, Accounts & Passwords

Certain features or services, such as the Self-Service Portal, may require you to open an account (including setting up a password to access your Member account).

You are entirely responsible for maintaining the confidentiality of the information necessary to access your Member account, including your password, and for any and all activities that occur under your Member account as a result of your failure to keep this information secure and confidential.

D. Submissions

Certain areas of the Platform may permit visitors to submit, send or upload Submissions. We have no obligation to accept, host, publish, display or distribute any Submission on or through the Platform. We accept no responsibility or liability with respect to any Submission.

By sharing a Submission through the Platform, you agree that:

• You are solely responsible for your Submission;
• Your Submission is considered non-confidential;
• You are providing information voluntarily, with no expectation of compensation;
• BSWHP may use, modify, reproduce, and/or distribute any Submission in whole or in part for its own business purposes without payment to you, and in accordance with applicable law.

E. Submission License Grant

By sharing a Submission through the Platform, you grant BSWHP on your behalf and on behalf of any person who might have any Intellectual Property Rights in your Submission, an irrevocable, perpetual, worldwide, royalty-free, nonexclusive, transferable, fully sublicensable, license to do any of the following (“License”) for any purpose, including, without limitation for commercial purposes, and in any manner, that BSWHP deems appropriate, to:

• Use, reproduce, modify, adapt, translate, publish, publicly perform, publicly display, broadcast, transmit, share and distribute the Submission (or any modification thereto), in whole or in part, in any form, medium or technology now known or later developed;
• Incorporate the Submission or any modification thereto, in whole or in part, into any material, technology, product or service that BSWHP subsequently distributes, sells or licenses to third parties;
• Display advertisements in connection with the Submission or use the Submission for advertising and promotional purposes.

F. Warranties Regarding Submissions

By sharing your Submission through the Platform, you represent and warrant that:

• You own all right, title, and interest, including all Intellectual Property Rights, in and to the Submission or, alternatively, you have acquired all necessary rights to enable you to grant to BSWHP the rights in your Submission as described in these Terms;
• You have the right and authority to grant the License;
• Your Submission does not violate any law, including, without limitation, those governing export control, consumer protection, unfair competition, anti-discrimination, or false advertising, and does not infringe the Intellectual Property Rights or privacy rights or other legal rights of any third party;
• The exercise by BSWHP of the rights granted pursuant to the License will not infringe or otherwise violate any third-party rights;
• You have paid and will pay in full all license fees, clearance fees, and other financial obligations, of any kind, if any, arising from any use or commercial exploitation of your Submission;
• You are the individual pictured and/or heard in your Submission or, alternatively, you have obtained permission from each person (including consent from parents or guardians for any individual who is deemed a minor under applicable law) who appears and/or is heard in your Submission, to grant the rights to BSWHP as described in these Terms;
• You are not aware and have not been informed that any information contained in the Submission is false, inaccurate, or misleading;
• Your Submission does not violate our Acceptable Use Policy (set forth below in the “Acceptable Use” Section);
• Your Submission does not incorporate material from a third-party’s website, or addresses, email addresses, contact information, or phone numbers of any person (other than your own);
• Your Submission does not contain any viruses, worms, spyware, adware, or other potentially damaging programs or files;
• You were not and will not be compensated or granted any similar consideration by any third party for submitting the Submission; and
• Your Submission does not contain or constitute any unsolicited or unauthorized advertising, promotional material, junk mail, spam, chain letters, pyramid schemes, or any other form of solicitation.

9. Acceptable Use & Removal

A. Acceptable Use

Visitors are not permitted to upload, post, transmit, distribute or publish through the Platform any Submissions that

• Restrict or inhibit any other visitor from using and enjoying the Platform;
• Are unlawful, misleading, harassing, threatening, intimidating, abusive, libelous, defamatory, obscene, vulgar, offensive, pornographic, profane, sexually explicit or indecent;
• Promote bigotry, hatred or harm against any group or individual, or is racially, ethnically, religiously, or otherwise discriminatory, biased or offensive;
• Constitute or encourage conduct that would constitute a criminal offense, give rise to civil liability or otherwise violate law,
• Violate, plagiarize or infringe the rights of third parties including, without limitation, Intellectual Property Rights, rights of privacy or publicity;
• Contain personal information of a third party;
• Contain confidential or sensitive of information or trade secrets of another person or entity;
• Contain viruses, worms, corrupted files or other harmful component designed to limit or harm the functionality of a computer;
• Contain any information, software or other material of a commercial nature;
• Constitute unsolicited commercial message, contain advertising of any kind or offers to sell personal goods, products or services;
• For which you do not have the right and authority to share or to grant the necessary rights and licenses granted under these Terms;
• Contain a solicitation of funds, goods or services;
• Are false or misleading; or constitute or contain false or misleading indications of origin or statements of fact.

B. Monitoring

BSWHP reserves the right, but does not undertake the obligation to pre-screen any Submission or monitor any area of the Platform through which Submissions may be submitted and may, in its sole discretion, refuse any Submission for any reason.

C. Removal and Blocking

BSWHP may remove or block access to any Submission if it determines, in its sole discretion, that the Submission violates these Terms, and in addition to any other rights it has under these Terms, may report you, the author of the Submission to the relevant authorities; and/or act to the fullest extent of applicable laws.

10. Electronic Communications & Links

A. Electronic Communications

When you visit the Platform, or send electronic communications to BSWHP, you are communicating with BSWHP electronically as defined by applicable laws. We may respond to you by email or by posting notices on the Platform. If you have made a comment or asked a question, we will respond in the same way as you communicated with us. You agree that all such notices, disclosures, and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.

B. Links to Third-Party Websites

BSWHP has selected links to third-party websites for your convenience. We do this because we think this information might be of interest or use to you or where, as a Member, we can provide you with value-added services. BSWHP disclaims all liability for use of the third-party site. BSWHP does not monitor or review the content of these sites.

Each site has its own terms and conditions and is responsible for the quality of its content. If you choose to visit these sites, you should read the editorial review policies of these sites to understand how these sites handle their content review. For additional security and protection, you should log off and close all browser(s) associated with your Member account and affiliated third parties when you leave your computer. You are responsible for reviewing the privacy practices of any web site you visit.

C. Linking to the Platform

We allow visitors to create links to the Platform from other websites. Unless an express agreement states otherwise, you must comply with the following terms and all applicable laws if you provide anyone with a link to the Platform:

• You may link to, but may not copy, frame, or create a browser or border environment around the Platform or any part thereof;
• You may only use and reproduce the BSWHP trademarks if you follow our trademark usage policy provided in these Terms;
• You may not imply that BSWHP endorses or is affiliated with any third-party website or any products, services, or content available through that website;
• You may not misrepresent your relationship with BSWHP;
• You may not present false or misleading information about BSWHP, its Platform or any Content, product or services available through the Platform;
• The website must meet the requirements of our Acceptable Use Policy; and
• The website must contain only material that is appropriate for all age groups.

11. Privacy and Monitoring

A. Privacy

These Terms incorporate by this reference the then-current version of BSWHP’s Information Collection and Use policy which applies to the personal information collected from visitors of the Platform, and the Notice of Privacy Practices, which applies to the personal information collected from Members when they use the Self-Service Portals. By using the Platform and/or Self-Service Portals, you consent to the use of your personal information by BSWHP and/or its Partners in accordance with the terms of and for the purposes set forth in the BSWHP Information Collection and Use policy and the Notice of Privacy Practices.

B. Monitoring

BSWHP may monitor your use of this Platform, and subject to BSWHP's Information Collection and Use policy, BSWHP may freely use and disclose any information and materials received from you or collected through your use of this Platform for any lawful reason or purpose as set forth in BSWHP’s Information Collection and Use document.

12. Your Indemnification Responsibilities

You hereby agree to indemnify, defend and hold BSWHP, and all its officers, directors, owners, agents, employees, information providers, affiliates, licensors and licensees (collectively, the "Indemnified Parties") harmless from and against any and all liability and costs incurred by the Indemnified Parties in connection with any claim (including, without limitation, attorney’s fees and costs) arising out of (i) the use of the Platform; (ii) any breach of these Terms, (iii) the violation or infringement of any third party’s Intellectual Property Rights, privacy rights, or any other legal rights, by you or by any person whom you allow (directly or indirectly) to access any Self-Service Area.

You shall cooperate as fully as reasonably required in the defense of any such claim. BSWHP reserves the right, at its own expense, to assume the exclusive defense and control of any matter otherwise subject to indemnification by you, and you shall not in any event settle any matter without the written consent of BSWHP.

13. BSWHP Social Media Terms of Use

The purpose of the BSWHP Social Media sites is to share up-to-date information with visitors. The BSWHP Social Media services allows us to share health plan information and wellness tips, providing updated information that is important to all of our customers—members, groups, providers, brokers and even the public. We are also providing an opportunity for you to share your questions, experiences and feedback regarding BSWHP. We appreciate visitor feedback.

A. Submissions

In addition to the rules regarding Submissions provided elsewhere in these Terms of Use, the following rules apply.

All Submissions made on or through BSWHP’s social media sites do not reflect the opinions, policies and/or ideas of BSWHP and/or its employees, officers, and directors. BSWHP accepts no responsibility for these Submissions, and does not endorse these Submissions.

Visitors of our Social Media sites should not post, upload or attach Submissions that contain personal health information, financial and/or other private information of any person or entity.

B. Removal

BSWHP may monitor Submissions posted on its social media sites, but does not have the obligation to do so. BSWHP reserves the right, in its sole discretion, to remove such Submissions, at any time, for any reason including if BSWHP deems such Submissions inappropriate.

C. Information for General Purposes

The information provided by BSWHP on its social media sites is not intended to be used for medical advice, diagnosis or treatment.

YOU SHOULD ALWAYS SEEK THE ADVICE OF A QUALIFIED HEALTHCARE PROFESSIONAL FOR ANY QUESTION REGARDING PERSONAL HEALTH OR MEDICAL CONDITIONS.

Do not rely on anything you have read on BSWHP’s social media pages in deciding to seek or obtain medical advice, even if the person who posted the information claims to be a healthcare professional or otherwise. For issues related to health insurance claims, please contact BSWHP Customer Service, using the number on the back of your ID card. BSWHP social media is not intended as a customer response/service site.

14. Intellectual Property Rights

A. BSWHP Intellectual Property Rights

Baylor Scott & White Health Plan owns all right, title and interest, including the copyright to this Platform as a compilation of third parties’ content.

We grant each visitor a limited, conditional, no-cost, non-exclusive, non-transferable, non-sub-licensable license to view and use the Platform as permitted by these Terms for noncommercial purposes. All rights not expressly granted are reserved.

Each visitor may make a single copy of the Content for non-commercial, archival or backup purposes, but must include all copyright, trademark and other intellectual property notices on all such copies.

This license is expressly conditioned on the visitor’s compliance with each of the provisions of these Terms. Your rights under these Terms will automatically terminate if you breach any of your material obligations under these Terms.

B. Trademarks

Baylor Scott & White Health Plan is a trade name of Scott and White Health Plan. Scott and White Health Plan has rights in this and other registered and unregistered trademarks, logos, and service marks (“BSWHP Trademarks”). Other names appearing on the Platform may be trademarks of their respective owners.

You may use the BSWHP Trademarks in text to refer fairly and accurately to BSWHP, its products and services; however, the BSWHP logos may not be used without our prior written permission. Any use of the BSWHP Trademarks that is likely to confuse or mislead the public is unlawful and expressly prohibited. You may not use the BSWHP Trademarks in anyway without our prior written permission.

C. Third Parties' Claims of Copyright Infringement

We respect the intellectual property rights of others, and we ask our employees, agents, officers and other third parties using our Platform do the same.

If you believe that your copyrighted work has been copied and is accessible on or from our Platform in a way that constitutes copyright infringement, please send a Notice to our Copyright Agent, providing the following information:

• The electronic or physical signature of the owner of the copyright or the person authorized to act on the owner's behalf
• A description of the copyrighted work that you claim has been infringed and a description of the infringing activity
• A description of where the material that you claim is infringing is located, such as the URL where it is posted
• Your name, address, telephone number and email address
• A statement by you that you have a good faith belief that the disputed use of the material is not authorized by the copyright owner, its agent or the law
• A statement by you, made under penalty of perjury, that the above information in your Notice is accurate and that you are the copyright owner or are authorized to act on the copyright owner's behalf

Our Copyright Agent for receiving notices of claims of copyright infringement can be reached at the following address. Please note that this contact information is to be used solely for reporting copyright infringement:

15. Termination of Use

At any time and in its sole discretion, BSWHP may, without prior notice, and for any reason discontinue providing or limit access to any or all areas of the Platform; or terminate, limit, block or suspend a visitor’s access to, or use of, the Platform.

BSWHP will not be liable to any visitor or any third party for any termination or limitation of the visitor’s access to, or use of, the Platform, or for the removal of any of the visitor’s Submission(s).

The termination of a visitor’s access to the Platform will result in the termination of any right or license granted to the visitor with respect to the Platform, and the visitor must immediately destroy any downloaded or printed Content or third party’s Submissions, and any copies thereof.

These Terms will remain in full force and effect notwithstanding any termination of your use of the Platform.

16. Legal Disputes & Arbitration Agreement

PLEASE READ THE FOLLOWING CLAUSE CAREFULLY
IT MAY SIGNIFICANTLY AFFECT YOUR LEGAL RIGHTS
INCLUDING YOUR RIGHT TO FILE A LAWSUIT IN COURT

A. Initial Dispute Resolution

We are available by email as indicated in the “Contact Information” section below, to address any concerns you may have regarding your use of the Platform. Most concerns may be quickly resolved in this manner. Each of you and BSWHP agrees to use best efforts to settle any dispute, claim, question or disagreement directly through consultation and good faith negotiations which shall be a precondition to either party initiating a lawsuit or arbitration.

B. Agreement to Binding Arbitration

If we do not reach an agreed-upon solution within a period of thirty (30) days from the time informal dispute resolution is pursued pursuant to section (A) above, then either party may initiate binding arbitration. All claims arising out of or relating to these Terms (including its formation, performance and breach), the parties’ relationship with each other and/or your use of the Service shall be finally settled by binding arbitration administered on a confidential basis by the American Arbitration Association in accordance with the provisions of the Consumer Arbitration Rules of the American Arbitration Association (the “AAA”), excluding any rules or procedures governing or permitting class actions. The arbitrator, and not any federal, state or local court or agency, shall have exclusive authority to resolve all disputes arising out of or relating to the interpretation, applicability, enforceability or formation of these Terms, including, but not limited to, any claim that all or any part of these Terms is void or voidable. The arbitrator shall be empowered to grant whatever relief would be available in a court under law or in equity. The arbitrator’s award shall be binding on the parties and may be entered as a judgment in any court of competent jurisdiction. The interpretation and enforcement of these Terms shall be subject to the Federal Arbitration Act.

The AAA rules governing the arbitration may be accessed at www.adr.org or by calling the AAA at 800.778.7879. To the extent the filing fee for the arbitration exceeds the cost of filing a lawsuit, we will pay the additional cost. If we are required to pay the additional cost of the filing fees, you should submit a request for payment of fees to AAA along with your form for initiating the arbitration, and we will make arrangements to pay all necessary fees directly to AAA. The arbitration rules also permit you to recover attorney’s fees in certain circumstances.

The parties understand that, absent this mandatory provision, they would have the right to sue in court and have a jury trial. They further understand that, in some instances, the costs of arbitration could exceed the costs of litigation and the right to discovery may be more limited in arbitration than in court.

C. Class Action and Class Arbitration Waiver

Each of you and BSWHP further agrees that any arbitration shall be conducted in your respective individual capacities only and not as a class action or other representative action, and you and BSWHP each expressly waive your respective right to file a class action or seek relief on a class basis. If any court or arbitrator determines that the class action waiver set forth in this paragraph is void or unenforceable for any reason or that an arbitration can proceed on a class basis, then the arbitration provision set forth above in Section (B) shall be deemed null and void in its entirety and the parties shall be deemed to have not agreed to arbitrate disputes.

D. Exception — Small Claims Court Claims

Notwithstanding the parties’ agreement to resolve all disputes through arbitration, either party may seek relief in a small claims court for disputes or claims within the scope of that court’s jurisdiction.

E. 30-Day Right to Opt Out

You have the right to opt out and not be bound by the arbitration and class action waiver provisions set forth in Sections (B), (C) and (D) above by sending written notice of your decision to opt-out to the address provided in the “Contact Information” section, below.

The notice must be sent within thirty (30) days of your first use of the Service, otherwise you shall be bound to arbitrate disputes in accordance with the terms of those sections. If you opt-out of these arbitration provisions, we also will not be bound by them.

F. Exclusive Venue for Litigation

To the extent that the arbitration provisions set forth in Section (B) do not apply, the parties agree that any litigation between them shall be filed exclusively in state or federal courts located in Bell County, Texas. The parties expressly consent to exclusive jurisdiction in Bell County, Texas for any litigation other than small claims court actions.

17. Governing Law

This Agreement is governed by the laws of the State of Texas applicable to agreements entered into and wholly to be performed therein. You hereby consent to the exclusive jurisdiction and venue of the state and federal courts within Bell County, Texas for the resolution of all disputes arising out of use of this Platform. Use of this Platform is unauthorized in any jurisdiction that does not give effect to all provisions of these terms and conditions, including, without limitation, this paragraph. You agree that no joint venture, partnership, employment, or agency relationship exists between you and BSWHP as a result of this Agreement or use of the Platform. You agree not to combine any claim you have arising out of the Internet Privacy Statement with the claims of others.

18. Legal Process

This Agreement is subject to existing laws and legal process. Nothing in this Agreement shall derogate BSWHP's right to comply with law enforcement requests or requirements relating to your use of this Platform or information provided to or gathered by BSWHP with respect to such use.

19. Miscellaneous

A. Waivers; Severability

The failure of BSWHP to exercise or enforce any right or provision of these Terms shall not constitute a waiver of such right or provision.

If any provision of these Terms is found by a court of competent jurisdiction to be invalid, you agree that the court should endeavor to give effect to the intentions of BSWHP and you as reflected in the provision, and that the other provisions of these Terms will remain in full force and effect.

B. Headings

The section titles in these Terms are for convenience only and have no legal or contractual effect.

C. Assignment

These Terms, and any rights and licenses granted hereunder, may not be transferred or assigned by you, but may be assigned by BSWHP without restriction.

D. Invalidity

If any part of this Agreement is determined to be invalid or unenforceable pursuant to applicable law including, but not limited to, the warranty disclaimers and liability limitations set forth above, then the invalid or unenforceable provision will be deemed superseded by a valid, enforceable provision that most closely matches the intent of the original provision and the remainder of the Agreement shall continue in effect.

E. Entire Agreement

This Agreement contains the entire agreement between you, the visitor and BSWHP with respect to this Platform. It supersedes all prior or contemporaneous communications and proposals, whether electronic, oral or written, between the user and BSWHP with respect to this Platform.

F. Waiver and Force Majeure

BSWHP’s failure to exercise or enforce any provision in these Terms will not constitute a waiver of such provision. BSWHP shall not be responsible for any failure to perform its obligation or any interruption or delay in the operation of the Platform due to circumstances beyond its reasonable control, including, without limitation, acts of civil, military or government authorities, war, riot, terrorism, fire, flood or accidents.

19. Contact Information

This Platform is provided by Baylor Scott & White Health Plan. If you have any questions regarding these Terms, please contact BSWHP as indicated on our website at: BSWHealthPlan.com/Contact.