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CHIP (HMO & RSA) Insurance In Texas

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Superior HealthPlan proudly offers CHIP insurance in 7 service areas around the state of Texas:

  • Bexar
  • El Paso
  • Hidalgo
  • Lubbock
  • Nueces
  • Travis
  • CHIP RSA – 170 rural counties in Texas

CHIP insurance in Texas provides health care for children from families who earn too much money to qualify for Medicaid, but not enough to pay for private health insurance.

CHIP benefits include:

  • Choice of doctors.
  • Regular checkups and office visits.
  • Prescription drugs and medical supplies.
  • Dental and vision services.
  • Vaccines.
  • Behavioral health care services.
  • Hospital coverage.

More information for our Texas program can be found in the CHIP handbook

Also through this program, pregnant women may be eligible for coverage through CHIP Perinate. Learn more about the benefits and services that are available.

At Superior, members can get many great services in addition to their regular benefits when enrolled in a CHIP insurance plan. These are called Value-added Services*. From extra vision care to cell phones and car seats, Superior is proud to offer many extra services to help keep our members healthy.

  • $60 for programs offered by YMCA and Boys & Girls Club.**
  • Extra vision benefits. This includes $150 toward prescription eyewear.
  • Online and mobile-accessible mental health services and nicotine recovery resources through myStrength myStrength.com.
  • $20 gift card and journal for members who complete a follow-up appointment within 7 days of leaving the hospital for an inpatient behavioral health or substance abuse stay.
  • $25 for over-the-counter items through the mail every quarter.
  • A 24-hour nurse advice line.
  • Annual sports physicals for children ages 4 through 18.
  • Up to 750 extra minutes per month for SafeLink phone users who are enrolled in Care Management.
  • Help for members enrolled in Asthma Care Management. This includes allergy free mattress covers and pillow cases.
  • Online social services resource directory for members to help locate community supports such as food and nutrition, housing, education and employment services.
  • Start Smart® For Your Baby Program - If you stay for an entire baby shower, or download a pregnancy program mobile app and engage for 30 days, you can get extra benefits* like:
         - A diaper bag and diapers when you complete the Notification of Pregnancy (NOP) form
         - A convertible baby car seat when you complete the NOP form and go to one prenatal visit within your first trimester or 42 days of enrollment with Superior
  • Telephonic outreach, education and support services offered to reduce the health risks associated with smoking during pregnancy through Superior’s Puff-Free Pregnancy program.
  • Up to $100 My Health Pays® rewards each year for completing prenatal and postpartum visits. Visit My Health Pays® for more rewards information.
     

* Restrictions and limitations may apply.
** YMCA Value-added Service excludes STAR members in the Hidalgo and MRSA Northeast service delivery areas. Excludes CHIP Perinate members. Boys & Girls Club Value-added Service excludes STAR members in Bexar, El Paso and Nueces service delivery areas. Excludes CHIP members in Bexar, El Paso and Nueces service delivery areas. Excludes CHIP Perinate members.

Value-added Services are extra health care services offered by Superior. Services may vary by area. These services are valid through 08/31/22.

Copayments for medical services or prescription drugs are paid to the health care provider at the time of service. You do not have to pay copayments for preventive care such as well-child or well-baby visits or immunizations. There are no copays for pregnancy related assistance either. Your child’s Superior ID card lists the copayments that apply to your family. Present your ID card when your child gets office visits or emergency room services or has a prescription filled. CHIP members who are Native American or Alaskan Native do not have any cost-sharing. This includes enrollment fees and co-pays. If you are Native American or Alaskan Native and your member ID card shows that a copay is required, please call Superior so we can send you a new card.

The table below lists the CHIP copayment schedule. It is listed according to a family’s income.

Effective January 1, 2014

Enrollment Fees (for 12-month enrollment period): Charge

At or below 151% of FPL*

$0

Above 151% up to and including 186% of FPL

$35

Above 186% up to and including 201% of FPL

$50

Co-Pays (Per Visit)

At or Below 151% of FPL

Service Charge
Office Visit $5
Non-Emergency ER $5
Generic Drug $0
Brand Drug $5
Facility Co-Pay, Inpatient (per admission)  $35
Cost-sharing Cap 5% (of family income)**

Above 151% up to and including 186% of FPL

Service Charge
Office Visit $20
Non-Emergency ER $75
Generic Drug $10
Brand Drug $35
Facility Co-Pay, Inpatient (per admission) $75
Cost-sharing Cap 5% (of family income)**

Above 186% up to and including 201% of FPL

Service Charge
Office Visit $25
Non-Emergency ER $75
Generic Drug $10
Brand Drug $35
Facility Co-Pay, Inpatient (per admission) $125
Cost-sharing Cap 5% (of family income)**

*The federal poverty level (FPL) refers to income guidelines established annually by the federal government.
**Per 12-month term of coverage.

The Member Guide you received from CHIP when you enrolled your child in CHIP insurance in Texas includes a tear-out form that you should use to track your CHIP expenses. To make sure you do not go over your cost-sharing limit, please keep track of your CHIP-related expenses on this form. The enrollment packet welcome letter tells you exactly how much you must spend before you are eligible to mail the form back to CHIP. If you lose your welcome letter, please call CHIP at 1-800-647-6558. They will tell you what your annual cost-sharing limit is.

When you reach your annual cost-sharing limit, please send the form to CHIP. They will notify Superior. We will issue a new Superior Member ID card for your child. This new card will show that no co-payments are due when your child receives services for the remainder of the enrollment period.