CHIP (HMO & RSA)

We Do More for CHIP Members.
Discover Superior HealthPlan.

Potential Members: 1-844-664-2257

Current Members: 1-800-783-5386

Superior HealthPlan proudly offers CHIP coverage in 7 service areas around the state:

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

This program 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.

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

To learn more, call 1-844-664-2257.

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 can be found in the CHIP handbook

 

At Superior, members can get many great services in addition to their regular benefits. 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.

  • Extra vision benefits. This includes $150 toward prescription eyewear.
  • Annual sports physicals for children ages 4 through 17.
  • Extra behavioral health services
  • Diaper bag and diapers for pregnant members who attend a baby shower class.#
  • A convertible baby car seat for completing 1 prenatal visit and attending an educational baby shower.#
  • Water safety course for members ages 4-10.*
  • Help for members in the asthma disease management program, including 1 peak flow meter and home visits for high-risk members.
  • Up to $150 each year through CentAccount®. This program is for pregnant women who complete prenatal visits, checkups, get a flu shot and agree to receive pregnancy-related text messages. Rewards can be used at many Texas retailers including Walmart. #
  • Up to 750 extra minutes per month for SafeLink phone users who are enrolled in Case Management.
  • Connections Plus phone for members who do not qualify for SafeLink and enroll in Case Management.
  • A 24-hour nurse advice line.

*Only for members in the Bexar, El Paso, Nueces and Travis county service areas.

#Only for members in the Bexar, El Paso, Lubbock, Nueces and Travis county service areas.

Restrictions and limitations may apply.

There are no co-pays for STAR, STAR+PLUS or STAR Health members. Superior fully covers all medically necessary needs for these programs. Information on co-pays for CHIP members is below.

  • The table below lists the CHIP co-payment schedule. It is listed according to a family’s income. Co-payments for health-care services or prescription drugs are paid to the health-care provider at the time of service. You do not have to pay co-payments for preventive care such as well-child or well-baby visits or vaccines.
  • Your child’s Superior Member ID card lists the co-payments that apply to your family. Present your Superior Member ID card when your child gets office visits or emergency room services or has a prescription filled.

CHIP Cost-Sharing - Effective January 2, 2014***

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

At or below 150% of FPL*

$0

Above 150% up to and including 185% of FPL

$35

Above 185% up to and including 200% of FPL

$50

Co-Pays (Per Visit)

At or Below 100% of FPL

Service Charge
Office Visit $3
Non-Emergency ER $3
Generic Drug $0
Brand Drug $3
Facility Co-Pay, Inpatient $15
Cost-Sharing Cap 5% (of family's income)**

Above 100% up to and including 150% 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's income)**

Above 150% up to and including 185% 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's income)**

Above 185% up to and including 200% 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's income)**

*The federal poverty level (FPL) refers to income guidelines established annually by the federal government.
**Per 12-month term of coverage.
***Effective January 2, 2014, CHIP Members will be required to pay an office visit co-payment for each non-preventive dental visit.

The Member Guide you received from CHIP when you enrolled your child in CHIP 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.