CHIP (HMO & RSA) Insurance In Texas
We Do More for CHIP Members.
Discover Superior HealthPlan.
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 to online resources and help getting a ride, 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/school physicals.
- $25 for over-the-counter items through the mail every quarter.
- Online and mobile-accessible mental health and nicotine recovery resources. Findhelp online directory to help locate community services.
- Start Smart® For Your Baby Program. Diaper bag, diapers and educational materials for pregnant members who complete the Notification of Pregnancy form and attend Superior’s baby shower.
- 6-month YMCA membership for member and one adult family member. Plus access to 4-month family based weight-management program.
- Up to $60 for programs offered by Boys & Girls Club.***
- Up to $150 My Health Pays® rewards each year for completing prenatal and postpartum visits. Visit My Health Pays® for more rewards information.
- $25 rewards card for getting a flu shot on or before member’s second birthday.
- Allergy free mattress cover and pillowcase for members enrolled in Asthma Care Management.
- A 24-hour nurse advice line.
- Joy for All™ battery-operated plush companion pet for members enrolled in Case Management for at least 60 days.^
- Home visits for members who are pregnant.
- Extra help getting a ride.
- Telephonic outreach, education and support services offered to reduce the health risks associated with smoking during pregnancy through Superior’s Puff-Free Pregnancy program.
Value-added Services are extra health care services offered by Superior. Services may vary by area. These services are valid through 08/31/23.
*Restrictions and limitations may apply. **YMCA weight-management program VAS for CHIP members in Bexar, El Paso, Travis SDAs only. ***Boys and Girls Club VAS excludes CHIP members in Bexar, El Paso and Nueces SDAs. ^For CHIP members in Bexar and El Paso SDAs.
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.