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Plans & Benefits: Texas CHIP Perinate

Here for you when you’re pregnant. Here for your baby.

CHIP Perinatal services, under the CHIP program, offer health-care benefits to unborn children of pregnant women who can’t get Medicaid or traditional CHIP due to income or immigration status.

Benefits beyond what you expect

At Amerigroup, we’re about more than just doctor’s visits. As an Amerigroup member, you also get no-cost extras like:

  • 24-hour Nurse HelpLine – nurses available 24 hours a day, 7 days a week for your urgent medical issues and health-care questions
  • Free cellphone with monthly minutes and texts for those that qualify

You can find benefit details, including exclusions and limitations, in the member handbook.

Focused on your baby’s health

Your baby’s health is important – and we’re here to help you stay focused on it. Even better, CHIP Perinatal benefits are no cost to all who are eligible.

Your baby’s health benefits

CHIP Perinatal benefits include:

  • A perinatal care doctor you choose in your own community
  • Doctors and hospitals nearby in our plan
  • Access to perinatal specialists when referred by your perinatal care doctor
  • Up to 20 prenatal visits
  • Prescriptions and prenatal vitamins
  • Labor and delivery
  • Two visits for the mother after the baby is born
  • Regular checkups, immunizations, and prescriptions for the baby after the baby is born

What is preapproval?

Some treatment, care, or services may need our approval before your doctor can provide them. This is called preapproval. Your doctor will work directly with us to get the approval. The following require preapproval:

  • Most surgeries, including some outpatient surgeries
  • All elective and nonurgent inpatient services and admissions
  • Certain prescriptions
  • Out-of-area or out-of-network care except in an emergency
  • Advanced imaging (things like MRAs, MRIs, CT scans, and CTA scans)

Preapproval is not needed for emergency services directly related to the delivery of the unborn child (CHIP Perinate member) until birth.

This list is subject to change without notice and isn’t a complete list of covered plan benefits. Learn more about your benefits by:

  • Reading your member handbook
  • Calling Member Services with questions about specific services
Eligibility & Enrollment

CHIP Perinatal services, under the CHIP program, are for pregnant women who:

  • Don’t have health insurance
  • Can’t get Medicaid
  • Are Texas residents

to apply:

Pharmacy: Your prescription drug benefits

We work with Express Scripts (ESI) to provide your pharmacy benefits.

You don’t have pharmacy copays.

To learn more about your pharmacy benefits, refer to the member handbook.

Getting your prescription filled is easy!

You can go to any pharmacy in our plan. Use the pharmacy locator tool to find a pharmacy close to you.

  • Give the pharmacist your written prescription or have the doctor call it in
  • Show your/your child’s Amerigroup ID card or Your Texas Benefits Medicaid card

It’s a good idea to use the same pharmacy for all your prescriptions. This way the pharmacist will know what medicines you’re taking and can tell you about any problems or drug interactions that could occur. If you use more than one pharmacy, tell them about all medicines you take.

Drug Coverage Information

Your doctor chooses drugs from the State Vendor Drug Program (VDP) list of drugs. It includes all medicines covered by Medicaid/CHIP.

View the Pharmacy Prior Authorization & Preferred Drug List

If you need a drug that isn’t listed on the Texas Medicaid formulary, you or someone you choose to act for you can request a formulary exception. Just email
submitmyexceptionreq@amerigroup.com

Prior authorization (preapproval)

Your doctor may need to get preapproval from us for certain drugs before prescriptions are filled.

To ask for an exception, email us at
wrkgp-submitmyexceptionreq@anthem.com.

When there is a generic drug available on the VDP list, it will be covered in place of the brand-name drug. Generic drugs are equal to brand-name drugs as approved by the Food and Drug Administration (FDA).

Searchable Formulary

Search for name brand and generic drugs in the formulary

Drug Interactions and Side Effects

Learn more about drug interactions or side effects at the ESI Drug Information website.

Express Scripts Prescription Drug Reimbursement Form

If you paid out-of-pocket for a prescription drug, you can ask us to pay you back. Please use the form below to request reimbursement.

Manage your prescriptions online

ESI online registration instructions:

Pharmacy: Frequently asked questions

What pharmacies are in the Amerigroup plan?

There are many chain and local pharmacies in our plan to choose from. You can find one by:

How do I transfer my prescriptions to a pharmacy in the plan?

If you need to transfer prescriptions:

  • Call a pharmacy in our plan and tell the pharmacist you want to transfer a prescription
  • Bring your prescription container to the new pharmacy and they will handle the rest

How does my provider request preapproval?

Your doctor can request preapproval by:

  • Faxing a completed prior authorization (preapproval) form to
    1-800-601-4829
  • Calling the Amerigroup Pharmacy department at 1-855-215-4496

What if a copay is required and I’m unable to pay it?

You don’t have pharmacy copays.

How do I get my medicine if I’m traveling?

We have pharmacies in our plan in all 50 states. Call your doctor for a new prescription to take with you on vacation.

What happens if my medicines are lost or stolen?

If your medicines are lost or stolen, call the doctor and ask him or her to call your pharmacy to authorize an early refill. The pharmacy may have to contact our Prior Authorization Desk for approval. We will review lost or stolen medicines on a case-by-case basis.

What if I paid out of pocket for a medicine and want to be reimbursed?

If you had to pay for a medicine, you may submit a request for reimbursement form. You’ll need to mail the completed Express Scripts Prescription Drug Reimbursement Form; Spanish form along with any receipts to:

Amerigroup
Pharmacy Department
PO Box 62509
Virginia Beach, VA 23466-2509

FAQs

Find answers to your questions below.

Who is Amerigroup?

Amerigroup is a health plan in Texas. We offer CHIP Perinatal benefits to those who qualify, along with other program benefits.

What is CHIP Perinatal?

CHIP Perinatal is a part of the CHIP program that offers no-cost health care benefits for unborn children of pregnant women who cannot get Medicaid or traditional CHIP due to income or immigration status.

Pregnant women with incomes up to 200 percent of the Federal Poverty Level (FPL) may be able to get CHIP Perinatal benefits. After being accepted, the baby gets 12 months of benefits.

How do I apply?

It’s easy to apply. You can apply for CHIP Perinatal benefits:

  • Online at YourTexasBenefits.com
  • Over the phone
    • Call 2-1-1 toll-free Monday through Friday from 8 a.m. to 6 p.m. Central time
    • Pick a language
    • Choose option 2 and follow the prompts
  • By mail or fax
    • Call 2-1-1 to have a paper application form sent to you or print a paper copy of the form at YourTexasBenefits.com
    • Mail your form to:

      HHSC
      PO Box 149024
      Austin, TX 78714-9968

    • Fax your form to: 1-877-447-2839
  • In person at an HHSC benefits office
    • Call 2-1-1, pick a language, and then select option 2 to find an office
    • Go to YourTexasBenefits.com and choose Find an Office

You can set up an account at YourTexasBenefits.com and download the Your Texas Benefits app to check your application status and much more. If you can get CHIP Perinatal benefits, HHSC will mail you an enrollment packet. You will have to choose a health plan and a perinatal care provider. Call 1-800-964-2777 to choose Amerigroup.

What does it cost?

There is no cost to those who can get CHIP Perinatal benefits from Amerigroup.

How long do my baby’s benefits last?

Your baby’s benefits start the first day of the month your unborn baby becomes eligible and lasts at least 12 months.

For example, if your baby is enrolled when you are 3 months pregnant, your baby will have 6 months of prenatal care and 6 months of full CHIP benefits after birth. If your baby qualifies for Medicaid, your baby will get 12 months of benefits from birth, once he or she is enrolled in Medicaid.

What benefits does my baby get with Amerigroup?

We offer CHIP Perinatal benefits, plus extras designed to make a difference in your day-to-day life. Amerigroup members get things like access to our 24-hour Nurse HelpLine with nurses available 24 hours a day, 7 days a week for your urgent medical issues and health-care questions and a free cellphone that includes minutes and text messaging if you qualify.

After birth, your new baby can get full CHIP or Medicaid benefits based on income.

Our CHIP Perinatal Plans and benefit page will tell you more about the benefits you can get with us.

Are my baby’s prescriptions included with CHIP Perinate benefits?

Yes, we use the Texas HHSC Pharmacy Benefit Management (HPBM) list of drugs for your doctor to choose from. Your prenatal vitamins are also included. Some prescriptions will need preapproval.

You can go to any pharmacy in our plan to have your prescriptions filled.

To find out more, call Member Services at 1-800-600-4441 (TTY 711).

What is preapproval?

Some treatment, care, or services may need our approval before your doctor can provide them. This is called preapproval. Your doctor will work directly with us to get the approval. The following require preapproval:

  • Most surgeries, including some outpatient surgeries
  • All elective and nonurgent inpatient services and admissions
  • Certain prescriptions
  • Out-of-area or out-of-network care except in an emergency
  • Advanced imaging (things like MRAs, MRIs, CT scans, and CTA scans)

Preapproval is not needed for emergency services directly related to the delivery of the unborn child (CHIP Perinate member) until birth.

This list is subject to change without notice and isn’t a complete list of covered plan benefits. Learn more about your benefits by:

  • Reading your member handbook
  • Calling Member Services with questions about specific services

How do I replace my Amerigroup ID card if it is lost or stolen?

If your ID card is lost or stolen, call us right away at 1-800-600-4441 (TTY 711). We’ll send you a new one. You may also print your ID card from our website. You’ll need to register and log in to the website to access your ID card information.

How can I get a new ID card, handbook, or provider directory?

Log on or call Member Services at 1-800-600-4441 (TTY 711) to ask for one.

Who do I call if I have concerns about my health-care benefits?

Call Member Services at 1-800-600-4441 (TTY 711).

Who do I call if I have concerns about my health-care benefits?

Call Member Services at 1-800-600-4441 (TTY 711).

If you have health-related questions, call that same number for help from a nurse 24 hours a day, 7 days a week with our 24-hour Nurse HelpLine.

Amerigroup members in the Medicaid Rural Service Area and the STAR Kids program are served by Amerigroup Insurance Company; all other Amerigroup members in Texas are served by Amerigroup Texas, Inc.