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Plans & Benefits: Texas CHIP

Your priorities are our priority

We know your kids are your priority and we want to help them get what they need to stay healthy. Amerigroup offers CHIP health-care benefits for people:

  • Age 18 and younger that are Texas residents and U.S. citizens or legal permanent residents
  • Whose family income is too high for Medicaid
  • Who don’t have other private health insurance

Benefits beyond what you expect

At Amerigroup, we’re about more than just doctor’s visits. Along with their regular CHIP benefits, your kids get no-cost extras designed to make a difference in their lives.

Extra benefits for our members
  • Help from a nurse anytime — day or night, with our 24-hour Nurse HelpLine
  • Real Solutions® Healthy Rewards debit card dollars getting well-child checkups
  • Up to $50 each school year for a Boys & Girls Club membership where available for members ages 6 to 18
  • One sports or school physical every year for members ages 6 to 18
  • Free cellphone with monthly minutes and texts for those that qualify
  • Free first aid kit after completing a personal disaster plan online
  • Taking Care of Baby and Me® program for pregnant members and new mothers
  • Allergy-free pillow cover for members with asthma
  • Rides to doctor visits for CHIP members with chronic illnesses

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

Benefits that keep your kids in mind

The benefits and services we offer are made to fit you and your kids’ busy lives. CHIP health-care benefits will help them feel their best, every day.

Your kids’ health benefits

CHIP benefits include:

  • Primary and specialty care
  • Prescriptions
  • Well-baby and well-child visits
  • Hospital stays
  • X-ray and lab services
  • Dental care
  • Vision care
  • And more

Visit our Find a Doctor page to find out more about your kids’ dental and vision benefits.

For benefits available to CHIP Perinate members, check the CHIP Perinatal Plans & Benefits page.

What is preapproval?

Some treatment, care, or services may need our approval before your child’s doctor can provide them. This is called preapproval. Your child’s 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
  • Chiropractic services
  • Most behavioral health and substance abuse services (except routine outpatient and emergency services)
  • Certain prescriptions
  • Certain durable medical equipment, including prosthetics and orthotics
  • Certain gastroenterology procedures
  • Digital hearing aids
  • Home health services
  • Hospice services
  • Rehabilitation therapy (physical, occupational, respiratory, and speech therapies)
  • Sleep studies
  • Out-of-area or out-of-network care except in an emergency
  • Advanced imaging (things like MRAs, MRIs, CT scans, and CTA scans)
  • Certain pain management testing and procedures

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
  • Visit our Find a Doctor page to find out more about your kids’ dental and vision benefits.

    For benefits available to CHIP Perinate members, check the CHIP Perinatal Plans & Benefits page.

Healthy mind, healthy body

It’s important to take care of kids’ minds and bodies so they grow up healthy. Our benefits help with your child’s emotional and mental health, too. We have physicians, therapists, and counselors in our plan that can help you or a family member with problems like depression, anxiety, family issues, and alcohol or drug abuse.

You can use our Find a Doctor search tool to find a doctor in your area.

Families get low-cost enrollment fees and copays

CHIP enrollment fees and copays are based on family income.

Enrollment fees are $50 or less per family, per year. Copays for doctor visits range from $5 to $25 and prescriptions cost $0 to $35 based on income.

Find out more about your costs by reading these sections in your CHIP member handbook:

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.

Eligibility & Enrollment

Your kids may be eligible for health-care benefits through the Amerigroup CHIP plan.To qualify for CHIP, a child must meet income requirements. CHIP is for kids:

  • Age 18 and younger
  • That are Texas residents and U.S. citizens, or legal permanent residents
  • Whose families don’t have other private health insurance

You must live in our CHIP Service area to get CHIP benefits from Amerigroup.

Any adult who lives with a child eligible for CHIP can apply for health-care benefits for the child. This includes parents, step-parents, grandparents, other relatives, legal guardians, or adult brothers or sisters. The Texas Health and Human Services Commission (HHSC) HHSC doesn’t ask about a parent’s citizenship or immigration status when only applying for benefits for children.

To find out if the kids in your family qualify for CHIP benefits, you can:

  • Call 2-1-1 (TTY 711)
  • Go online and choose What help can you get?

You can apply:

  • Online — Go to the Your Texas Benefits website and choose Apply for new benefits
  • Over the phone — Call 2-1-1 toll-free Monday through Friday from 8 a.m. to 6 p.m. Central time
  • By mail or fax — Print a paper form from the Your Texas Benefits website or call 2-1-1 to have a paper form sent to you
  • In person — Go to an HHSC benefits office near you. You can find one by calling 2-1-1 or visit the Your Texas Benefits website and choose Find an Office

After your child is approved, HHSC will mail you an enrollment packet. You have to choose a health plan and a primary care provider. Fill out the enrollment/transfer form in your enrollment packet and mail it back, with any required enrollment fee. Call the Enrollment Broker at 1-800-964-2777 to join Amerigroup.

Children enrolling in CHIP for the first time after being covered by private health insurance will have a 90-day waiting period before benefits start. There are some exceptions to this rule.

Pharmacy: Your prescription drug benefits

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

To see your child’s copay amount, read the member handbook or check your member ID card.

To learn more about your child’s 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 child’s Amerigroup ID card

It’s a good idea to use the same pharmacy for all your child’s prescriptions. This way the pharmacist will know what medicines your child is 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 your child takes.

Drug Coverage Information

Your child’s doctor chooses drugs from the State Vendor Drug Program (VDP) list of drugs. It includes all medicines covered by 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 child’s 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 happens if my child’s medicines are lost or stolen?

If your child’s 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 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 Children’s Health Insurance Program (CHIP) health-care benefits for kids whose parents’ income doesn’t qualify them for Medicaid, along with other program benefits.

What is CHIP?

The Children’s Health Insurance Program (CHIP) offers no- or low-cost health-care benefits for kids:

  • Age 18 and younger that are Texas residents and U.S. citizens or legal permanent residents, based on family income
  • Whose families don’t have other private health insurance

The Texas Health and Human Services Commission (HHSC) decides who is able to get CHIP benefits. If you’re trying to get benefits for only your children, HHSC doesn’t ask about a parent’s citizenship or immigration status.

How do I apply for CHIP?

Any adult who lives more than half the time with an uninsured child can apply. This includes parents, stepparents, grandparents, other relatives, legal guardians, or adult brothers or sisters.

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

  • Online 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 towww.YourTexasBenefits.comlink 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 your kids qualify, HHSC will mail you an enrollment packet. You will have to choose a health plan and a primary care provider. Call the Enrollment Broker at 1-800-964-2777 to choose Amerigroup.

What does it cost?

Your enrollment fee and copays are based on family income.

  • Enrollment fees are $50 or less per family, per year
  • Copays for doctor visits and prescriptions range from $3 to $25 and from $0 to $35 based on income

Copays don’t apply, at any income level, to:

  • Well-baby and well-child care services
  • Preventative services
  • Pregnancy-related services

Please note: enrollment fees and copays don’t apply for CHIP Perinate Newborn members and CHIP members who are Native Americans or Alaskan Natives. If your child is a Native American or an Alaskan Native and the ID card shows copay requirements, call Member Services to get a new ID card with the correct information.

Find out more about your costs by visiting the CHIP website

My child just lost his or her benefits. How do I re-enroll?

You must recertify your child's CHIP eligibility every 12 months. You should get a letter from HHSC when it’s time to renew. Follow the instructions in your renewal letter on time or renew online at YourTexasBenefits.com.

To find out how to re-enroll, call 2-1-1. Make sure HHSC has your correct contact information.

What benefits do I get with Amerigroup?

We offer all the regular CHIP benefits, plus extras designed to make a difference in your child’s day-to-day life. Amerigroup members get things like extra transportation benefits, debit cards for getting some checkups and screenings, programs for pregnant women and new moms, Boys & Girls Club memberships, and more.

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

Do I have to choose a health plan?

Yes. When your child gets CHIP, you must choose a health plan in your area or HHSC will pick one for you. Call the Enrollment Broker at 1-800-964-2777 to choose Amerigroup.

Can I keep the same doctor?

Yes — as long as he or she is in our plan. You can check to see if your child’s doctor is in our plan by going to the Find a Doctor page.

Can I see a doctor outside of the Amerigroup plan?

Sometimes you may need to see a doctor who isn’t part of our plan. But you will need to get preapproval first. Call Member Services before you see a doctor who isn’t in our plan

In an emergency, you can see any doctor or go to any hospital.

How do I switch my child’s primary care provider?

You can choose your child’s primary care provider by going to the Find a Doctor. To make a change:

  • Call Member Services at 1-800-600-4441 (TTY 711), or
  • Log in to your account

The change will start right away, and your child will get a new ID card in the mail within 10 business days.

Will my child lose benefits if I switch his or her primary care provider?

No — your child won’t lose any benefits as long as the doctor is in our plan.

Can my children have different doctors?

Yes.

Are prescription drugs covered?

Yes, we use the State Vendor Drug Program list of drugs for your child’s doctor to choose from. 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).

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.

If I don’t have my child's ID card, can he or she still go to the doctor?

If you do not have your child's member ID card, tell the doctor’s office you are with Amerigroup. They should be able to help you.

Who do I call if I have concerns about my child's 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.