CHIP

Your child’s benefits include:

• Regular checkups and office visits
• Prescription drugs and vaccines
• Specialist visits
• Lab and X-ray services
• Behavioral health care (mental health and substance abuse services)
• Hospital care and services
• Medical supplies

See your member handbook for a full list of benefits in your plan.

Dental benefits are offered through a dental managed care organization. Call your child’s dental plan to find a dentist and learn about covered services:

• DentaQuest: 1-800-508-6775
• MCNA Dental: 1-800-494-6262
• UnitedHealthcare Dental: 1-877-901-7321

Amerigroup offers vision care through Superior Vision of Texas. To find or change your child’s eye doctor, call Superior Vision of Texas at 1-800-428-8789 or go to the Superior Vision website.

We are here to help you with more than just doctor visits. Starting September 1, 2020, you can receive these free extra benefits designed to make a difference in your child’s life:

• Earn Healthy Rewards dollars by doing healthy activities like completing certain checkups or treatments. Then, use your dollars to pick gift cards to use at your favorite retailers.
• Online mental health — access to a secure website and mobile app for members ages 13 and older to help improve mental and emotional health, anytime you need it
• Rides for you and your child to:
  • Doctor visits for members with chronic illnesses
  • Pregnancy, birthing, or newborn classes for pregnant members
  • WIC offices
  • Member Advisory Group meetings
• Up to $50 per semester for a Boys & Girls Club basic membership where available for members ages 6 to 18
• Cellphone or smartphone with monthly minutes, data, and texts
• One sports or school physical every year for members ages 4 to 18
• Help from a nurse, day or night, to answer your health questions with 24-hour Nurse HelpLine
• First-aid kit and a personal disaster plan
• Personal coaching to help your child quit smoking for life, and nicotine replacement therapy for members age 18
• Taking Care of Baby and Me® program for pregnant members and new moms
• Allergy-free pillow cover for members with asthma
• Access to special programs:
  • Weight management virtual program
  • Nicotine recovery support program
  • Pregnancy and early parenting program
  • Social services resource directory

• Member Handbook – English
• Member Handbook – Spanish

Sign up for our Healthy Rewards program and earn rewards for completing healthy activities, like getting certain checkups or screenings.

Healthy Rewards are available beginning September 1st, 2020.

For children

• $120 for completing six well-child checkups per the American Academy of Pediatrics recommended schedule (ages 0–15 months)
• $20 per visit for well-child checkups (at ages 18, 24, or 30 months)
• $20 each year for well-child checkups (ages 3–18)
• $20 for getting a full series of rotavirus vaccinations (ages 42 days through 24 months)
• $20 for getting a full series of flu (influenza) vaccinations (ages 6 months through 24 months) (gift card allowance for over-the-counter medicines)
• $20 each year for getting a flu vaccination, for members ages 3 or older (gift card allowance for over-the-counter medicines)
• $20 for members newly diagnosed with attention deficit hyperactivity disorder (ADHD) who have a follow-up visit with their prescribing provider within 30 days after starting their medication treatment, for members ages 6 to 12
• $20 for having a follow-up outpatient visit with a mental health provider within seven days of discharge from the hospital for a mental health stay, up to four times per year
• $20 for getting a full series of the human papillomavirus (HPV) vaccination, for members ages 9 through 12

For pregnant members

• $25 for getting a prenatal checkup in the first trimester of pregnancy or within 42 days of joining the health plan
• $50 for getting a postpartum checkup within 7 to 84 days after giving birth

Sign into your secure account to access Healthy Rewards.

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

Your child’s benefits include a wide range of prescription drugs. We work with CarelonRx to provide these pharmacy benefits.

You can find your child’s pharmacy copay amount on their member ID card or in the member handbook.

Visit the Pharmacy page to find a pharmacy near you and check if your child’s medicine is covered.

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.

You will need preapproval for:

• 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)
• Genetic testing
• 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

Referrals

You may need to see a specialist or another provider for care or services that your primary care provider can’t give you. You don’t need a referral from your primary care provider to get care from other doctors in our plan. This includes behavioral health services and OB/GYN care. It’s a good idea to talk to your primary care provider first about other types of care you may need. He or she can tell you about other doctors in our plan and help you coordinate the care you receive.

You can learn more about the preapprovals (prior authorizations) process on the Amerigroup provider website.