STAR

There are no copays for covered services. Benefits include:

• Primary care provider visits
• Prescription drugs
• Immunizations and wellness visits
• Specialist visits
• Urgent care
• Emergency care
• Lab and X-ray services
• Pregnancy services
• Family planning
• Hospital care
• Chiropractic services
• Speech and hearing services
• Physical therapy
• Behavioral health care (mental health and substance abuse services)
• Home health care
• Disease management services

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

Staying healthy means getting regular checkups. Children need more wellness checkups than adults. These medical checkups, for children birth through age 20 who have Medicaid, are called Texas Health Steps. Your child should get Texas Health Steps checkups at:

After age 2 ½, your child should visit the doctor every year.
Be sure to make these appointments and take your child to his or her doctor when scheduled. These checkups can:

• Find health problems before they get worse and harder to treat
• Prevent health problems that make it hard for your child to learn and grow

There is no cost for these checkups.

Questions about Texas Health Steps? Call 1-877-847-8377 (1-877-THSTEPS) or go to the Texas Health Steps website.

Are you a seasonal farmworker? We will help you find doctors and clinics and help you set up appointments for your children. Your child can receive his or her checkup or service sooner if you are leaving the area.

• Health care services for children of farmworkers - English
• Health care services for children of farmworkers - Spanish

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: 1-800-516-0165
• 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 eye doctor, call Superior Vision of Texas at 1-800-428-8789 or go to the Superior Vision website.

• Members age 20 and younger can get an eye exam once every 12 months and prescription glasses (if necessary) once every 24 months
• Members age 21 and older can get an eye exam and prescription glasses (if necessary) once every 24 months

You can get no-cost rides to your health-care services. Amerigroup will provide rides to the doctor, dentist, hospital, pharmacy, and any other places you receive Medicaid services. Call us at least two working days before you need a ride. If you need to travel out of town or out of your service area, call us at least five working days before you need a ride. Amerigroup will use Access2Care to arrange all travel. Call 833-721-8184 (TTY 711) to schedule a ride.

Visit the Transportation page under the Benefits tab for more details

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 life:

• Earn Healthy Rewards dollars by doing healthy activities like completing certain checkups or treatments. Then, use your dollars to pick gift cards you can 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:
  • Family members to go with you to medical services
  • Pregnancy, birthing, or newborn classes for pregnant members
  • Trips to WIC offices
  • Member Advisory Group meetings
• Cellphone or smartphone with monthly minutes, data, and texts
• Help from a nurse, day or night, to answer your health questions with 24-hour Nurse HelpLine
• Up to $50 per semester for a Boys & Girls Club basic membership (where available) for members ages 6 to 18
• Dental hygiene kit for members ages 21 and older
• Taking Care of Baby and Me® program for pregnant members and new moms
• One sports or school physical every year for members ages 4 to 19
• Allergy-free pillow cover for members ages 20 and younger with asthma
• First-aid kit and a personal disaster plan
• We will cover the cost of your General Education Diploma (GED) test for members age 18 and older.
• Access to special programs:
  • Weight management virtual program
  • Nicotine recovery support program
  • Pregnancy and early parenting program
  • Social services resource directory

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

• 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 Texas Health Steps checkups per the Texas Health Steps visit schedule (ages 0–15 months)
• $20 per visit for Texas Health Steps checkups (at ages 18, 24, or 30 months)
• $20 each year for Texas Health Steps checkups (ages 3–20)
• $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 (influenza) vaccination (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 getting a full series of the human papillomavirus (HPV) vaccination, for members ages 9 through 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

For adults

• $20 each year for getting a flu (influenza) vaccination (ages 3 or older) (gift card allowance for over-the-counter medicines)
• $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

For pregnant women

• $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

For members with diabetes

• $20 every 6 months for getting a blood sugar test (HbA1c) (age 18 or older)
• $20 every 6 months for getting a blood sugar test (HbA1c) with a result less than 8 (age 18 or older)

Sign into your secure account to access Healthy Rewards.

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

Your benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with CarelonRx to provide these pharmacy benefits.

You do not have pharmacy copays.

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

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.

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, OB/GYN care, and family planning. 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.