STAR Kids

There are no copays for covered services.

• Primary care provider visits
• Prescription drugs
• Specialist visits
• Hospital care
• Preventive care
• Urgent care
• Emergency care
• Lab and X-ray services
• Personal care services
• Behavioral health services
• Private duty nursing
• Durable medical equipment and supplies
• Long-term services and supports including home- and community-based care

If your child has both Medicare and Medicaid, Amerigroup will provide your child’s long-term services and supports benefits. Medicare will provide your child’s primary medical care benefits.

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:

Service coordination helps you get the care and services your child needs. A service coordinator works closely with you and your child, gets to know you, and acts as your main contact when you have questions or need help. Your service coordinator will also:

• Work with you and your care team to create a service plan based on your child’s health needs and goals.
• Make sure you and your child understand the service plan and help you learn more about your care and service options.
• Help you make appointments with your child’s providers, arrange services, and get transportation, when needed.
• Coordinate all of the services you get from us and other providers and community organizations.

You can have a service coordinator if you ask for one. We may also assign one after we look at your child’s health and support needs.

If you think you need a service coordinator or if you’d like to speak with one, call
1-866-696-0710, Monday through Friday from 8 a.m. to 5 p.m. local time.

Transition services
Your child will transition out of STAR Kids and into STAR+PLUS for health care after his or her 21st birthday. A transition specialist will work with your child’s service coordinator starting when your child turns 15. They will work together to create a plan for your child’s transition into adulthood. A transition plan describes the types of services your child will need, the doctors he or she will see, and other things, like health-care benefits, that will change when he or she turns 21.

Your child may need help with everyday tasks like eating, dressing, or personal care. Our service coordinators can help you get the services he or she needs to live at home. If you allow it, your service coordinator will talk to you, your child, and your child’s doctors to determine the kinds of help your child needs. Then, the service coordinator will tell you about the help we may be able to get for your child. We can also help get your child’s services started. Afterward, your service coordinator will call to see how your child is doing.

If you think your child needs long-term services and supports, call the service coordination line at
1-866-696-0710.

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 an eye doctor and learn more about covered services, call Superior Vision of Texas at 1-800-428-8789 or go to the Superior Vision website.

Members can get an eye exam once every 12 months and prescription glasses (if necessary) once every 24 months.

If your child has both Medicare and Medicaid, contact your child’s Medicare plan to learn more about vision benefits.

You can get no-cost rides to your child's health-care services. Amerigroup will provide rides to the doctor, dentist, hospital, pharmacy, and any other place 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 844-864-2443 (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 help support you and your child:

• 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:
  • 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
• Up to $50 per semester for the cost of activities in Boys & Girls Clubs, Boy Scouts, Girls Scouts, or other similar organizations
• Up to $75 per year to use for texture fidgets, compression clothes, weighted blankets, and more for children with sensory sensitivities
• Cellphone or smartphone with monthly minutes, data, and texts
• One sports, camp, or school physical every 12 months
• Eyeglasses strap
• Pest control services once every three months
• Taking Care of Baby and Me® program for pregnant members and new moms
• First-aid kit and a personal disaster plan
• Healthy Families program for qualifying members ages 7 to 17
• Inhaler sensor for members with asthma to find or help stop health problems by tracking inhaler use
• Allergy-free pillow cover for certain members with asthma
• Respite care hours so family members and caregivers can take a break
• 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 child's member handbook.

• Medicaid (Non-Dual) Member Handbook – English
• Medicaid (Non-Dual) Member Handbook – Spanish
• Medicaid/Medicare (Dual) Member Handbook – English
• Medicaid/Medicare (Dual) Member Handbook – Spanish
• STAR Kids Value-Added Benefit Changes Insert - Spanish
• STAR Kids Value-Added Benefit Changes Insert - English
• External Medical Review Insert – English
• External Medical Review Insert – 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 -20) (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

For members with diabetes

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

Sign into your secure account to access Healthy Rewards.

You can find specific benefit details, including exclusions and limitations, in your member handbook. Members with Medicare are not eligible for Healthy Rewards.

STAR Kids Medicaid/Medicare (Dual) members

If your child has both Medicare and Medicaid, contact your child’s Medicare Part D plan to learn more about pharmacy benefits.

STAR Kids Medicaid (Non-Dual) members

Your benefits include a wide range of prescription 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 child’s doctor can provide them. This is called preapproval. Your child’s doctor will work directly with us to get the approval.

Your child 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
• Long-term services and supports

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.

We put tools and technology in your hands to make it easy to get care and services. Your Service Plan is an easy-to-use, online tool that helps you stay connected with your service coordinator or case manager. It lets you:

• Get your service coordinator or case manager’s phone number and email address
• Send your service coordinator or case manager secure messages about your diagnoses, goals, medicines, services, and more
• View your goals and objectives
• Check due dates and status for goals and objectives

To use this tool:

• Choose Continue to your Service Plan below
• Log in or register first if you don't have an account

Healthy Families is a six-month program for members ages 7-17. The goal of the program is to help families form healthy eating habits and become more active.

For kids who qualify, parents will get one-on-one coaching phone calls with us to:

• Create health goals just for your child that are clear and that they can meet.
• Make a plan to reach those goals.
• Talk about getting and staying active and healthy food choices.
• Help find resources to support a healthy life in your area.
• Find out if your health plan has extra benefits to help with living a healthier life.

Learn more and join

Give us a call at 844-421-5661 Monday through Friday from 8:30 a.m. to 5:30 p.m. Central time to find out more about the Healthy Families program. We’ll ask you some questions about your child’s health to see if they qualify.