CHIP (HMO & RSA) Insurance In Texas
We Do More for CHIP Members.
Discover Superior HealthPlan.
Superior HealthPlan proudly offers CHIP insurance in 7 service areas around the state of Texas:
- Bexar
- El Paso
- Hidalgo
- Lubbock
- Nueces
- Travis
- CHIP RSA – 170 rural counties in Texas
CHIP insurance in Texas provides health care for children from families who earn too much money to qualify for Medicaid, but not enough to pay for private health insurance.
CHIP benefits include:
- Choice of doctors.
- Regular checkups and office visits.
- Prescription drugs and medical supplies.
- Dental and vision services.
- Vaccines.
- Behavioral health care services.
- Hospital coverage.
More information for our Texas program can be found in the CHIP handbook.
Also through this program, pregnant women may be eligible for coverage through CHIP Perinate. Learn more about the benefits and services that are available.
At Superior, members can get many great services in addition to their regular benefits when enrolled in a CHIP insurance plan. These are called Value-added Services*. From extra vision care to to online resources and help getting a ride, Superior is proud to offer many extra services to help keep our members healthy.
- Extra vision benefits. This includes $150 toward prescription eyewear.
- Annual sports/school physicals for members 4 to 18 years old.
- $25 for over-the-counter items every quarter.
- Start Smart® For Your Baby Program. Diaper bag, diapers and educational materials for pregnant members who complete the Notification of Pregnancy form and attend Superior’s educational baby shower.
- 6-month YMCA membership for members and one adult family member.**
- One membership or sports registration per year offered by Boys & Girls Club.***
- Up to $150 My Health Pays® rewards each year for completing prenatal and postpartum visits. Visit My Health Pays® for more rewards information.
- Allergy free mattress cover and pillowcase for members enrolled in Disease Management or Service Coordination.
- A 24-hour nurse advice line.
- Joy for All™ battery-operated plush companion pet for CHIP members 5 to 17 years old enrolled in Servcice Coordination for at least 30 days.
- Home visits for members who are pregnant.
- Extra help getting a ride. Extra help getting a ride for members to Social Security Administration-approved physician appointments requested by disability determination services and for members to participate in Superior's Member Advisory Group meetings. Rides are provided through Superior’s Medical Ride Program.
- Telephonic outreach offered to reduce the health risks associated with smoking during pregnancy through Superior’s Puff-Free Pregnancy program.
Value-added Services are extra health care services offered by Superior. Services may vary by area. These services are valid 9/1/24 through 08/31/25.
*Restrictions and limitations may apply. **Membership excludes CHIP members in Nueces SDA. ***Boys and Girls Club VAS excludes CHIP members in Bexar, El Paso and Nueces SDAs.
Copayments for medical services or prescription drugs are paid to the health care provider at the time of service. You do not have to pay copayments for preventive care such as well-child or well-baby visits or immunizations. There are no copays for pregnancy related assistance either. Your child’s Superior ID card lists the copayments that apply to your family. Present your ID card when your child gets office visits or emergency room services or has a prescription filled. CHIP members who are Native American or Alaskan Native do not have any cost-sharing. This includes enrollment fees and co-pays. If you are Native American or Alaskan Native and your member ID card shows that a copay is required, please call Superior so we can send you a new card.
The table below lists the CHIP copayment schedule. It is listed according to a family’s income.
Effective July 1, 2023
| Enrollment Fees (for 12-month enrollment period): | Charge |
|---|---|
At or below 151% of FPL* | $0 |
Above 151% up to and including 186% of FPL | $35 |
Above 186% up to and including 201% of FPL | $50 |
Co-Pays (Per Visit)
At or Below 151% of FPL
| Service | Charge |
|---|---|
| Office Visit | $5 |
| Non-Emergency ER | $5 |
| Generic Drug | $0 |
| Brand Drug | $5 |
| Facility Co-Pay, Inpatient (per admission) | $35 |
| Cost-sharing Cap | 5% (of family income)** |
Above 151% up to and including 186% of FPL
| Service | Charge |
|---|---|
| Office Visit | $20 |
| Non-Emergency ER | $75 |
| Generic Drug | $10 |
| Brand Drug | $25 for insulin, $35 for all other drugs*** |
| Facility Co-Pay, Inpatient (per admission) | $75 |
| Cost-sharing Cap | 5% (of family income)** |
Above 186% up to and including 201% of FPL
| Service | Charge |
|---|---|
| Office Visit | $25 |
| Non-Emergency ER | $75 |
| Generic Drug | $10 |
| Brand Drug | $25 for insulin, $35 for all other drugs*** |
| Facility Co-Pay, Inpatient (per admission) | $125 |
| Cost-sharing Cap | 5% (of family income)** |
*The federal poverty level (FPL) refers to income guidelines established annually by the federal government. **Per 12-month term of coverage. ***Copays for insulin cannot exceed $25 per prescription for a 30-day supply, in accordance with Section 1358.103 of the Texas Insurance Code.
The Member Guide you received from CHIP when you enrolled your child in CHIP insurance in Texas includes a tear-out form that you should use to track your CHIP expenses. To make sure you do not go over your cost-sharing limit, please keep track of your CHIP-related expenses on this form. The enrollment packet welcome letter tells you exactly how much you must spend before you are eligible to mail the form back to CHIP. If you lose your welcome letter, please call CHIP at 1-800-647-6558. They will tell you what your annual cost-sharing limit is.
When you reach your annual cost-sharing limit, please send the form to CHIP. They will notify Superior. We will issue a new Superior Member ID card for your child. This new card will show that no co-payments are due when your child receives services for the remainder of the enrollment period.