NOW RESUMED: Co-Pays for Certain CHIP Services

Date: 06/16/23

During the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for Children’s Health Insurance Program (CHIP) medical office visits for CHIP members whose benefit includes a co-payment for some services. As a reminder, this waiver ended on May 11, 2023.

For CHIP medical office visits scheduled on or after May 12, 2023, providers must now resume collecting a co-payment from the member/patient.*

*EXCEPTION: To comply with federal regulations, CHIP co-pays no longer apply for mental health and substance use disorder outpatient office visits and COVID-19-related office visits for COVID-19 vaccines, testing, and treatment. For these services, Superior HealthPlan will reimburse the member’s co-payment for claims received, and you should NOT collect a co-payment from the member/patient for these two office visit categories. CHIP co-pays also do not apply to Native Americans, Alaska Natives, CHIP Perinate and CHIP Perinatal Newborn members.   

CHIP co-pays that members must pay are determined based on their income. Providers must reference and adhere to co-pay guidelines outlined in the Provider Manual.

For any questions, please contact your local Account Manager.