Here you'll find important information about your CHIP plan.
Searchable handbook
You can get a copy of your member handbook at no charge. Just call Member Services at the number below and we will send it to you within 5 business days.
Schedule of Benefits
Copay Table
Evidence of Coverage (EOC)
You can get a printed copy of this handbook at no cost. We can also give this to you in other formats or other languages at no cost if you need it. We can even provide interpreters to help you better understand your plan if you need them. To get this support, call our Member Services team.
You can request a new Member ID card by calling our Member Service team at the numbers below.
We care about protecting your privacy, you can view our privacy practices online.
Keep up on notices from the state and from Texas Children’s Heath Plan.
Learn more about Prior Authorization.
How to file a Complaint
If you are not happy with your health care or services provided by your doctor, their office staff, or the Texas Children’s Health Plan staff, you can file a complaint.
Appeals
You can also file an appeal of an action made by Texas Children’s Health Plan.
External Medical Review
If you, as a member of the health plan, disagree with our internal appeal decision, you can ask for an External Medical Review.
MAXIMUS Federal Service
1-888-866-6205
Monday – Friday 8:00am – 5:00pm EST
Health-care billing mistakes happen a lot. The rules that doctors and hospitals must follow are very tricky. Mistakes also happen because the doctor’s office or emergency room is just really busy. Most doctors and hospitals want to do what is right. They want to follow the rules and take care of your family.
But, you may have read about hospitals and providers that have cheated the system. They billed for services they did not do, or worse. We need your help to stop this. Texas Children’s Health Plan has been authorized by the State of Texas to implement a program to identify and prevent fraud, abuse, and waste. These terms mean:
Fraud, abuse, and waste hurt everyone. It raises taxes. It reduces funds available to pay benefits. It may even reduce the quality of care.
Some examples of fraud you might see include:
Be on the lookout for common scams such as:
To help us prevent fraud, follow some of these tips:
Can members commit fraud?
Some members do commit fraud. They might change doctors to feed a bad habit. They might ask for services they do not need or they may lie to a doctor. Some may even work with a doctor to commit fraud in return for money. Member fraud is against the law. Member fraud could result in losing your benefits. It could also mean fines or jail.
If you suspect fraud, abuse, or waste
What if you suspect fraud? Contact us immediately. Do not wait more than one day.
Texas Children’s Health Plan’s fraud hotline is 1-832-828-1320. The fax number is 1-832-825-8772. You can e-mail us at TCHPSIU@texaschildrens.org
Or send a letter to:
Texas Children’s Health Plan
Fraud and Abuse Investigations
Mail Code WLS 8360
PO Box 301011
Houston, TX 77230-1011
You do not have to give your name. Just tell us why you think there is fraud. Give us the name of the provider and tell us what you are worried about. We will take your concerns seriously. We will investigate every case. We may even send your concern to the State. Most often, we will teach the provider what they did wrong.
Please help us
Texas Children’s Health Plan wants to identify and prevent fraud. We need and appreciate your help. Call us with any questions.
Do you have thoughts or ideas that can help Texas Children’s Health Plan improve? We want to hear them!
Our Member Advisory Group (MAG) gives members a chance to tell us how we are doing, ask questions, and share ideas on how we can do better. MAG meeting participants include Texas Children’s Health Plan members, staff, and community partners. We value your opinion and are committed to providing you with the best quality of care.
Your feedback is important to us! Join our upcoming virtual MAG meeting and receive a $10 gift card for attending! As a member or parent, you are welcome to attend at no cost!
Member Advisory Group Registration
Topics will include:
Harris SA STAR/CHIP Member Advisory Groups
Thursdays 11:30 to 1:00 pm
Currently online
Jefferson SA STAR/CHIP Member Advisory Groups
Wednesdays 10:00 am to 11:00 am
Currently online
To learn more or if you have questions, call 832-828-1650 (CHIP/STAR)
Harris SA STAR Kids Member Advisory Group
Thursdays 11:30 am to 1:00 pm
Currently online
Jefferson SA STAR Kids Member Advisory Group
Wednesdays 11:15 am to 12:30 pm
Currently online
NE MRSA STAR Kids Member Advisory Group
Thursdays 11:30 am to 1:00 pm
Currently online
To learn more or if you have questions, call 903-594-4958 (STAR Kids)
How do I claim my card?
Who is eligible?
CHIP, STAR and STAR Kids members who attend the MAG meetings during July 1, 2022 and December 31, 2022.
Restriction and limitations may apply. Eligible participants may receive one (1) card per household per meeting, not to exceed $40/year.