For Members | Texas Children's Health Plan
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For Members

 

Helpful Information for Members

Our Member Services team is ready to take your call from 8 a.m. to 5 p.m., Monday through Friday. After hours, on weekends and holidays, our answering service is ready to help you and/or take your messages. A Member Service Advocate will return your call the next business day. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages. Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.

Member Services

  • CHIP: 1-866-959-6555
  • STAR: 1-866-959-2555
  • STAR Kids: 1-800-659-5764 (Service Coordination)
  • TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1

To join, you can call: 1-877-782-6440 (STAR Kids) or 1-800-964-2777 (CHIP and STAR). For TTY/TDD call 1-800-735-2989.

Not a member? Call our Marketing Hotline at 1-800-990-8247 from 8 a.m. to 5 p.m., Monday through Friday. One of our representatives will be happy to assist you. You can also call the enrollment broker at 1-800-964-2777 from 8 a.m. to 6 p.m., Monday through Friday.

In case of an emergency, go to your nearest in-network emergency room or call 9-1-1.

Regular checkups and shots keep your children healthy. You can go to any Texas Health Steps doctor without a referral. To find a Texas Health Steps (THSteps) doctor near you, call us at 1-866-959-2555 or use our "Find a Doctor" tool.

For more information visit www.TXHealthSteps.com

Do not let other people use your/your child’s ID card. If the card is lost or stolen, call Member Services (toll-free) and a Member Advocate will send a new card to you.

CHIP: 1-866-959-6555
STAR: 1-866-959-2555
STAR Kids: 1-800-659-5764

Texas Children’s Health Plan will host quarterly Member Advisory Group meetings to gain valuable feedback from our current members on the initiatives, services, and programs offered by the health plan.  The information and member feedback gathered during these meeting will be used to guide future programs. 

These meetings will last no longer than one hour.  These quarterly meetings are being mandated by the state. Texas Children’s Health Plan must maintain a record of member advisory group meetings, including agendas, and minutes.

A State Fair Hearing is a chance for you tell the reasons why you think the services you asked for and couldn’t get should be allowed.

Can I ask for a State Fair Hearing? If you, as a member of Texas Children’s Health Plan, disagree with the health plan’s decision, you have the right to ask for a fair hearing. You may name someone to represent you by writing a letter to the health plan telling them the name of the person you want to represent you. A doctor or other medical provider may be your representative. If you want to challenge a decision made by Texas Children’s Health Plan, you or your representative must ask for the fair hearing at any time up until 90 days of the date on the health plan’s letter with the decision. If you do not ask for the fair hearing within 90 days, you may lose your right to a State Fair Hearing.To ask for a fair hearing, you or your representative should either send a letter to the health plan or call:

Texas Children’s Health Plan
Attention: Appeals Department NB8390
PO Box 300709
Houston, TX 77230
Fax: 832-825-8796
Phone: 832-828-1001 or 1-866-959-2555
TDD 1-800-735-2989 (Texas Relay) or 7-1-1

Click here for more information on State Fair Hearings

HHSC continues to require of Texas Children’s Health Plan to allow an extension for up to 30 days for members to request continuation of benefits after they receive an adverse benefit determination. This continuation of benefits extension time frame will end June 30, 2021.

Starting July 1, 2021, Texas Children’s Health Plan must apply the normal, regular and set timeframes for members to request continuation of benefits, which is no later than 10 days from the date they receive the adverse benefit determination notice.

As a Texas Children’s Health Plan member, you get all of the great health benefits from either CHIP or STAR Medicaid. You also get extra benefits that you may not get from other health plans. We want our members to be healthy and happy. That’s why we give our members fun things to do such as:

To request a printed handbook, please call member services. A handbook will be mailed within 5 business days at no cost to the member. The member services number can be found on the back of the ID card.

CHIP Member Helpful Links

CHIP Member Handbook
CHIP Provider Directory
CHIP Member Rights and Responsibilities
What Does it Cost?
CHIP Complaints
How To Submit a Complaint
CHIP Appeals
HHS-Administered Federal External Review Request Form

STAR Member Helpful Links

STAR Member Handbook
STAR Provider Directory
STAR Member Rights and Responsibilities
Medicaid Complaints
How To Submit a Complaint
Medicaid Appeals

STAR Kids Member Helpful Links

STAR Kids Member Handbook
STAR Kids Provider Directory
STAR Kids Member Rights and Responsibilities
STAR Kids Complaints
How To Submit a Complaint
STAR Kids Appeals
Service Coordination
The Consumer Directed Services (CDS) Option