Beneficios de CHIP y STAR Medicaid

Es su mundo. Nostros lo cubrimos.

Como miembro del Dell Children’s Health Plan recibes toda la cobertura y beneficios que vienen con CHIP y STAR Medicaid. Si tienes preguntas sobre tus beneficios, queremos ayudar. Por favor llámanos al 1-888-596-0268 (TTY 711) o llena un formulario de contacto.

CHIP y STAR Medicaid cubren:

  • Chequeos médicos regulares y visitas al consultorio
  • Medicamentos recetados
  • Vacunas
  • Servicios de hospital (si es necesaria una hospitalización o solo venir por un par de horas)
  • Servicios de sala de emergencia y ambulancia
  • Exámenes de los ojos y anteojos para niños y adultos
  • Exámenes dentales (solo para menores de 21 años)
  • Visitas de Pasos Sanos de Tejas (solo para miembros de STAR Medicaid)
  • Chequeos de rutina anuales (solo para miembros de CHIP)
  • Servicios de salud mental para el tratamiento de la adicción al alcohol o drogas
  • Suministros médicos
  • Rayos X
  • Pruebas de laboratorio
  • Consejos médicos de un especialista pediátrico en nuestra red
  • Poder reunirte con un médico de salud mental
  • Tratamiento de necesidades especiales:
    • Terapia física
    • Cuidado de salud en el hogar
    • Cuidado de los pies
    • Terapia del habla
    • Terapia ocupacional (para miembros que necesitan ayuda adicional para aprender destrezas tales como agarrar correctamente el lápiz o abrocharse los botones de la ropa)
    • Trasplantes
  • Tratamiento de condiciones preexistentes (preexistente significa cualquier necesidad médica que tenías antes de entrar al plan de salud)
  • Transporte a citas médicas
  • Servicios de interpretación y traducción
  • Cuidado de salud para la mujer:
    • Cuidado para el embarazo y cuidado prenatal
    • Cuidado por enfermeras/parteras
  • ¡Más ostros beneficios extra!

Beneficios para mamás embarazadas a través de CHIP Perinatal

  • Hasta 20 visitas durante el embarazo
  • Cobertura de medicamentos recetados
  • Costos del parto
  • Dos visitas al doctor después del parto
  • Chequeos médicos regulares, vacunas y medicamentos recetados para tu bebé

¡Visita nuestra página de Beneficios para mamás embarazadas y nuevas para aprender sobre más beneficios extra!

Farmacia

Si necesitas ayuda para encontrar una farmacia, visita nuestra página Encuentra un doctor.

Si tienes problemas para que te despachen tus medicamentos o necesitas más ayuda para encontrar una farmacia, llama a Servicios a los Miembros al 1-888-596-0268 (TTY 711).

Si estás tomando un medicamento con receta por más de 30 días, considera usar la farmacia de pedido por correo. Es fácil y te ahorra dinero. Visita Navitus Health Solutions para más información.

El Programa de farmacia de CHIP no cubre:

  • Medicamentos de venta sin receta
  • Medicamentos anticonceptivos necesarios solo para propósitos del control de la natalidad
  • Productos nutricionales
  • Suministros o equipo médico, excepto jeringas para insulina
  • Medicamentos que solo se pueden despachar en el consultorio médico o clínica

Regresar arriba

Salud del comportamiento y abuso de sustancias

Los miembros pueden recibir ayuda para el comportamiento llamando al 1-888-596-0268 (TTY 711). En la sección Encuentra un doctor hay una lista de proveedores de salud mental.

Mental Health or Substance Abuse Benefits Flyer (Hoja informativa sobre los beneficios de salud mental o abuso de sustancias) (PDF, 493 KB)

Regresar arriba

Asthma is a long-term condition that makes it hard to get air into the lungs. Asthma may cause wheezing, tightness in the chest, shortness of breath, and coughing.

We can give you an asthma action plan for you and your health-care provider to complete. This will help monitor your condition, stay away from your triggers, and manage your medication (meds).

Learn more:

Asthma

Know Your Triggers

Asthma Attack

Asthma Action Plan

Bipolar disorder is a brain disorder that can cause unusual changes in mood, energy and activity level, and make it hard to carry out day-to-day tasks.

It can feel uneasy to learn you’re living with bipolar disorder, so we’re here to help. With proper treatment and support, you can enjoy a healthy, happy and productive life.

Learn more:

Bipolar Disorder

Symptoms

When to Call a Doctor

COPD is a condition in which damage to the lungs has caused the airways to change shape and feel partly blocked. This makes it hard to breathe.

We can help you learn to breathe easier to possibly improve your quality of life. We’ll help you learn how to use inhalers, spacers, nebulizers, and other devices, along with other skills for living with COPD.

Learn more:

COPD

COPD: Learning to Breathe Easier

Taking care of your heart is one of the best things you can do for your health. The heart pumps blood to the whole body. Having CHF means the heart can’t pump as hard as it should.

We can help you understand CHF better. That way, you and your health-care provider(s) can work together to help you feel your best.

Learn more:

Heart Failure

Symptoms

When to Call a Doctor

Your heart is only the size of a fist, but it’s one of the most important muscles in your body. Arteries throughout the body supply blood to your heart. When those arteries are blocked, and blood flow to the heart is reduced, it causes CAD.

We can help you with tips and tools, like making good food choices and following up with your doctor to keep your CAD in check.

Learn more:

Coronary Artery Disease (CAD)

Symptoms

Health tools

When to Call a Doctor

If you’re living with diabetes, you’re not alone. Diabetes happens when your body’s blood sugar (the amount of sugar in the blood) levels are usually higher than normal. It means there’s a problem making enough of a hormone called insulin, or your body isn’t using insulin like it should.

We can help you lower your risk of complications (problems or issues) and make your quality of life better.

Learn more:

Type 1 Diabetes

Type 2 Diabetes

Taking Care of Your Feet

Healthy Eating Tips

Human immunodeficiency virus (HIV) is a virus that attacks the immune system (the body’s natural defense against illness). It makes it hard for the body to fight infection and disease. If HIV isn’t treated, it can lead to AIDS. AIDS stands for acquired immunodeficiency syndrome. It is the last stage of the HIV virus.

We’re here to help you with simple steps for living with HIV/AIDS. Taking your medications the right way, eating healthy, staying active, and following your treatment plan can make a difference.

Learn more:

HIV (Human Immunodeficiency Virus) Infection

AIDS

Symptoms

Health Tools

Hypertension is also called high blood pressure. Blood pressure is the amount of force it take for your heart to pump blood through your body. When your blood pressure is high, it can lead to other health problems.

We can help you make short- and long-term goals that will help you manage your blood pressure.

Learn more:

High Blood Pressure

Symptoms

What Increases Your Risk

Everyone feels blue or sad some of the time, but these feelings don’t last very long. When a person has major depressive disorder (MDD or clinical depression), these feelings don’t go away easily. They can get in the way of your everyday life.

Depression is common and a real illness. The important thing to know is that it can be treated. We’re here to help you find resources in your area or help you talk with your family or caregiver about MDD.

Learn more:

Depression

Symptoms of Depression

Kids and teens can also have major depressive disorder (MDD or clinical depression).

We can help kids and teens talk with their families and health-care providers about MDD, get treatment, and live a healthier life.

Learn more:

Depression in Children and Teens

Schizophrenia is a behavioral health disorder that affects a person’s thoughts, feelings, emotions, decisions, and actions. Some even have a hard time with focusing and memory loss. It can get in the way of daily life.

We’re here to help you learn how to manage schizophrenia with medication, treatment, and support.

Learn more:

Schizophrenia

Symptoms

Schizophrenia: When Hospital Care is Needed

When to Call a Doctor

Substance use disorder is a disease that leads to the use of drugs, alcohol, or other substances in a way that causes problems for your health or in your life.

We can help those with substance use disorder work together with their health-care provider(s) to talk about treatment options (choices of ways to get better) and finding local community programs and resources.

Learn more:

Substance Use Disorder

Treatment

For Family and Friends

When to Call a Doctor

Any Dell Children’s Health Plan member with any of the health conditions listed can participate in a DM program. Our DM case manager can talk with you about your health history and health goals, and work with you to offer strategies and support so you can live well.

They can also offer educational materials and tools for weight management and tobacco cessation (how to stop using tobacco, like quitting smoking).

Members, you’ll get a letter welcoming you to a DM program, if you qualify. Or, call us toll free at
1-888-830-4300 (TTY 711) from 8:30 a.m. to 5:30 p.m. Central time, Monday through Friday.

When you call, we’ll:

  • Set you up with a DM case manager to get started
  • Ask you some questions about your or your child’s health
  • Start working together to create your or your child’s plan

You can also email us at dl-txdelladvocate@anthem.com.

Please be aware that emails sent over the internet are usually safe, but there is some risk third parties may access (or get) these emails without you knowing. By sending your information in an email, you acknowledge (or know, understand) third parties may access these emails without you knowing.

You can choose to opt-out (we’ll take you out of the program) of the program at any time. Please call us toll free at 1-888-830-4300 (TTY 711) from 8:30 a.m. to 5:30 p.m. Central time, Monday through Friday to opt-out. You may also call this number to leave a private message for your DM case manager 24 hours a day.

When you join a DM program, you have certain rights and responsibilities. You have the right to:

  • Get details about us, such as:
    • Programs and services we offer
    • Our staff and their qualifications (skills or education)
    • Any contractual relationships (deals we have with other companies)
  • Opt-out of DM services
  • Know which DM case manager is handling your DM services and how to ask for a change
  • Get support from us to make health-care choices with your health-care providers
  • Ask about all DM-related treatment options (choices of ways to get better) mentioned in clinical guidelines (even if a treatment is not part of your health plan), and talk about options with treating health-care providers
  • Have personal data and medical information kept private
  • Know who has access to your information and how we make sure your information stays secure, private, and confidential
  • Receive polite, respectful treatment from our staff
  • Get information that is clear and easy to understand
  • File complaints to Dell Children’s Health Plan by calling 1-888-830-4300 (TTY 711) toll free from 8:30 a.m. to 5:30 p.m. Central time, Monday through Friday and:
    • Get help on how to use the complaint process
    • Know how much time Dell Children’s Health Plan has to respond to and resolve issues of quality and complaints
    • Give us feedback about the DM program

You also have a responsibility to:

  • Follow the care plan that you and your DM case manager agree on
  • Give us information needed to carry out our services
  • Tell us and your health-care providers if you choose to opt-out (leave the program)

Disease Management does not market products or services from outside companies to our members. DM does not own or profit from outside companies on the goods and services we offer.

For a written version of your DM rights and responsibilities or information on this website, please print this page or call Member Services.

El Programa de Seguro Médico para Niños (CHIP) es una cobertura de cuidado de salud para personas que no califican para Medicaid pero que no pueden pagar un seguro de salud privado.

CHIP cubre a los niños desde el nacimiento hasta los 18 años de edad por estos servicios:

  • Cuidado médico
  • Medicamentos recetados
  • Cuidado dental
  • Cuidado de la vista
  • Salud del comportamiento

CHIP Perinatal cubre a las mujeres embarazadas y nuevas mamás.

Cuota de inscripción

  • La cuota se basa en los ingresos de la familia. Algunas familias deberán pagar $35 o $50 al año para inscribirse, pero las familias de menores ingresos no pagan nada.

Copagos

  • Los copagos se basan en los ingresos de la familia.
  • Las familias de menores ingresos tendrán copagos entre $0 y $5.
  • Las familias de mayores ingresos tendrán copagos entre $10 y $35.

No hay cuotas de inscripción ni copagos para los miembros de CHIP Perinatal.

Los beneficios de CHIP se deben renovar cada 12 meses. Renueva tus beneficios.

Visita YourTexasBenefits.com para más información sobre CHIP.

STAR Medicaid provee cobertura de cuidado de salud para niños desde el nacimiento hasta los 20 años de edad. También se llama Medicaid para Niños. Cubre niños, mujeres embarazadas y algunos jóvenes que estuvieron en hogares de crianza en el pasado.

Cada plan tiene:

  • Un médico de cuidado primario de tu elección
  • Un amplio grupo de especialistas
  • Terapeutas
  • Clínicas
  • Hospitales

Algunos servicios incluyen:

  • Cuidado médico
  • Medicamentos recetados
  • Cuidado dental
  • Cuidado de la vista
  • Salud del comportamiento
  • Servicios perinatales

No hay cuotas de inscripción ni copagos.

Los beneficios de STAR Medicaid se deben renovar cada 12 meses. Renueva tus beneficios.

Visita YourTexasBenefits.com para más información sobre STAR Medicaid.

Es posible obtener cobertura perinatal de CHIP si todos los siguientes aplican en tu caso:

  • Estás embarazada
  • Eres residente de Texas
  • No tienes seguro
  • No puedes obtener Medicaid

La cobertura de CHIP Perinatal es para tu bebé que no ha nacido y cubre:

  • Hasta 20 visitas durante el embarazo
  • Medicamentos recetados
  • Costos del parto
  • Dos visitas al doctor para la mamá después del parto

Chequeos médicos regulares, vacunas y prescripciones para tu bebé Es posible que tu niño también pueda continuar la cobertura bajo el programa CHIP.

Una mujer embarazada con poco o ningún ingreso puede recibir beneficios de Medicaid durante el embarazo y hasta dos meses después del parto si cumple con ciertos requisitos de ingresos.

Consulta nuestros Beneficios para mamás embarazadas y nuevas.

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¿Preguntas?

¡Estamos aquí para ayudar! Llámanos al 1-888-596-0268 (TTY 711) o llena un formulario de contacto. También puedes ver el manual para miembros para más información sobre cómo usar tus beneficios.

Si ya tienes CHIP or STAR Medicaid, también puedes cambiar tu plan de salud en cualquier momento. Solo llama a la Línea de Ayuda de CHIP/STAR Medicaid al 1-800-964-2777 y diles que deseas convertirte en miembro del Dell Children’s Health Plan.