About the Health Plan
Texas Children’s Health Plan was founded in 1996 by Texas Children’s Hospital. We are the nation's first health maintenance organization (HMO) created just for children. We cover kids, teens, pregnant women, and adults. If you are able to get Medicaid or the Children’s Health Insurance Program (CHIP), we have a large group of more than 4,300 doctors, 6,800 specialists, 118 hospitals, and health resources to care for your needs.
What We Offer
Finding the right health plan for your family is important. Below you’ll find some of the exclusive benefits that are available to Texas Children’s Health Plan members.
It’s easier to renew while you still have CHIP and/or Medicaid coverage, and having good healthcare will prepare you for whatever comes your way. Renew now to continue access to benefits like doctor visits, prescriptions and dental care.
At Texas Children’s Health Plan, we go beyond our members’ medical needs. We offer extra benefits for you and your family to enjoy, in addition to rewarding you for keeping track of your health!
We put your family at The Center of care. The Center offers state-of-the-art healthcare all in one place, and it’s only for Texas Children’s Health Plan members.
Texas Children’s Health Plan is dedicated to helping you have a healthy pregnancy. Learn more about the resources and services available to pregnant members.
A better plan today means bigger dreams tomorrow.
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.
Veyo Member Transportation Line:
- 1-888-401-0170 (toll free)
- 1-346-232-4130 (local)
- For TTY/TDD call 1-800-735-2989
- Trip scheduling available Monday- Friday, 8am-5pm CT.
- “Where’s My Ride” trip updates will available 5am-7pm, Monday- Saturday. For updates, call the Member Transportation Line above.
- We speak English and Spanish. We also have interpreters available by phone who speak 140 different languages.
For more information about Veyo "Where's my ride" benefit click here.
Lost your coverage? There are a number of programs offered through Texas Health and Human Services that can help.
- The Healthy Texas Women Program - offers women’s health and family planning services. Is available to Texas women who meet the program rules.
- Healthy Texas Women Plus – gives more postpartum services for women. Available to those in the Healthy Texas Women program.
- Family Planning Program – focused on family planning and other healthcare. Available to women and men in Texas.
- Primary Health Care Program - works with clinics across Texas. It makes sure Texas residents can get the primary care they need. The program serves men, women and children.
Each program has rules for who can join. Visit the links above for more information on what they cover and how to join.
Texas Children’s Health Plan provides a Member Advocate to assist you if you have a complaint. Our team of member advocates will help you write and file a complaint or appeal on your behalf and monitor it until it is resolved. We have a member advocate dedicated for each line of business and service delivery area. We speak English and Spanish. We also have interpreters available by phone who speak 140 different languages.
To have a Member Advocate assigned to you, call 866-219-5411.
Before going to the Emergency Room, call the Nurse Help Line (unless it is an emergency). We are available 24-hours a day, 7 days a week. We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.
1-800-686-3831 or TDD 1-800-735-2989
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.
Here are some services our team can help you with, if needed:
- Oral interpretation (over the phone and face to face) and written translations assistance. Sign language available.
- Information in formats such as print, Braille, audiotapes or accessible electronic.
- Access to TTY/TDD services for hearing and speech impairment
Member Services Program Hotlines:
- 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
In case of an emergency, go to your nearest in-network emergency room or call 9-1-1.
Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.
Behavioral Health/Substance Abuse Hotline:
- CHIP: 1-800-731-8528
- STAR: 1-800-731-8529
- STAR Kids: 1-800-731-8529 (Service Coordination)
(no provider referral needed)
Providers can use this number for claims, inquiry, questions and information about CHIP, STAR, or STAR Kids products and to check eligibility/benefits.
Toll free: 1-877-213-5508
Texas Children’s Health Plan’s automated Telephone TouCHPoint system allows Texas Children’s Health Plan providers to check eligibility, benefits, and claims status after hours. The service is available 24 hours a day, 7 days a week. To access Telephone TouCHPoint call 832-828-1007. Enter the member’s identification number and the provider’s NPI number.
Telephone TouCHPoint: 832-828-1007
The Children’s Health Insurance Program (CHIP) offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage.
We offer CHIP in more than 20 counties in the Jefferson and Harris Service Areas.
STAR is a Medicaid-managed care plan. This plan helps family members of any age. Texas Children’s Health Plan offers STAR in more than 20 counties in the Jefferson and Harris Service Areas. Learn more about STAR.
STAR Kids is a Medicaid-managed care plan. This plan helps children and young adults under the age of 21 with disabilities. Texas Children’s Health Plan offers STAR Kids in the Harris, Jefferson and Northeast Service Areas.
Texas Children’s Health Plan offers CHIP perinatal services. CHIP prenatal is no-cost health coverage for pregnant women. To get CHIP perinatal, you must:
- Meet certain income requirements.
- Not qualify for Medicaid.
- Not have any other health coverage.
How is the Texas Vendor Drug Program (VDP) used for Texas Children's Health Plan Medicaid members?
Navitus is the provider for drug store services for members. The Texas VDP maintains and publishes the Texas VDP Formulary and the associated PDL. It also maintains and publishes the clinical guidelines for drugs not on the PDL which require pre-approval, and are used by Navitus to give benefits for Texas Children's Health Plan STAR and CHIP members.
What drug stores does Navitus have contracts with?
Navitus has contracts with more than 95% of the VDP providers in Texas. The Navitus drug store network includes national chain drug stores such as Walgreen's, CVS, HEB, Wal-Mart, Target, and Kroger. And many others. Navitus' drug store network can be found here.
Contact Member Services at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR) if you need help finding a drug store.
We want you to have the best resources for your health. Here is a list of helpful websites and links to our vendors:
1-844-212-7269 (STAR Kids)
Your child will have one of the following dental plans:
If you don't know who your child's CHIP dental plans is, call CHIP toll-free at 1-866-959-6555
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 State 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
Phone: 832-828-1001 or 1-866-959-2555
TTY/TDD: 1-800-735-2989 (Texas Relay) or 7-1-1
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, braille, and other formats)
Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact Texas Children’s Health Plan Member Services Department at 866-959-2555 (STAR),
866-959-6555 (CHIP), 800-659-5764 (STAR Kids) (TTY 7-1-1)