Insurance | PH&H

Anchor 1

ACCEPTED INSURANCE PLANS

Individual Health Care Plans
Employer health plans

Services Covered at 30% coinsurance member cost

Home Health Care Services (60 visits/year. Referral required. Preauthorization may also be required; see your benefit booklet* (Extended Care Services) for details.)
Rehabilitation services (Separate 35-visit maximum per benefit period for Habilitation and Rehabilitation services, including chiropractic care. Referral required. Preauthorization may also be required; see your benefit booklet* (Rehabilitation Services and Habilitation Services) for details.)
Skilled nursing care (25 days/year. Referral required. Preauthorization may also be required; see your benefit booklet* (Extended Care Services) for details.)

STAR Group
CHIP Perinatal Group
Community Premier Bronze Marketplace Group
Community Select Limited Network Bronze Marketplace Group
Community Select Limited Network Gold Marketplace Group
Community Premier Gold Marketplace Group
CHIP Group
D-SNP Group
STARPLUS Group
Community Select Limited Network Silver Marketplace Group
Community Premier Silver Marketplace Group

Services Covered by Medicaid and CHIP

Regular checkups at the doctor and dentist
Medicine and vaccines
Hospital care and services
X-rays and lab tests
Vision and hearing care
Access to medical specialists and mental health care
Treatment of special health needs and pre-existing conditions

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

Superior HealthPlan has a program for CHIP Perinatal Care that is part of Texas’ Children’s Health Insurance Program (CHIP). These benefits are designed to provide prenatal services to unborn children of pregnant low-income women, who do not qualify for Medicaid.

Superior also offers CHIP Perinatal Newborn coverage in Texas. With CHIP Perinatal Newborn, your baby’s healthcare coverage is available for twelve months. The coverage begins when you enroll the unborn baby while you are pregnant.

• For D-SNP members, Medicare is always the primary payor and Medicaid is secondary payor. • D-SNP members may have both Superior Medicare and Superior Medicaid but not always, so it is important to verify coverage prior to servicing the member. You may see members with Superior Medicare where their Medicaid is under another health plan or traditional Fee-For-Service (FFS) Medicaid or vice versa.

Geriatrics and Extended Care

Medicaid is a state administered insurance program that helps people with low income pay for their medical costs. This may include help with Medicare premiums, copays, and deductibles. Medicaid can also pay for some services not covered by Medicare, including long term care services.

Medicaid for person(s) with

Have two or more chronic conditions
Have one chronic condition and are at risk for a second
Have one serious and persistent mental health condition

Services include the following:

Comprehensive care management
Care coordination
Health promotion
Comprehensive transitional care/follow-up
Patient & family support
Referral to community & social support services

Home Health Services

Medically necessary part-time or intermittent skilled nursing care, like:
- Wound care for pressure sores or a surgical wound
- Patient and caregiver education
- Intravenous or nutrition therapy
- Injections
- Monitoring serious illness and unstable health status

PH&H

ACCEPTED INSURANCE PLANS

Services Covered at 30% coinsurance member cost

Home Health Care Services (60 visits/year. Referral required. Preauthorization may also be required; see your benefit booklet* (Extended Care Services) for details.)

Rehabilitation services (Separate 35-visit maximum per benefit period for Habilitation and Rehabilitation services, including chiropractic care. Referral required. Preauthorization may also be required; see your benefit booklet* (Rehabilitation Services and Habilitation Services) for details.)

Skilled nursing care (25 days/year. Referral required. Preauthorization may also be required; see your benefit booklet* (Extended Care Services) for details.)

Services Covered by Medicaid and CHIP

Geriatrics and Extended Care

Program of General Caregiver Support Services

Medicaid for person(s) with

Part B (Medical Insurance)

Home Health Services

PH&H

Start yourhealth journeytoday at PH&HStart yourhealth journeytoday at PH&H

ACCEPTED INSURANCE PLANS

Geriatrics and Extended Care

Medicaid for person(s) with