How to Enroll in Health Plans
New Member Enrollment
Once the children in the family are found to be eligible and a start date for coverage has been set, HHSC will send the family a new member enrollment packet. Everyone who qualifies for CHIP can choose between at least two medical plans and two dental plans. Most children that qualify for Medicaid have a choice of several medical plans. They also have a choice of two dental plans. The enrollment packet will come with two Enrollment / Transfer Forms, one for medical and one for dental, and a payment coupon (if the family needs to pay an enrollment fee for CHIP). The family must take the following steps to complete enrollment:
- Pick a medical and dental plan.
- Sign both Enrollment / Transfer Forms.
- Return the Enrollment / Transfer Forms by the due date.
- Pay the enrollment fee by the due date, if there is a fee to be paid.
The family also can pick a medical or dental plan by calling the CHIP / Children's Medicaid call center at 1-800-964-2777. That call center is open 8 a.m. to 8 p.m. Central Time Monday to Friday except federal holidays. CHIP or Medicaid coverage cannot begin unless the family completes the enrollment process. Families, too, can find and pick their health plans and main doctor and dentist by going to YourTexasBenefits.com and following these steps:
1. Click on "View my case."
2. Log into your account or set up an account.
3. After you log in, the "Case facts" page will open.
4. Under your case number, there will be a "status" column. It will say “Pending: you need to enroll.”
5. Click on “enroll.”
6. Another website will open. Log in or set up an account.
7. Follow steps to add your CHIP EDG to your account. Then, you can use the site to pick: (1) a medical and dental plan, and (2) a doctor and dentist. Some families also need to pay a fee.
Families that need to pay a CHIP enrollment fee can pay by credit card online or by sending a check to:
PO Box 660287
Dallas, TX 75266-9792
Monthly Cutoff Dates for Enrollment
Both CHIP and Medicaid coverage are prospective. That means the start date of the coverage is relative to both the monthly cutoff date and when HHSC finishes processing the application.
|If HHSC receives the enrollment forms/fees…||Then coverage begins…|
|Before cutoff||1st day of the next month|
|After cutoff||1st day of the next process month|
|CHIP and Medicaid Cutoff Dates|
|March 19, 2014|
|April 16, 2014|
|May 14, 2014|
|June 18, 2014|
|July 16, 2014|
|August 19, 2014|
|September 17, 2014|
|October 15, 2014|
|November 18, 2014|
|December 17, 2014|
HHSC will send the family an enrollment confirmation notice when the enrollment process is complete. The notice will list:
- The enrollment start date
- The medical and dental plan that the family selected
- Each plan’s phone number
- What the family’s co-payments will be, if any
For families enrolled in CHIP, a Medical Payment Form is included with the notice to help families keep track of how much they pay in medical expenses while their children are covered. Once the family reaches the Payment Limit, which is based on the family’s income, they pay no more co-payments for the rest of that coverage period.
90-Day Waiting Period
Children enrolling in CHIP for the first time after being covered by private health insurance will have a 90-day waiting period before coverage begins.
There are some exceptions to this rule:
Children who lost insurance coverage because:
- Their parent lost their job because of a layoff, reduction-in-force, or the closing of a business.
- Their insurance benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) were stopped.
- The marital status of a child's parent changed.
- Their parent's employer stopped offering dependent coverage.
- Children who no longer are covered by insurance provided by the Texas Employees Retirement System (ERS) or CHIP in another state.
- Children whose previous health insurance coverage cost more than 10 percent of the family's gross income.
- Children who were covered under the Medicaid Program, but now determined eligible for CHIP by HHSC.
- Children, including newborns, who have been added to an existing CHIP or Medicaid case.