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CHIP Member Handbook
Community participates in the Children's Health Insurance Program (CHIP), including CHIP Perinatal (CHIP-P). CHIP is a health insurance plan for children under the age of 19 and is designed for families who earn too much money to qualify for Texas Medicaid programs, yet cannot afford to buy private insurance. CHIP-P provides prenatal care for the unborn children of low-income women who do not qualify for Medicaid.
STAR Member Handbook
Community participates in the State of Texas Access Reform (STAR) Managed Care Program (Medicaid). As a part of Medicaid, Community provides both Children’s Medicaid and Medicaid for Pregnant Women. These programs are at no cost to U.S. residents who cannot afford health insurance.
Community proudly offers individual health insurance in the new Health Insurance Marketplace. With a range of plan options to fit any budget, and a network of doctors you can trust, like Kelsey-Seybold Clinic and Memorial Hermann, Community makes it easy to get the care you need and deserve.
During the Health Insurance Marketplace’s open enrollment, October 31 through March 31, our Member Services Department will be extending their hours. We’ll be answering phone calls from 7:00 a.m. – 7:00 p.m. to make sure that you can get the help you need, when you need it.
Information is available in English and Spanish. Call us to get an interpreter. Information can also be made available in audio, large print, Braille or other languages, if needed.
Call our Member Services toll-free at 1.888.760.2600 to ask for these special services or to answer any questions you may have about the Member Handbook. Call 8:00 a.m. – 6:00 p.m., Monday – Friday, excluding state-approved holidays. Access your Member account online 24 hours a day, seven days a week.
Call the Nurse Help line before going to the emergency room, unless it is an emergency. A nurse will answer your health care questions and help the Member get the care they need.
Information is available in English and Spanish. Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital.
Providers call this number for information on our health plan and our Members that they serve.
713.295.2295; Monday - Friday; 8:00 a.m. - 5:00 p.m.
When can I request a State Fair Hearing?
You can request a State Fair Hearing anytime during or after Community Health Choice’s appeals process. You do not have to follow the internal complaint and appeal’s process before requesting a Fair Hearing.
Can I ask for a State Fair Hearing?
If you, as a Member of the 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 your health plan, you or your representative must ask for the fair hearing within 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 fair hearing. To ask for a fair hearing, you or your representative should either send a letter to the health plan at:
Community Health Choice, Inc.
Member Appeals Coordinator
2636 South Loop West, Suite 125
Houston, TX 77054
You have the right to keep getting any service the health plan denied or reduced, at least until the final hearing decision is made if you ask for a fair hearing by the later of: (1) 10 calendar days following the MCO’s mailing of the notice of the Action, or (2) the day the health plan’s letter says your service will be reduced or end. If you do not request a fair hearing by this date, the service the health plan denied will be stopped.
If you ask for a fair hearing, you will get a packet of information letting you know the date, time, and location of the hearing. Most fair hearings are held by telephone. At that time, you or your representative can tell why you need the service the health plan denied.
HHSC will give you a final decision within 90 days from the date you asked for the hearing.
Beacon Health Options
24 hours a day, 7 days a week
Information is available in English and Spanish. Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital. This includes assessment, counseling, and treatment services. Services provided by a licensed psychologist, licensed professional counselor, licensed master’s social worker, advanced clinical practitioner or licensed marriage and family therapist are not covered for Members 21 years and older. You do not need a referral for behavioral (mental) health services or drug and alcohol treatment. Community Health Choice follows the Mental Health Parity Addiction Equity Act (MHPAEA). We review to make sure that requirements for mental health benefits are the same or less than medical benefits.