Health Care Benefits


  • 72-hour supplies of emergency prescriptions
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  • Ambulance services
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  • Audiology services (hearing tests) including hearing aids for adults (audiology services and hearing aids for children under the age of 21 are a non-capitated service)
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  • Behavioral Health

     

    • Inpatient mental health services for adults and children
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    • Outpatient mental health services for adults and children
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    • Outpatient chemical dependency services for children (under age of 21)
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    • Detoxification services
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    • Psychiatry services
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    • Counseling service for adults (21 years of age and over)
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  • Substance use disorder treatment services, including:

     

    • Outpatient services, including:

       

      • Assessment
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      • Detoxification services
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      • Counseling treatment
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      • Medication assisted therapy

       

    • Residential services, including:

       

      • Detoxification services
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      • Substance use disorder treatment

       

    • Mental Health Rehabilitative Services: Services that reduce a Member’s disability resulting from severe mental illness, serious emotional, behavioral, or mental disorders

       

    • Targeted Case Management: Services that assist Members with getting access to needed medical, social, educational, and other services and supports.

     

  • Birthing services provided by a physician or Advanced Practice Nurse in a licensed birthing center
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  • Birthing services provided by a licensed birthing center
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  • Cancer screening, diagnostic and treatment services
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  • Chiropractic services
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  • Dialysis
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  • Disease management programs
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  • Drugs and biologicals provided in an inpatient setting
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  • Durable medical equipment and supplies
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  • Early childhood intervention services
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  • Emergency services
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  • Family planning services
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  • Health education related to obesity
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  • Home health care services, including home telemonitoring
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  • Hospital services, inpatient and outpatient
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  • Laboratory services
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  • Mastectomy, breast reconstruction, and related follow-up procedures, including:

     

    • Outpatient services provided at an outpatient hospital and ambulatory health care center as clinically appropriate; and physician and professional services offered in an office, inpatient, or outpatient setting for:
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      • All stages of reconstruction on the breast(s) on which medically necessary mastectomy procedure(s) have been performed
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      • Surgery and reconstruction on the other breast to produce symmetrical appearance
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      • Treatment of physical complications from the mastectomy and treatment of lymphedemas
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      • Prophylactic mastectomy to prevent the development of breast cancer

       

    • External breast prosthesis for the breast(s) on which medically necessary mastectomy procedure(s) have been performed

     

  • Medical checkups and Comprehensive Care Program (CCP) Services for children (under age 21) through the Texas Health Steps Program
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  • OB/GYN
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  • Optometry, glasses, and contact lenses, if medically necessary
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  • Oral evaluation and fluoride varnish in the Medical Home along with Texas Health Steps medical checkup for children 6 months through 35 months of age
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  • Outpatient drug programs
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  • Outpatient drugs and biologicals; including pharmacy-dispensed and provider-administered outpatient drugs and biologicals
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  • Prenatal Care
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  • Podiatry
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  • Primary care provider services
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  • Preventive services including an annual adult wellcheck for patients 21 years of age and over
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  • Radiology, imaging, and X-rays
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  • Service Coordination
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  • Specialty physician services
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  • Therapies: physical, occupational, and speech
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  • Transplantation of organs and tissues
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  • Vision Care
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If you have Medicare coverage and STAR+PLUS, your Medicare coverage will be your primary coverage. This means that your Medicare coverage is always the first insurance to be used. STAR+PLUS will not change your Medicare coverage.

 

If you can receive Medicare and Medicaid, you are Dual-Eligible. If you have questions about your Medicare benefits and coverage, please visit www.medicare.gov.