CHIP Perinate

Call Member Services at 1-888-814-2352 (TTY 7-1-1) or view your Member Handbook.

Hours of operation are Monday - Friday from 8 am to 5 pm. 

If you have health-related questions, call our 24-hour Nurse Line at 1-800-357-3162 for help from a nurse 24 hours a day, 7 days a week.

We have special services for people who have trouble reading, hearing, or seeing, or speak a language other than English or Spanish. If you prefer materials in alternate formats, we will mail you a hardcopy, or you can ask for the handbook in audio, Braille, large print, or another language — at no cost to you. Just contact us, and we’ll make sure you get it in the format you need.

Please call Member Services at 1-888-814-2352 (TTY 7-1-1) to contact interpreter services.

If you are a CHIP Perinate recipient, we offer regular benefits to you such as:

• Up to 20 prenatal visits
  • Every 4 weeks through 28 weeks
  • Every 2–3 weeks from 28–36 weeks
  • Weekly from 36 weeks to delivery
  • Extra visits if medically necessary
• Lab tests, assessments, education, and counseling
• Prescription drug coverage, including prenatal vitamins
• Diabetic supplies with a doctor’s prescription
• Hospital and delivery services, with coverage depending on income:
  • If your income is a little higher, CHIP pays for both the hospital stay and doctor services (199–202% of the Federal Poverty Level, or FPL).
  • If your income is lower, CHIP pays for doctor services and Emergency Medicaid pays for the hospital stay (198% of the FPL or below).          

After delivery:

• Two postpartum visits for the mother.
• The baby receives CHIP or Medicaid coverage based on family income, including regular checkups, immunizations, and prescriptions
• Most CHIP Perinate newborns qualify for Medicaid. If eligible, you’ll receive a letter and Form H3038-P (CHIP Perinatal – Emergency Medical Services Certification) before delivery.

Once you have chosen Parkland Community Health Plan, your next step is to select who will provide the majority of health care services to you. Your primary care physician (PCP) will be the one you call when you need medical advice, when you are sick, and when you need preventive care such as immunizations. Each member may select his or her own PCP.

You will select a PCP from PCHP’s extensive network of family or general practitioners and pediatricians. The selection of a PCP is crucial for immediate access to acute and preventive care.

Find a list of physicians and providers in the Parkland Community Health Plan network. You can also call our Member Services department at 1-888-814-2352 for assistance.

A referral is when your primary care provider (PCP) recommends that you or your child see a specialist for care they cannot provide in their office. Your PCP can help you choose the right specialist and coordinate the next step in your care. If your doctor refers you to an in-network doctor, you do not need to get approval from Parkland Community Health Plan (PCHP) before you visit that doctor. However, referrals to out-of-network doctors; and certain services, treatments, or procedures you may receive from your doctors may require approval. That approval is called prior authorization. Your doctors are responsible for coordinating prior authorizations with PCHP, but if you have any questions, call Member Services at 1-888-814-2352.

Having a baby can be exciting and life-changing. What you do during your pregnancy can have a big impact on your baby’s health – and your own health as well. Our pregnancy guide will give you an idea of what to expect throughout your pregnancy, as well as during and after childbirth.

Use it as a place to:

• Write down questions for your doctor.
• Take notes about how you’re feeling.
• Track your baby’s progress.
• Keep your baby’s ultrasound photos.
• And more!

We’re here to help you and your baby stay healthy, during your pregnancy and after the baby is born. If you have questions about the information in this guide, ask your doctor. You can also call Parkland Community Health Plan (PCHP) for more details about plan benefits and services. Check the back of this guide for contact information.

English Guide.

Spanish Guide.

What is a prior authorization?

Under medical and prescription drug plans, certain services and medications may need approval from PCHP before they’re covered. This approval is called a prior authorization, and your doctor will work with PCHP to get this approval for you.

What types of medications typically need approval?

Those that:

• May be unsafe when combined with other medications
• Have lower-cost, equally effective alternatives available
• Should only be used for certain health conditions
• Are often misused or abused
• Are often used for cosmetic purposes

Medications that require approval will only be covered by your plan if your doctor requests and receives approval from PCHP.

What types of services typically need approval?

Your doctor and PCHP can tell you if the services you need will require prior authorization. You member handbook is also a good resource and lists limitations and exclusions for your health plan. Generally, these services may require prior authorization:

• Durable medical equipment
• Home health
• Private duty nursing
• Rehabilitation
• Surgery
• Therapy

Refer to your member handbook or call Member Services if you have questions about services requiring prior authorization.

What’s the difference between prior authorization and pre-authorization?

None; these terms mean the same thing and are used interchangeably. However, most insurance companies will use the term “prior authorization” instead of “pre-authorization.”

How does the prior authorization process work?

Prior authorizations are handled by your doctor’s office and PCHP. We will contact you with the results to let you know if your medications or services have been approved or denied, or if we need more information.

If you are unhappy with your prior authorization decision, you or your doctor can ask for a review of the decision. In the case of denials for prescription drugs, your doctor may choose to prescribe a different but equally effective medication. In some instances, PCHP may recommend you try an alternative medication that’s less costly, but equally effective, before the medication your doctor originally prescribed can be approved.

Learn more here.