Parkland KIDSfirst (CHIP)

Parkland KIDSfirst (CHIP)

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.

 

With Parkland KIDSfirst, you and your child can go to health education classes to learn how to treat certain medical conditions, such as diabetes and asthma.

Parkland KIDSfirst members have healthcare for 12 months. Parents must re-enroll every 12 months for coverage to continue.

Perinate & Newborn Services

If you are pregnant, a Texas resident, do not have insurance, and cannot get Medicaid, you may be able to get perinatal coverage from Parkland CHIP.

This coverage is for your unborn baby, including your labor with delivery, and your baby’s health and medical services for its first months of life.

CHIP Copayments

Copayments for medical services or prescription drugs are paid to the healthcare provider at the time of service. You do not have to pay copayments for preventive care such as well-child or well-baby visits or immunizations. There are no copays for pregnancy-related assistance, either.

Your child’s PCHP ID card lists the copayments that apply to your family. Present your ID card when your child gets office visits or emergency room services or has a prescription filled.

Enrollment fees are $50 or less per family each year. Copays range from $3 to $35 depending on income. There are no copays for services covered by CHIP Perinate.

PCHP CHIP Cost Sharing Chart


Members may make changes to their account online at www.yourtexasbenefits.com, by calling 2-1-1, or by contacting a local HHSC benefits office.


 

Frequently Asked Questions

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.

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

Once you have chosen Parkland Community Health Plan, your next step is to select who will provide the majority of healthcare 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.

Click here for 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.

PCHP makes every effort to provide new members with ID cards as quickly as possible. During the time of enrollment processing, members and providers may verify eligibility through PCHP’s secure web portals.

If you need to request a replacement or additional ID card, you may do so through our Member Portal. You may also call Member Services at 1-888-814-2352.

To learn more about your ID card, click here.

If you go to the doctor’s office without your member ID card, you can tell them you’re with Parkland Community Health Plan. The doctor’s office will call us to verify your information.

You can also view your ID card on our Member Portal. Do your best to bring your card with you to every appointment.

The Member Guide you received from CHIP when you enrolled your child in CHIP insurance in Texas includes a tear-out form that you should use to track your CHIP expenses. To make sure you do not go over your cost-sharing limit, please keep track of your CHIP-related expenses on this form.

The enrollment packet welcome letter tells you exactly how much you must spend before you are eligible to mail the form back to CHIP. If you lose your welcome letter, please call Member Services at 1-888-814-2352. They will tell you what your annual cost-sharing limit is.

When you reach your annual cost-sharing limit, please send the form to CHIP. They will notify PCHP. We will issue a new PCHP Member ID card for your child. This new card will show that no co-payments are due when your child receives services for the remainder of the enrollment period.

You can access your secure member portal by using the Member Login link. This is a secure web portal where you can request an ID card, ask to change your PCP, file a complaint, or ask a question.

One of our main goals is to help you stay as healthy as possible. The HRA is one way we do this. It’s a series of easy questions about your health and lifestyle.

Filling out the HRA is easy and should take less than 15 minutes to complete.

Log into your Member Portal and complete the "Children and Adults Health Survey" or "Pregnant Moms Health Survey".

Please visit the online pharmacy listing or call Member Services at 1-888-814-2352 for drugstores that are near you. For local pharmacies in the Dallas service delivery area, click here.

There are some medications that may not be covered through Medicaid or CHIP. A pharmacy in the Navitus network can let you know which medications are not covered. The pharmacy can also help you find another medication that is covered. You can also ask your doctor or clinic about what medications are covered, and what is best for you.

The Texas Vendor Drug Program has a list of drugs on the Preferred Drug List (PDL). A drug that is covered by this PDL may be brand or generic. The provider is asked to look at the Vendor Drug Program website when prescribing medication and write for the preferred product.

If you need help with a problem or have a complaint, please call our Member Services department at 1-888-814-2352. You can also send a written complaint, or a Member Services advocate can write down your complaint for you.

Parkland Community Health Plan
Attention: Member Advocate
P. O. Box 560347
Dallas, TX 75356

For more information on the process, timeframes, and next steps, visit our Complaints & Appeals page.

If you suspect a client (a person who receives benefits) or a provider (e.g., doctor, dentist, counselor, etc.) has committed fraud, waste, or abuse, you have a responsibility and a right to report it.

Fill out our fraud, waste, or abuse form, and submit it to us directly by:

  • Mail: Parkland Community Health Plan
    Attn: Special Investigations Unit
    P.O. Box 560307
    Dallas, TX 75356
  • Phone: 800-351-0093
    Available 24 hours a day, 7 days a week.
  • Email: PCHPSIU@phhs.org

For more information, visit our Fraud & Abuse page.

What is prior authorization?

Under medical and prescription drug plans, certain medications may need approval from your health insurance carrier before they’re covered.

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 your health insurance company.

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 for prescription drugs are handled by your doctor’s office and your health insurance company. Your insurance company will contact you with the results to let you know if your drug coverage has been approved or denied, or if they need more information.

If you are unhappy with your prior authorization decision, you or your doctor can ask for a review of the decision, or, your doctor may prescribe a different but equally effective medication. In some instances, your health insurance company 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 about Prior Authorization here.

Call toll-free to talk to someone if you need help right away. You do not need a referral for mental health or substance abuse services.

STAR/CHIP: 1-800-945-4644
CHIP Perinate: 1-888-814-2352
English/Spanish interpreter services available 24 hours a day, 7 days a week
https://www.beaconhealthoptions.com/members/login/

Please contact your dental plan:

If you have any additional questions regarding your eligibility, please contact Member Services at 1-888-814-2352.

Please contact SuperiorVision regarding your vision eligibility and benefits at 1‐800‐879‐6901, or click here to visit their website.

As a CHIP member, you have access to the following extra benefits including:

  • 24-hour Nurse Line
  • Extra vision benefits
  • Free sports and school physicals
  • Member paid rewards programs
  • And more…

Call us at 1-888-814-2352 to learn more about these and other benefits. You can also see all the rewards and track your reward points online.