Revision 18-4; Effective October 1, 2018

CHIP, CHIP Perinatal

All children enrolled in CHIP are eligible to receive dental benefits. Dental benefits include both therapeutic and preventive services. CHIP perinatal pregnant women do not receive dental benefits. However, upon birth, the newborn is eligible for dental benefits. The dental benefit is for a 12-month period that is the same as the child's 12-month enrollment period. Note: Children with private dental insurance still qualify for CHIP.

Households are required to pay copayments for dental services. Assess dental office visit copays at the office visit copay rate. The applicable copayment requirements are:

Coverage Description At or below 151% FPIL Above 151% up to and including 186% FPIL Above 186% up to and including 201% FPIL
Office visit

$5

$20

$25
Non-emergency ER visit

$5

$75

$75
Generic prescription

$0

$10

$10
Name-brand prescription

$5

$35

$35
Inpatient hospital care (per admission)

$35

$75

$125

 

D—1751 Dental Providers

Revision 15-4; Effective October 1, 2015

CHIP, CHIP Perinatal

DentaQuest and Managed Care of North America (MCNA) Dental are the dental managed care organizations (DMOs) for dental benefits. Eligible CHIP households receive an enrollment packet that provides information on the DMOs available in their area and how to choose a dental plan. The packet contains plan comparison charts, an enrollment form and a business reply envelope. A 30-day reminder letter is sent to households that have not made a dental plan selection. CHIP households make a dental plan selection through the following options:

  • by phone,
  • in writing using the Enrollment/Transfer form submitted by fax or mailed to:

HHSC
PO Box 149023
Austin, TX 78714-9023

Related Policy

Enrollment Process, D-1720