Your Coverage

Explore this section to learn about the kinds of care your health plan covers, including:

CHIP Copayments

If you get CHIP Perinatal benefits, you do not have cost-sharing obligations, including enrollment fees and copayments (copays). CHIP Members who are Native American or Alaskan Native also do not have cost-sharing obligations, including enrollment fees and copays.

How much are copays and when do they apply?

Your member's card shows if you have a copay. If you are a Native American or an Alaskan Native, then please call BCBSTX to have this copay amount corrected. You will not have to pay copays for the following:

  • Primary Care Provider (PCP) visits for well-baby and well-child services
  • Preventive services
  • Pregnancy-related assistance

The following chart shows your copay for different services, based on income guidelines.

Copays and Cost-Sharing

SERVICE

At or below 151% FPL*

Above 151% up to and including 186% FPL*

Above 186% up to and including 201% FPL*

Enrollment Fee

$0

$35

$50

Office visit

$5

$20

$25

Non-emergency ER (per visit)

$5

$75

$75

Emergency room (ER)

$0

$0

$0

Facility Co-pay, Inpatient (per admission)

$35

$75

$125

Generic drug

$0

$10

$10

Brand drug

$5

$35

$35

Cost-sharing cap (limit)

5% of family's income**

5% of family's income**

5% of family's income**

*The federal poverty level (FPL) refers to income guidelines established annually by the federal government.
** Per 12-month term of coverage.

Health Care Programs and Classes

When you choose BCBSTX for CHIP, you have access to programs and classes that can help you live healthier.

Our health care programs will help you take better care of yourself if you have:

  • Asthma
  • Diabetes
  • Heart Disease

Use our Provider Finder® to search for doctors and other health care providers near you.

  • 1-888-657-6061 (TTY 7-1-1)
  • 8 a.m. to 8 p.m. Central Time
    Monday through Friday