New Member Information
After you enroll in the BCBSTX STAR Kids plan, BCBSTX will send your child's new member materials in the mail. You should expect the following:
After your child is enrolled, we will give you a BCBSTX ID card. Keep this ID card with you at all times.
When you go to your doctor, hospital or other provider, show your BCBSTX ID card. It has the following information:
- Your child's name
- Your child's member ID number
- Your child's Medicaid number
- The date your child's coverage starts
- The name of the PCP you have selected, a default PCP if you have not selected a PCP, or one of the categories: Dual Eligible or Commercial PCP
After you get your child's ID card, you'll get your welcome kit. It includes the Member Handbook. You'll also get brochures on our transportation services and our value-added services. These handbooks tell you everything you'll need to know about the BCBSTX STAR Kids program.
If you do not receive a welcome kit, please call customer service at 1-877-688-1811 (TTY 7-1-1). We'll send out a replacement. We can also provide your kit in another language other than English or another format, such as Braille, CD or large print. We will send you this information in your preferred format for free.
Member Programs and Resources
We want you to have access to resources that can help your child to meet health goals. That's why we offer the following programs.
- Member Advisory Group — Each quarter, Blue Cross and Blue Shield of Texas (BCBSTX) holds a Member Advisory Group (MAG) Meeting so that we can find out how we can serve you better. If you would like to come and share your ideas with BCBSTX staff and community partners on what you like about your plan benefits or where we can do better, please contact the STAR Kids member advocate in your area for details. For the Travis Service Area call toll-free at 1-877-375-9097, or in the Central Service Area call 1-855-497-0857; TTY at 7-1-1. Find a MAG meeting.
- 24/7 Nurse Hotline — If you have questions, our nurses have answers. This help line is staffed 24 hours a day with registered nurses who can help you get answers to your health questions. If an unexpected medical situation arises, a nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem yourself. You can call 1-855-802-4614 (TTY 7-1-1) to access the Nurse Hotline.
- Aunt Bertha – This website helps you find the resources you need for food, housing, legal issues, financial issues and more. Find programs, connect to services and apply for assistance.
The National Committee for Quality Assurance (NCQA) evaluates health plans and the care that they provide to their members. NCQA identifies health care organizations that are run in ways that make care better.
Here are some terms you may see on this website or in your member handbook:
A request for your managed care organization to review a denial or a grievance again.
A grievance that you communicate to your health insurer or plan.
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
Durable Medical Equipment (DME)
Equipment ordered by a health care provider for everyday or extended use. Coverage for DME may include but is not limited to: oxygen equipment, wheelchairs, crutches, or diabetic supplies.
Emergency Medical Condition
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.
Emergency Medical Transportation
Ground or air ambulance services for an emergency medical condition.
Emergency Room Care
Emergency services you get in an emergency room.
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Health care services that your health insurance or plan doesn’t pay for or cover.
A complaint to your health insurer or plan.
Habilitation Services and Devices
Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
Home Health Care
Health care services a person receives in a home.
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
Hospital Outpatient Care
Care in a hospital that usually doesn’t require an overnight stay.
Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
A provider who doesn’t have a contract with your health insurer or plan to provide covered services to you. It may be more difficult to obtain authorization from your health insurer or plan to obtain services from a non-participating provider instead of a participating provider. In limited cases, such as when there are no other providers, your health insurer can contract to pay a non-participating provider.
A Provider who has a contract with your health insurer or plan to provide covered services to you.
Health-care services a licensed medical physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) provides or coordinates.
A benefit, like Medicaid, which provides and pays for your health-care services.
A decision by your health insurer or plan that a health-care service, treatment plan, prescription drug, or durable medical equipment that you or your provider has requested, is medically necessary. This decision or approval, sometimes called prior authorization, prior approval, or pre-certification, must be obtained prior to receiving the requested service. Pre-authorization isn’t a promise your health insurance or plan will cover the cost.
The amount that must be paid for your health insurance or plan.
Prescription Drug Coverage
Health insurance or plan that helps pay for prescription drugs and medications.
Drugs and medications that by law require a prescription.
Primary Care Physician
A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health-care services for a patient.
Primary Care Provider
A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health-care services.
A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), health-care professional, or health-care facility licensed, certified, or accredited as required by state law.
Rehabilitation Services and Devices
Health-care services such as physical or occupational therapy that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled.
Skilled Nursing Care
Services from licensed nurses in your own home or in a nursing home.
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
Get Ready for a Disaster
Natural and man-made disasters can occur at any time and it is important to be prepared. Use the tools below to make sure you and your family are ready when a disaster hits.
- Register with the State of Texas Emergency Assistance Registry (STEAR) . If you or your child have a disability or medical condition that would require extra help during a disaster, you should register with STEAR. You can register online or call 2-1-1.
- Family Emergency Communication Plan – Create a plan ahead of time to make sure you and your family know what to do and where to go when a disaster hits.
- Emergency Supply List – Make an emergency supply kit now to make sure you have the basic supplies needed during a disaster.