Texas Children's Health Insurance 
Texas Children’s Health Plan
Frequently Asked Questions
The plan is designed to educate families, to promote and facilitate preventive care and to provide members with quality medical services.
Q Is my child’s care limited to Texas Children’s Hospital?
A No, Texas Children’s Hospital in one of more than 53 area hospitals that
participate in the individual health plan for children. for a complete list, click the Participating Hospitals link.
Q Are there any financial qualifications for eligibility?
A No. Anyone can apply regardless of income or employment status.
Q Is there an age limit for children who are eligible to be covered by the health plan?
A Yes, this benefit plan is designed specifically for children from the 32nd day of life
until their 19th birthday.
Q Can my child be covered with this plan even though I am covered elsewhere?
A Yes.
Q What is a primary care physician?
A Your child’s primary care physician (PCP) is either a pediatrician or family
practice doctor and is his or her personal doctor. The PCP will provide your child’s routine medical care and refer you to a specialist or hospital when needed.
Q Can I change my PCP for my child?
A Yes, your relationship with your child’s PCP is very important. If you need to
change your PCP, simply contact Member Services at (800) 659-5764 to implement the change.
Q What if my child needs a specialist?
A If your child needs care or services that your PCP cannot provide directly
the PCP will refer your child to a specialist.
Q What happens if my child has an emergency?
A Texas Children’s individual Health Plan covers your child seven days a week,
24 hours a day, even if your child is out of town. In the event of a serious or life-threatening situation, take your child to the nearest hospital emergency room or call 911. Call you PCP as soon as possible regarding the emergency.
Q Are dental benefits included with the plan?
A No.
Q Are pre-existing conditions covered?
A Yes, pre-existing conditions may be covered if you child is approved for coverage.
Q Do I have to pay a deductible with this Plan?
A No.
Q What are the premium payment options?
A You can pay by bank draft or credit card on a monthly, semi-annual or annual
basis.
Q What is the service area for the plan?
A The Health Plan serves 12 counties in the Greater Houston area, including Austin,
Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty,
Matagorda, Montgomery, Waller and Wharton.
Q Are adopted children covered? What about foreign adoptions?
A The requirements are the same for any child. However, for foreign-born children,
required medical records must be translated into English, or the child must have a
check-up by a licensed physician in the United States.
Q How long is the application process?
A In most cases, this process takes two or three weeks.
Q When does coverage start?
A Coverage begins on the first day of the month following approval of your child’s
Application.
Q How do I get a quote for coverage of my child?
A Click the Quote Button (or click here) and complete the information form via fax, mail or on-line.
Q What are the steps in the application process?
A 1. Click here to download an application [requires Acrobat Reader. Click here to download the reader]
2. Complete the application and either fax or mail the application to us.
3. The underwriting staff will review you application, and if addition information is needed we will contact you.
4. You will be notified when a decision has been made.
5. To check on the status of your application you may:
- E-mail us at agents@texaschildrenshealthinsurance.com
- Call Greater Houston Area (936) 321-6286 or toll free 1 (866) 779-3068
- Mail Managed Care Marketing
P.O. Box 8667
The Woodlands, Texas 77387-8667
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