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BENEFITS
There are two types of benefits included with
CHIP dental coverage: preventative and therapeutic.
Examples of Preventative Services
- Routine check-ups
- Routine cleanings
- X-rays
- Sealants to prevent decay
Preventative services
have a $175 maximum for a 12-month period.
All children receive the same amount of preventative services.
Examples of Therapeutic Services
- Fillings
- Extractions (tooth removal)
- Crowns/caps
- Root canals
Therapeutic services
are based on a three-tier program. The higher the tier, the higher the
maximum allowable amount for therapeutic services. The child’s tier
level depends on many factors, such as renewing on time, the amount of
time a child as been enrolled in CHIP and recent gaps in coverage. [FAQ
about tier levels]
INCREASING YOUR CHILD’S DENTAL BENEFITS
Children in CHIP will receive more dental
coverage each year until the maximum benefit is reached. These extra
dental benefits are a bonus when you renew your child’s CHIP
coverage on time. Just follow these steps:
- Make sure to fill out your CHIP renewal form.
- Mail the renewal form on time.
- Pay your enrollment fee promptly, if required.
If you have any questions about the amount of
your child’s dental coverage, please call the CHIP Dental Benefits
Call Center, (866) 561-5892
(toll free), Monday through Friday, 8 a.m. to 7 p.m. Central Time.
RESOURCES
FREQUENTLY ASKED QUESTIONS ABOUT
CHIP DENTAL BENEFITS
- What
dental services are covered?
CHIP Dental
benefits include preventative and therapeutic services:
Examples of preventative services:
- Routine check-ups
- Routine cleanings
- X-rays
- Sealants to prevent decay
Examples of therapeutic services:
- Fillings
- Extractions (tooth removal)
- Crowns/caps
- Root canals
- Which tier
level of service does my child qualify?
CHIP offers three tiers or levels of therapeutic or corrective coverage. Your child’s dental benefit increases when you renew your coverage and pay your CHIP enrollment fee on time. The tier level is based on the number of years your child has had CHIP coverage. Children new to CHIP start at Tier I, children who have had coverage 2 years can get Tier II dental coverage and children with CHIP three years can get Tier III coverage. For all children in CHIP there is a $250 maximum benefit for preventive services like checkups and cleanings. The benefit levels in each Tier are:
- Tier I: Preventive services plus up to $285 of annual therapeutic services.
- Tier II: Preventive services plus up to $425 of annual therapeutic services.
- Tier III: Preventive services plus up to $565 of annual therapeutic services.
Most children
currently enrolled in CHIP will start on Tier I. CHIP enrolled
children with a family income less than 133 percent federal
poverty level, Alaskan Natives and American Indians are an
exception. They will begin coverage on Tier II. Children
of families who paid monthly premiums between January 2004 and October
2004 without a gap in coverage will also start on Tier II.
If you have any
questions about your child’s dental coverage or tier level, please
call the CHIP Dental Benefits Call Center, (866)
561-5892 (toll free), Monday through Friday, 8 a.m. to 7 p.m. Central
Time. A representative can help you confirm your benefit level.
- How do I select a dentist?
All CHIP families
are mailed a dental ID card, a CHIP dental handbook and a directory of
Texas CHIP contracted dentists. Look through the directory and find
the name of a dentist in your area. The dentist directory is also
available online. If
you need help finding a dentist, please call the CHIP Dental
Benefits Call Center, (866)
561-5892 (toll free), Monday through Friday, 8 a.m. to 7 p.m. Central
Time.
You can choose any
dentist listed in the directory for your dental care. If you go to a
dentist who does not participate in the Texas CHIP dental program, you
will have to pay for your child’s treatment, except in the case of
an emergency.
- How do I
schedule an appointment?
After you choose a
dentist, call the dentist’s office to schedule an appointment. Tell
the dentist your child is covered by Texas CHIP. Ask the dentist to
confirm that he or she is a contracted dentist for the Texas CHIP
dental program.
If you go to a
dentist who does not participate in the Texas CHIP dental program, you
will have to pay for your child’s treatment, except in the case of
an emergency.
When you call for
an appointment for routine services, your child should be scheduled to
see the dentist within three weeks. When you call for an appointment
due to an emergency, your child
should be seen within 24 hours.
If you need help
scheduling an appointment, please call the CHIP Dental Benefits
Call Center, (866) 561-5892
(toll free), Monday through Friday, 8 a.m. to 7 p.m. Central Time.
- What if I want to change my child’s dentist?
You can change your
child’s dentist at any time. If you wish to change dentists, find a
dentist in the directory,
then call the dentist to schedule an appointment.
If you need help
finding a new dentist, please call the CHIP Dental Benefits
Call Center, (866) 561-5892
(toll free), Monday through Friday, 8 a.m. to 7 p.m. Central Time.
If you still have
work to be done and your dentist decides to not be a contracting
dentist anymore, give us a call. Depending on the situation, you may
be able to continue seeing that dentist to complete the dental work.
- What do I bring to my dental
appointment?
Bring the child’s
dental ID card. If your child has other dental coverage, bring that
information to show the dentist too.
- What does the CHIP dental
identification (ID) card look like and how do I use it?
All children
enrolled in CHIP are given a CHIP dental ID card. This card has
important information regarding your child’s dental benefits. Only
the child can use his or her ID card for dental services. No one else
can use the card to get services.
How to Read the
CHIP Dental ID Card:
- Enrollee Name
– child’s name
- Client ID Number
– child’s Texas CHIP dental services ID number
- Group Number –
this should be TX60 for all Texas CHIP members
- Date of Birth
– child’s birth date
- Effective
Date – date the child’s Texas CHIP dental services coverage
started
How to Use the CHIP Dental ID Card:
- Have the
child’s ID handy when calling the CHIP Dental Benefits Call
Center, (866) 561-5892 (toll
free).
- Bring the child’s ID
with you when you go to the dentist.
-
Show your dental ID card at
the dentist’s office. Your dentist needs your child’s dental ID
card to check eligibility and benefits.
How
to Replace a Lost CHIP Dental ID Card:
Please call us if you have
not received your child’s dental ID card or if you have lost it.
Call the CHIP Dental Call Center at (866) 561-5892 (toll-free) or
(800) 735-2922 (TDD/TTY for the hearing impaired).
- What if I don’t have my child’s
CHIP Dental ID card?
If you have not
received your child’s dental ID card, but are enrolled in CHIP, you
may still go to a CHIP contracted dentist. Call the
CHIP Dental Benefits Call Center, (866)
561-5892 (toll free), for assistance. A representative will ask you
some questions to verify your child’s CHIP coverage. They can help
you find a dentist and set up an appointment for your child.
- What
benefits are not covered?
The following
dental services are excluded dental benefits under the plan:
- Services that
are not necessary to the child’s dental health.
- Orthodontic
treatment.
- Cosmetic dental
care.
- General
anesthesia or intravenous/conscious sedation.
- Experimental
procedures.
- Services that
are included under any other insurance or health care service plan
that covers the CHIP member.
- Hospital charges
of any kind.
- Major surgery
for fractures and dislocations.
- Dental expenses
for dental procedures started before the child is enrolled in CHIP or
when the child is no longer in CHIP.
- Any service that
is not specifically listed as a covered benefit.
- Dispensing of
drugs.
- Additional
treatment costs incurred because a dental procedure is unable to be
performed in the dentist’s office due to the general health and
physical limitations of the CHIP member.
- The placement
and/or removal of implants.
- How much do
I have to pay for my child’s dental care?
There are no
co-payments for covered dental services.
You must pay
for:
- Non-covered or
optional dental services that you choose to have done.
- Services that
you have done more often than is allowed by the plan.
- Services
provided by a non-contracted dentist, except in the case of an emergency.
If your child
receives services before their dental coverage starts, you must pay
for them. You will also have to pay for services that are:
- What is
emergency dental care?
Emergency
dental services are limited to the following:
- Procedures
necessary to control bleeding, relieve pain and eliminate acute infection.
- Procedures
required to prevent imminent loss of teeth.
- Treatment of
injuries to the teeth and supporting structures.
Routine
restorative procedures and root canal therapy are not emergency
services.
- Who should I call when there is an
emergency?
Please call your
child’s contracted dentist for emergency dental care. Your child
should be seen within 24 hours. You can also call the CHIP Dental
Benefits Call Center, (866) 561-5892 or (800) 735-2922 (TDD/TTY), for
assistance. A benefits representative is available 24 hours a day, 7
days a week.
CONTACT US
CHIP Dental Benefits Call Center
(866) 561-5892 (toll
free)
(800)
735-2922
(TDD/TTY
– toll free number for the hearing impaired)
Monday
– Friday, 8 a.m. to 7 p.m. Central Time
Dental
emergency assistance is available 24 hours a day, 7 days a week.
Call these numbers if you have an emergency
or need help:
- Choosing a
dentist.
- Changing to
another dentist.
- Scheduling
appointments with your child’s dentist.
- Obtaining dental
health education material.
- Obtaining
information on health fairs and health education classes.
- Receiving
assistance and information on all of your child’s dental plan
services.
- Getting
translation and interpretive services.
- Receiving
assistance with filing complaints and appeals.
General CHIP Information
800-647-6558
Call this number to start an application or get more
information about CHIP. Assistance
is available in English and Spanish from 8 a.m. to 8 p.m. Central
Time, Monday through Friday.
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