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CHIP Perinatal Coverage


Information for Clients

En Español

Covered Services

Benefits of CHIP perinatal coverage include:

  • Up to 20 prenatal visits.
  • Prescriptions and prenatal vitamins.
  • Labor with delivery of the baby.
  • Two doctor visits for the mother after the baby is born.
  • Regular check-ups, immunizations and prescriptions for the baby after the baby leaves the hospital.

What services are not covered?
Some of the services not covered include:

  • A mother’s hospital visit for services not related to labor with delivery, such as a broken arm or false labor. (You can apply for Emergency Medicaid to cover your hospital visit, but you must meet the income limits.)
  • Specialty treatment for the mother, such as care for asthma, heart conditions, mental health or substance abuse.

Who may qualify?

CHIP perinatal services are for the unborn child of pregnant women who are uninsured, do not qualify for Medicaid. The expecting mother must meet certain income requirements.

CHIP Perinatal Coverage Income Limits
Family Size Maximum Monthly Income
1 $1,915
2 $2,585
3 $3,255
4 $3,925
5 $4,595
6 $5,265
7 $5,935
8 $6,605
For each additional person, add: $670

Some women who apply may get coverage under Medicaid’s Pregnant Women program.

Pregnant women who do not qualify for Medicaid because of their income or immigration status or, because their income is too high, may still qualify for CHIP perinatal coverage.

How to Apply

CHIP perinatal coverage is included in the application for children’s health insurance (CHIP and Children’s Medicaid).  To see if you can get it, you can:

Documents You Need to Apply

Proof of Pregnancy

A woman who applies for CHIP perinatal must send with her application a Report of Pregnancy (Form 3037). This form must be signed by a doctor, nurse, or another medical person acting on behalf of the doctor. It asks for information such as your due date, and the number of babies you are expecting If you don’t have a Form 3037, you can also send us a letter signed by your doctor or a medical person with the same information asked for in the form.

Proof of Income

Besides the Report of Pregnancy form, you will also need to send us proof of your income.  These documents must show income for each person in your home.  Proof can be:

    • Pay check sub from the last 60 days showing pay before taxes or deductions (gross pay).
    • Most recent IRS tax return with schedule C, if filed.
    • Proof of self employment.
    • Letter from your employer. This letter takes the place of a paycheck stub and should include your current income, and how often you get paid. It should also include your name, the employer’s name, and the employer’s signature.
    • Social Security statement.
    • Child support check stub or receipt.
    • TANF forms.

Proof of Expenses

Proof can be receipts for:

    • Child care expenses, including the cost of transportation to and from daycare.

Common Errors During the Application Process

    • Incomplete applications. Applications must be complete, including a response to each question, even if the answer is “not applicable.” If you do not have any income, place “0.00” on the income line.
    • No signature on the application.
    • Failure to submit all required documents. Without all the required proof, work on your application will stop while we ask you for the documents of proof we need or other information missing from your application.

How to Return the Application

A finished application can be sent by fax, mail or in person.  The application should have all the needed documents (listed above) together.

Fax
Fax your completed and signed application, along with all the required information to our toll-free fax number, 1-877-542-5951.

Mail
Mail the complete application and copies of the required information to:
Texas Health and Human Services Commission
P.O. Box 14200
Midland, TX 79711-9901

In person
You can turn your application in at a local Health and Human Services Commission benefits office.  Call toll-free 2-1-1 (Option 1 after the language prompt) to ask about an office nearby.

Frequently Asked Questions

How long does the eligibility and enrollment process take?
HHSC will determine if you qualify for the program within 15 business days of receiving your application.  If you qualify, you will receive instructions on how to enroll in a CHIP perinatal health plan.

You can see a list of CHIP health plans that provide perinatal coverage or see a list of these plans by county.

When does my coverage start?  How long does it last?
Coverage starts the first day of the month your unborn child is enrolled in CHIP perinatal coverage.  For example, if you turn in your application on Feb. 20, 2009, and you and your baby are enrolled March 12, 2009, coverage would start March 1, 2009.  There is no waiting period.

Coverage lasts 12 months.  For example, if your baby is enrolled when you are three months pregnant and the child is born six months later, your baby will have six months of prenatal care, and six months of full CHIP coverage upon delivery.

How do I get services not covered by the program?
Your CHIP perinatal provider will give you information on other clinics or doctors who can provide services that are not covered by CHIP.  However, you may have to pay for these services. If you have an emergency condition, you may apply for Emergency Medicaid to pay for these services.

Do I have to pay anything for covered services? 
No. There are no fees or co-payments for services provided by CHIP perinatal coverage.

Who are CHIP perinatal providers?
A CHIP perinatal provider can be an obstetrician/gynecologist (OB/GYN), a family practice doctor or another qualified health care provider that provides prenatal care. We have posted a list of health plans, contact phone numbers and links to provider directories.

However, once your baby is born you will need to choose a Primary Care Provider (PCP) for your baby.  A PCP can be a doctor, a nurse practitioner, a clinic, or a physician assistant.

How do I choose my provider?  Can I choose my own OB/GYN?
You choose a provider from your health plan’s provider directory. You may select an obstetrician/gynecologist (OB/GYN), a family practice doctor or another qualified health care provider that provides prenatal care.

If you already have an OB/GYN, family practice doctor or clinic that you like, you may be able to keep seeing this provider if they are included in the health plan’s provider directory.  Call your health plan’s member services hotline for help in choosing a provider.

Once your baby is born, you will need to choose a Primary Care Provider for your baby. This can be a doctor, a nurse practitioner, a clinic or a physician assistant. See more information about this under "How do I choose a Provider once my baby is born?"

What do I do when it’s time for me to deliver?
Bring your CHIP perinatal health plan identification card with you to the hospital. If you have been mailed an Emergency Medical Services Certification (Form H3038), bring that, too. The Form H3038 helps to make sure Emergency Medicaid pays for your hospital bills.  The doctor who delivers your baby can fill out the form for you. The hospital can fax this form, along with a copy of your CHIP perinatal identification card, to 1-877-542-5951, or hospital staff can mail it to:

HHSC
P.O. Box 14400
Midland, Texas 78711-4400

It is important that the name on your Form H3038 matches the name on your CHIP perinatal card, or we may not be able to process it.  Once the form H3038 is completed and sent in, you can call 1-800-647-6558 to verify if it has been received.

How do I choose a provider once my baby is born?
You may choose a provider from the CHIP perinatal health plan’s provider directory.  Call your health plan’s member services hotline if you need a directory or need help choosing your baby’s provider. 

Once my baby is born, what benefits will my baby get?
Once your baby is born you will need to let us know that you have delivered your baby.  Please call 1-800-647-6558 Monday – Friday, 8 a.m. to 8 p.m. Central Time except for federal holidays.  Callers with hearing impairments may contact Relay Texas at 7-1-1 or 1-800-735-2989 (TDD).

Your baby will get most of the health care benefits available under the traditional CHIP program. For a complete list of services, look at the member handbook you will receive from your health plan.

What if I have other children who are already enrolled in CHIP?
All of your children must receive their CHIP benefits from the same health plan.  If your children’s current CHIP health plan does not include CHIP perinatal coverage, all of your children will be covered by the unborn child’s CHIP perinatal health plan. If you were paying co-payments before the birth of your new baby, you will continue to pay those co-payments for those children after your baby is born.

Your children will all be in one health plan, but there are different costs for CHIP perinatal coverage and traditional CHIP. You will continue to pay enrollment fees and co-payments for your children in traditional CHIP, if required.



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