What does superior health plan cover. The clarity to see today.

• What does superior health plan cover This is a summary of drug and health services covered by Wellcare Simple (HMO) and Wellcare Assist (HMO) from January 1, 2025 to December 31, 2025. Superior HealthPlan exists to improve the health of Texas Medicaid beneficiaries through focused, compassionate & coordinated care. Jun 24, 2021 · Does Superior Vision cover LASIK? Superior Vision does not cover LASIK or other types of vision surgery on any of its plans. We want you to keep getting the care you need. *Value-added Services are extra health care services offered by Superior. Oct 18, 2024 · Last updated: 10/01/2024. How to use an out-of-network eye doctor with Superior Vision from Superior HealthPlan Provider Training 3/8/2018 Ambetter. Superior: 800-783-5386 ; 833-731-2160 . **Available for all STAR, CHIP and STAR+PLUS members, excludes STAR+PLUS dual members, STAR+PLUS Nursing Facility Medicaid-only members and STAR+PLUS Nursing Facility dual members. Requested care, one of the following: 1. Choose from a range of prices and coverage levels. Superior Dental Plans The superior difference starts with truly superior dental plans. The SBC shows you how you and the plan would Ambetter from Superior HealthPlan offers affordable health-care coverage for individuals and families. "Telehealth services" are virtual healthcare visits with a provider through a mobile app, online video or phone. Support for Superior HealthPlan Members Affected by Severe Weather, Wildfire, or Other Natural Disaster; REMINDER: Updated TAC References in CDS Forms; HHSC REMINDER: Postpartum Medicaid and CHIP Coverage Extension; Effective December 1, 2024: Pharmacy and Biopharmacy Policies; Effective December 1, 2024: Pharmacy and Biopharmacy Policies Sep 18, 2024 · Discover Ambetter's health insurance, available in 26 states. Expand You should receive your Superior HealthPlan ID card in the mail as soon as you are enrolled with Superior. Member Handbook . Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan, Inc. No matter which option you select, your group will have access to our national network (one of the largest dental networks in the country with over half a million access points nationwide!), famous superior service, value-added benefits and more! Refer to Superior HealthPlan's policy documents or call 866-461-3339 to get accurate details on your policy’s mental health rehab coverage. The benefit information is a brief summary, not a complete description of benefits. Jan 29, 2023 · Benefits from Superior HealthPlan (Ambetter) Texas healthcare plans include telehealth services, rewards programs for healthy behavior, a 24/7 nurse health line, and more. Get complete healthcare coverage in Texas with Ambetter from Superior HealthPlan. As part of this new contract, Superior will no longer provide STAR+PLUS Medicaid coverage to members in the Bexar SDA. , Monday through Friday. Or Prescription Coverage Get coverage for your medical prescriptions. Jan 24, 2023 · Since Superior HealthPlan (Ambetter) insurance in Texas is a Health Insurance Marketplace plan, the good news is that it does provide coverage for mental health and substance use treatment. Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: EPO Focused Silver: Standard Silver On Exchange Plan SBC-29418TX0140100-01-2025 Underwritten by Celtic Insurance Company The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. com SHP 20174271 . Jan 1, 2024 · Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. If you did not get this card, please call Superior at 1-800-820-5685. The Superior MBCC team includes Registered Nurses (RNs) trained to assist members in identifying service needs and coordinating their benefits. All services are subject to eligibility at the time of service and benefit limitations or exclusions. 99441 for . , which are Qualified Health Plan issuers in the Texas Health Insurance Marketplace. It all starts with routine vision, which […] WRITTEN DESCRIPTION OF COVERAGE PROVIDED BY AMBETTER FROM SUPERIOR HEALTHPLAN (Hereafter referred to as “Ambetter from Superior HealthPlan”) The entity providing this coverage to you is an HMO, Superior HealthPlan. About . After hours, on weekends and on holidays, you may be asked to leave a message. Affordable rates and quality coverage. Medicare Advantage plans such as HMO’s and PPO’s. How Does Superior HealthPlan Serve Members In The Medicaid Program? Superior HealthPlan is a managed care organization (MCO) that provides healthcare services to 2 million members in Texas. This is a list of drugs that members can get in Superior STAR+PLUS MMP. “Enhanced Profile” listings mean the doctor has purchased profile upgrades from Castle Connolly in order to offer potential patients more information about their practice and approach to medicine. Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: EPO Focused Silver: 94% AV Level Silver Plan SBC-29418TX0140100-06-2025 Underwritten by Celtic Insurance Company The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. It does not constitute a contract or guarantee regarding payment or results. The new nursing facility does not have an available room. You do not need to take any action to remain a Superior HealthPlan member. List of Covered Drugs (Formulary) Introduction . SuperiorHealthPlan. 800-735-2989 : 7-1-1 English and Español . The email is not encrypted and is not transmitted in a secured format. PLAN Your Health Plan * Your Choice TEXAS Health and Human Services . Superior HealthPlan requires that all services described on this list be authorized prior to the services being rendered. Superior HealthPlan is committed to providing our participating providers with the best tools possible to support their administrative needs. Aug 11, 2022 · Effective October 1, 2022, Superior HealthPlan’s preferred blood glucose meter and test strips will be OneTouch products. The SBC shows you how you and the plan would Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2023 – 12/31/2023 Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: HMO Focused VALUE Silver: 87% AV Level Silver Plan Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnership’s (TMHP) Eligibility Verification Issues; Support for Superior HealthPlan Members Affected by Severe Weather, Wildfire, or Other Natural Disaster; Support for Superior Members Affected by Severe Weather, Wildfire, or Other Natural Disaster providers, that does not have a contract with Ambetter from Superior HealthPlan to provide medical care or health care on a preferred benefit basis to you through this health insurance policy. The new nursing facility is not a Superior nursing facility. The SBC shows you how you and the plan would Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2023 – 12/31/2023 Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: HMO CMS Standard Silver VALUE: 94% AV Level Silver Plan Superior HealthPlan is proud to offer members Value-added Services. These diabetes testing products will be available to Superior HealthPlan Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), and CHIP members at no cost. 2. Please call us if: – You want to get your materials in Spanish or in an alternate format. *Restrictions and limitations apply. **Superior will provide STAR+PLUS coverage to members who live in the Travis SDA, starting 9/1/2024. If Ambetter from Superior HealthPlan does not have a record that the required medication was tried, the member’s practitioner may be required to provide additional information. 4 As a result, can rely on Ambetter from Superior HealthPlan to cover at least some of the cost of rehab treatment within the Jan 9, 2024 · As a part of this new contract, Superior will continue to provide STAR+PLUS Medicaid coverage in your area. Any provider in the Superior HealthPlan network can offer telehealth services to Superior members for certain healthcare needs. Superior is contracted with Express Scripts (ESI) as our Pharmacy Benefit Manager (PBM). STAR+PLUS does not change how people get their Medicare services. Superior HealthPlan is committed to providing appropriate, high-quality and cost-effective drug therapy to all members. Since 1999 , Superior has taken a members-first approach to health care by focusing on the whole health of the individual and forming community partnerships to support their members, one person at a time. Expand Call us toll-free at the number on the back of your Superior member ID card or by using Superior's phone directory. However, there are some situations in which this rule does not apply: conditions. Superior HealthPlan proudly offers STAR Health, a Medicaid managed care program serving children and youth in foster care. Medicaid Medicare • _ PLAN Your Health Plan * Your Choice O TEXAS Health and Human Services H6870_21_20970LOD_001_FINAL_Approved_09022020 Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) 2021 List of Covered Drugs (Formulary) Introduction This document is called the List of Covered Drugs As a Superior HealthPlan Value-added Service*, STAR+PLUS**, STAR Kids and STAR Health members can get $30 for commonly used over-the-counter (OTC) items every quarter, per member. Does Superior HealthPlan Medicaid Cover Dual Diagnosis? Superior HealthPlan Medicaid typically covers dual diagnosis services as part of their behavioral health coverage. May 4, 2021 · Superior HealthPlan’s MBCC team was created to serve this population. The SBC shows you how you and the plan would Sep 21, 2022 · Superior HealthPlan has updated certain policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. In this section, you can learn about the Texas Medicaid benefits, pharmacy services and value- added services Superior HealthPlan offers. Ambetter from Superior HealthPlan is a Qualified Health Plan issuer in the Texas Health Insurance Marketplace and does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. This document is called the . This is not a complete list. Superior HealthPlan can help new mothers and their infants. These rewards can help you pay for things such as utilities or transportation. If the provider does not want to join the Superior network, we will work with the provider to keep caring for you until medical records can be transferred to a new Superior doctor. Discover Superior HealthPlan. This is only a summary. The clarity to see today. One of the important topics for providers is immunizations. Check out the map below to see where we offer our Marketplace plans. **CHIP, STAR, STAR+PLUS members can earn up to $150 in rewards. This portion pays for hospital stays, skilled nursing facilities and hospice stays. that are within the core network for Superior HealthPlan Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2023 – 12/31/2023 Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: HMO Focused VALUE Silver: 87% AV Level Silver Plan Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan, Inc. We can send materials to you in Spanish or in alternate formats if you a sk for it this way. Comprehensive treatment for dual Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan, Inc. COVERAGE IN YOUR AREA. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Services may vary by area. ©2025 Celtic Ins. MA plans cover the same services as traditional Medicare and may offer prescription drug coverage (Part D), dental, vision and hearing care. To get STAR Kids services, an individual must: Be age 20 or younger. As a Superior HealthPlan Value-added Service*, STAR+PLUS**, STAR Kids and STAR Health members can get $30 for commonly used over-the-counter (OTC) items every quarter, per member. Molina Dual Options Superior HealthPlan STAR+PLUS MMP To ask about services or doctors: 866-856-8699 866-896-1844 TTY line for people with a hearing or speech disability: 800-735-2989 or 7-1-1 English 800-662-4954 Spanish 7-1-1 Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan, Inc. If you did not get this card, please call Superior at 1-800-783-5386. Superior HealthPlan offers managed healthcare coverage to nearly 2 million Texas residents in all 254 state counties. Initial request for ≤ 90 days, and the provider has examined or treated the member within the past 30 days; 2. Requests should be submitted no less than 5 business days prior to the start of service. Jun 14, 2024 · This means the company must abide by the Affordable Care Act (ACA). Superior HealthPlan. Find coverage in your area. Learn more about Texas Medicaid options and plans available through Superior HealthPlan. Superior HealthPlan will manage CFC in all STAR+PLUS Service Delivery Areas (SDA) and throughout the State of Texas through the STAR Health Program, except members who are enrolled in a 1915(c) waiver. Introduction . . List of Covered Drugs The Ambetter from Superior Healthplan Formulary or Prescription Drug List, is a guide to available brand and generic drugs that are approved by the Food and Drug Administration (FDA) and covered through your prescription drug Extra vision benefits, including a $150 retail allowance towards select prescription eyeglass frames, lenses or contact lenses not covered by CHIP, once per year. this evidence of coverage (contract) is issued to you, who have enrolled in . Expand It is the policy of Superior HealthPlan that private duty nursing (PDN) services are medically necessary when all the following criteria are met: A. One Plan. Currently get Supplemental Security Income-related Medicaid or be enrolled in a home and community-based services waiver program, including: Superior HealthPlan empowers Texans to put their health first. Claim Disputes: (Form located on website) – Must use Total Vision Health Plan network superior healthplan ™ TEXAS-. Learn more about these changes by visiting Superior's STAR+PLUS news page. Learn about limitations in our detailed review. Call 1-800-964-2777 (TTY 711) to join Superior. Superior HealthPlan CHIP RSA ID Card. Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. If you have questions, please call Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) at 1-866-896-1844 (TTY: 711) from 8 a. Introduction. Email: Create or log into your Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: HMO Standard Silver VALUE: 94% AV Level Silver Plan SBC-87226TX0100011-06-2024 Underwritten by Superior HealthPlan The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. For more information, call 1-866-819-4298. A vision insurance plan will help you to better manage your eye care costs. Superior does not accept responsibility or liability for any loss or damage arising from the use of email. 3, bulleted list. Jan 1, 2024 · Last updated: 10/01/2024. Vision and Eye Health Solutions Your all-in-one solution to routine vision, medical claims review, and utilization management. Please note: if the item or service is never covered by Superior as clearly denoted in the member’s Evidence of Coverage, Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) wants to make sure you understand your health plan information. to 8 p. As a result, the following policies are effective on September 26, 2022, at 12:00AM. This chart reflects Medicare’s waiver of the geographic and place of service restrictions for Medicare. You can also visit Superior's Find a Provider webpage to find an in-network behavioral health provider near you. This program is included in the Texas Medicaid plan coverage for qualified individuals. S-1 STAR Member Handbook. 3 of Texas Medicaid Provider Procedures Manual 2013) ‒ Members under three (3) years have multiple checkups within each year; 6 outpatient checkups in the 1st year Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2023 – 12/31/2023 Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: HMO CMS Standard Silver VALUE: 87% AV Level Silver Plan Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: EPO Complete Silver: Standard Silver On Exchange Plan SBC-29418TX0140019-01-2025 Underwritten by Celtic Insurance Company The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 12/23 Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) is a dual Medicare-Medicaid Plan. Expand Dec 12, 2024 · 196 reviews from Superior Health Plan employees about Superior Health Plan culture, salaries, benefits, work-life balance, management, job security, and more. These benefits are designed to provide prenatal services to unborn children of pregnant low-income women, who do not qualify for Medicaid. It also has Service Coordinators and service coordination teams to help you manage all your providers and services. Ambetter from Superior HealthPlan is the company’s Health Insurance Marketplace product, but Superior HealthPlan also offers other health coverage options, such as Medicaid and Medicare Advantage plans. Vision care plans include coverage for expenses like routine eye exams, prescription glasses and contact lenses. What Substance Addiction Does Superior HealthPlan Texas (Ambetter) Cover? There are a wide variety of substances that people can struggle with. Superior: Coverage. Doctors cannot pay to be listed on Castle Connolly. Superior covers prescription medications as outlined by the Texas Medicaid and CHIP Vendor Drug Program (VDP). Policies in the Superior HealthPlan Payment Policy Manual may have either a Superior HealthPlan or a “Centene” heading. Agenda • Overview • Dependent coverage to age 26 Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: HMO Standard Silver VALUE: Standard Silver On Exchange Plan SBC-87226TX0080011-01-2025 Underwritten by Superior HealthPlan The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. “With more plan options than ever before, we’re confident Texans can find the Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan, Inc. The SBC shows you how you and the plan would ambetter from superior healthplan, inc. We know how important it is to have a health plan you can count on. Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnership’s (TMHP) Eligibility Verification Issues; Support for Superior HealthPlan Members Affected by Severe Weather, Wildfire, or Other Natural Disaster; Support for Superior Members Affected by Severe Weather, Wildfire, or Other Natural Disaster The success of the bariatric surgery does rely on the motivation and dedication to the program of the patient. Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: HMO Standard Silver VALUE: 87% AV Level Silver Plan SBC-87226TX0100011-05-2025 Underwritten by Superior HealthPlan The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. A Member-centric Approach to Vision Care and Eye Health Our continuum of vision solutions helps ensure quality and appropriateness of care. You should receive your Superior HealthPlan ID card in the mail as soon as you are enrolled with Superior. Ranging from prenatal care to doctor visits, this site contains all the resources that an expectant mother needs to get started. n . Superior HealthPlan offers affordable individual and family health insurance in Texas. , evidence of If Ambetter from Superior HealthPlan has a record that the required medication was tried first the step therapy medications are automatically covered. If you are a new mother or have an infant, check out this page to see the resources available for you and your baby. Superior HealthPlan provides benefits and services for Medicaid, CHIP, and health insurance in Texas. This handbook tells you about your coverage under Superior STAR+PLUS MMP through December 31, 2021. Feb 29, 2024 · In Texas, WellCare and WellCare TexanPlus Health Plans and Superior Health Plan are bringing our health plans together to better serve our members, providers, partners and communities. Inpatient Hospitalization: A “blank” under a plan’s name means that the plan does not offer the service listed. Help for mental health, Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: EPO Everyday Gold: Standard Gold On Exchange Plan SBC-29418TX0140102-01-2024 Underwritten by Celtic Insurance Company The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The list includes: Medicare Part D drugs; Some Medicaid covered prescription and over-the-counter drugs and items; In general, we cover drugs if they are medically necessary. These services are effective 9/1/24-8/31/25. g. superior healthplan - TEXAS---. Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) 2020 . S. Superior HealthPlan CHIP Perinate Newborn RSA ID Card Jun 28, 2022 · Superior HealthPlan has developed a Telemedicine Quick Reference Chart (PDF) to help providers navigate telemedicine and telehealth reimbursement. Material ID: H6870_WEBSITE_2025 Approved 10232024. Member is < 21 years of age; B. A diabetes Care Manager can answer questions about your specific coverage options. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Texas Medicaid. Medicare Advantage Protect your dental health with our comprehensive dental insurance plans. Your Health and Drug Coverage under the Superior HealthPlan STAR+PLUS Medicare-Medicaid (MMP) Plan . If you are a provider, explore this page and resources about immunizations. 835 Health Care Payment/Advice 005010X221A1; 837 Health Care Claim: Professional 005010X222A1; 837 Health Care Claim: Institutional 005010X223A2; 276/277 Status Inquiry and Response 005010X212 Ambetter from Superior HealthPlan (Health Insurance Marketplace) The Health Insurance Marketplace is an online shopping mall of healthcare plans. If you have questions, please call Superior STAR+PLUS MMP at 1-866-896-1844 (TTY: 711) from 8 a. Texas STAR Medicaid is a managed health care plan for residents of the Lone Star State. superior healthplan ™ TEXAS-. Ambetter from Superior HealthPlan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Program eligibility depends on your: Age; Income; Family size; Any special health needs you may have; View all of our available programs for health insurance in The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Get the benefits you need with affordable vision insurance coverage. Part A - Hospital coverage; Wellcare By Allwell from Superior HealthPlan 7700 Forsyth Boulevard Clayton, MO 63105. Coverage is for frames and lenses and does not cover additional features such as tints and coating. STAR and CHIP members can get $25 every quarter, per member. Always Covered. You can continue to get regular medical care from your Medicare doctor and providers or from a Medicare managed care health plan. , evidence of component of the guidelines used to assist in making coverage decisions and administering benefits. You may have received a letter from HHSC. you agree to adhere to these provisions for covered health Ambetter from Superior HealthPlan PO Box 5010 Farmington, MO 63640-5010 . Sep 1, 2023 · Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP): Summary of Benefits 2024 . with Superior HealthPlan before providing respite services • For additional information, visit: https://hhs. texas. Superior does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Usually the plan will not cover health care services from a provider who does not work with the health plan. Expand It is the policy of Superior HealthPlan that DME is medically necessary for the following indications: A. Residents within the nine coverage areas are eligible to utilize this plan to access healthcare including primary care, specialists, hospitals, and more. 1, Top bulleted list, 5th bullet There are 200 substance use treatment centers in the U. Vision services for our Health Insurance Exchange plans are provided through Superior Vision. H6870_20_LOD3_FINAL_Approved_10032019 . At Superior HealthPlan, we aim to support providers by giving them the information they need to succeed. Superior HealthPlan has a program for CHIP Perinatal Care that is part of Texas’ Children’s Health Insurance Program (CHIP). The SBC shows you how you and the plan would share the cost for covered health care services. Superior HealthPlan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. 5 million members across Texas 2 and offers nine products. We encourage our participating providers to take advantage of our easy-to-use secure web portal for fast resolution of routine needs. Health Insurance Exchange. *Note: Members can move to a nursing facility outside of their current service area, but they would need to select a new health plan. Visit us online to learn more about the diabetes management program with Superior. Get Texas health insurance or become a provider today. If Ambetter from Superior HealthPlan has a record that the required medication was tried first the step therapy medications are automatically covered. Pros include competitive rates, PPO options, and a rewards program. Our plans fit your unique need. Superior offers Telehealth at no cost to you. com SHP_20231009A Rev. Superior is the only health program to include STAR Health coverage for children and youth in foster care in all 254 counties in Texas. These companies are each Qualified Health Plan issuers in the Texas Health Insurance Marketplace. Superior HealthPlan has a special program for members with diabetes. This is a solicitation for insurance. Check your mail and choose Superior After you’re approved, you’ll get an enrollment packet in the mail. In the event you need medicine that your lock-in pharmacy does not have, your lock-in pharmacy is closed, you are currently not near your lock-in pharmacy, or need any other assistance getting your medicine, please contact Superior HealthPlan by calling the Member Services number located on the back of your ID card. Available for 2025 coverage, Ambetter Health Premier insurance plans make it easy to find the right fit. These services include medical, dental, vision, pharmacy and behavioral health. NOTE: Information about the cost of this plan (called the premium) will be provided separately. The SBC shows you how you and the plan would How Does Superior HealthPlan Serve Members In The Medicaid Program? Superior HealthPlan is a managed care organization (MCO) that provides healthcare services to 2 million members in Texas. 4 The ACA requires that all long-term health insurance plans cover 10 essential health benefits, including substance use disorder (SUD) treatment. Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: EPO Standard Gold: Standard Gold On Exchange Plan SBC-29418TX0140109-01-2025 Underwritten by Celtic Insurance Company The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. January 1, 2021 – December 31, 2021 . (TTY 1-800-735-2989) Medical professionals can answer your health questions and help set up doctor appointments. This includes My Health Pays, a rewards program offering incentives for completing healthy activities. This booklet will provide you with a summary of what we cover and the cost-sharing responsibilities. This pays for prescription drugs for home use. Superior HealthPlan CHIP ID Card. 5-10 minutes of medical discussion Superior HealthPlan Vision coverage through CHRISTUS Health Plan differs by plan. Nov 7, 2024 · Our List of Drugs (Formulary) shows the drugs we cover. Ambetter from Superior HealthPlan offers reliable health insurance plans for individuals and families. The Castle Connolly Top Doctor selection process is entirely merit-based. This joining of our organizations will allow us to become a more robust health plan and enhance the delivery of best-in-class care to our members. The patient must be able to participate in the treatment and long-term follow up required after surgery. Superior HealthPlan Pharmacy Quick Reference Guide SuperiorHealthPlan. The SBC shows you how you and the plan would Jan 1, 2024 · Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) is a Medicare-Medicaid Plan made up of doctors, hospitals, pharmacies, providers of long-term services and supports, and other providers. Get Insured through Superior HealthPlan. CMS announced coverage for physician/patient phone calls: Place of service 11 for office . You can buy an Ambetter Health Vision plan in addition to your health insurance plans. You can continue receiving your STAR+PLUS Medicaid coverage from Superior. health benefit plan. evidence of coverage health maintenance organization . When you join STAR+PLUS, you will pick a STAR+PLUS health plan and start getting Medicaid long-term services and supports through your health plan. Learn more about Superior’s services for new mothers and infants. Medical Necessity Review: 1. By communicating with Superior through email, you accept the risks associated thereof. component of the guidelines used to assist in making coverage decisions and administering benefits. Refer to your provider manual for information regarding specific vision plans. You need to choose a health plan or the enrollment broker will choose one for you. One group that Superior aims to help are expectant mothers. Studies have shown that about 10% of patients may have unsatisfactory weight loss or regain much of the weight they have lost. In addition, Superior HealthPlan may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a service Does Superior HealthPlan support the version 5010 TR3 Errata? Superior supports HIPAA adopted TR3 Errata, when applicable and most up to date version. 1 Marketplace insurer*, Ambetter from Superior HealthPlan has the experience and resources available to provide reliable coverage to more people throughout Texas,” said Mark Sanders, President and CEO of Superior HealthPlan. Superior works with the Texas Health and Human Services Commission (HHSC) and with many doctors, clinics and hospitals to give you/your child the care you Jan 11, 2022 · “As part of the nation’s No. If the provider does not request prior authorization, the claim may be denied and the provider will be liable for the cost of the service. This is your easy, 24-hour access to in-network providers for non-emergency health issues. Get medical advice, a diagnosis or a prescription. Covered Services and Benefits Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan, Inc. Ambetter from Superior HealthPlan offers affordable healthcare coverage for individuals and families. m. Ambetter from Superior HealthPlan is a Qualified Health Plan issuer in the Texas Health Insurance Marketplace. Get a quote today! Jan 1, 2024 · Last updated: 10/01/2024. But Superior Vision plan members do get discounts ranging from 15 to 50 percent on LASIK from in-network eye surgeons. Jan 9, 2025 · Superior HealthPlan has 1. DME may be medically necessary when there is an expectation that the item requested will make a meaningful contribution to the treatment of the member’s illness, injury, or malformation. Depending on your family size and income, you may even qualify for help to pay your monthly premium. what the front and back of the Superior ID card looks like. Understanding your eligibility and benefits is the first step to accessing life-changing healthcare services in the Lone Star State. Services received from a non-network provider are not covered, except as specifically stated in this policy. Here’s . Coverage decisions and the administration of benefits are subject to all terms, conditions, exclusions and limitations of the coverage documents (e. gov/laws- • Does not apply to moving from one placementto another • Existing members with Superior follow the periodicity schedule (see Volume 2 Section 5. Jan 1, 2024 · Most of the time, you must get your health care from a Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) contracted provider. _• n •Medicaid Medicare • ----. ambetter from superior healthplan, inc. Your health insurance Evidence of Coverage only provides benefits for services received from participating This form will send your message to Superior HealthPlan as an email. Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2023 – 12/31/2023 Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: EPO Complete Silver: Standard Silver On Exchange Plan Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnership’s (TMHP) Eligibility Verification Issues; Support for Superior HealthPlan Members Affected by Severe Weather, Wildfire, or Other Natural Disaster; Support for Superior Members Affected by Severe Weather, Wildfire, or Other Natural Disaster When does CFC start? Where will Superior HealthPlan manage CFC services? Texas is planning to begin CFC on March 1, 2015. Superior HealthPlan CHIP Perinate Newborn RSA ID Card Superior HealthPlan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The foresight to see tomorrow. Superior HealthPlan is a Managed Care Organization (MCO) that offers health care for Texans enrolled in the STAR program. TTY line for people with a hearing or speech disability: 7-1-1 . Jan 1, 2021 · Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) Member Handbook . Texas D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. Superior HealthPlan CHIP Perinate Newborn ID Card Ambetter from Superior HealthPlan Coverage for: Individual/Family | Plan Type: EPO Complete Gold + Vision + Adult Dental: Standard Gold On Exchange Plan SBC-29418TX0160020-01-2024 Underwritten by Celtic Insurance Company The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Call us today at 1-877-687-1196 (Relay Texas/TTY 1-800-735-2989). This allowance may not be used toward replacement eyewear or sunglasses. bxs otogdopof nrporftq mrzhmk pqeh fqm ysahn pfvm xvcgz obphco