Mental Health and Substance Use Services for Adult Members
CHIP (Children’s Health Insurance Program) is the healthcare program for families who do not qualify for Medicaid-managed STAR programs. It provides low-cost, quality coverage for newborns and children up to 18 years old. The CHIP program may require enrollment fees based on HHSC Guidelines. To continue enjoying the cost-effective coverage and excellent benefits, CHIP families must renew their coverage yearly.
Texas Health and Human Services Commission (HHSC) enrollment fees range from $0 - $50 a year for all the children in the family.
| Income Level | Enrollment Fees: (for 12-month enrollment period) |
|---|---|
| At or below 151% of FPL* | $0 |
| Above 151% up to and including 186% of FPL | $35 |
| Above 186% up to and including 201% of FPL | $50 |
| Type of Visit | Co-Pays (per visit): |
|---|---|
| Office Visit (non-preventive) No Co-Pay is applied for Mental Health/Substance Use Disorder office visits. | $5 |
| Non-Emergency ER | $5 |
| Generic Drug | $0 |
| Brand Drug | $5 |
| Facility Co-pay, Inpatient (per admission) No Co-Pay is applied for Mental Health/Substance Use Disorder office visits. | $35 |
| Cost-sharing Cap | 5% (of family’s income)** |
| Type of Visit | Co-Pays (per visit): |
|---|---|
| Office Visit (non-preventive) No Co-Pay is applied for Mental Health/Substance Use Disorder office visits. | $20 |
| Non-Emergency ER | $75 |
| Generic Drug | $10 |
| Brand Drug | $35 |
| Facility Co-pay, Inpatient (per admission) No Co-Pay is applied for Mental Health/Substance Use Disorder office visits. | $75 |
| Cost-sharing Cap | 5% (of family’s income)** |
| Type of Visit | Co-Pays (per visit): |
|---|---|
| Office Visit | $20 |
| Non-Emergency ER | $75 |
| Generic Drug | $10 |
| Brand Drug | $25 for insulin, $35 for all other drugs*** |
| Facility Co-pay, Inpatient (per admission) No Co-Pay is applied for Mental Health/Substance Use Disorder office visits. | $75 |
| Cost-sharing Cap | 5% (of family’s income)** |
| Type of Visit | Co-Pays (per visit): |
|---|---|
| Office Visit (non-preventive) No Co-Pay is applied for Mental Health/Substance Use Disorder office visits. | $25 |
| Non-Emergency ER | $75 |
| Generic Drug | $10 |
| Brand Drug | $25 for insulin, $35 for all other drugs*** |
| Facility Co-pay, Inpatient (per admission) No Co-Pay is applied for Mental Health/Substance Use Disorder office visits. | $125 |
| Cost-sharing Cap | 5% (of family’s income)** |
*The federal poverty level (FPL) refers to income guidelines established annually by the federal government.
** Per 12-month term of coverage.
***Copays for insulin cannot exceed $25 per prescription for a 30-day supply, in accordance with Section 1358.103 of the Texas Insurance Code
In addition to your regular health benefits, Driscoll Health Plan offers extra services to our members at no cost.
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Your Primary Care Provider or another doctor is available by phone 24 hours a day, 7 days a week. If you get sick at night or on the weekend, you can call your Primary Care Provider’s office number for help. The office will have an answering service or message on how to contact your Primary Care Provider. Your Primary Care Provider should return your call within 30 minutes.
You must take your DHP ID Card. Bring a list of medicines you are taking, including any herbal supplements. A list of health concerns. Medical records if you are a new patient.
You may choose a Perinatal Provider from the DHP Provider Directory or you can get help picking a Perinatal Provider by calling Driscoll Health Plan Member Services at 1-877-451-5598.
If you go to a Provider that is not in DHP's network, you might have to pay the bill.
You can change your Perinatal Provider by calling Member Services at 1-877-451-5598.
You should be able to get an appointment for routine care within two weeks. If you have had problems with previous pregnancies, or if you are more than seven months pregnant, you should be given an appointment within five days of the request.
