WIXLIB

STARMember HandbookSuperiorHealthPlan.comSHP 20217618042021

Numbers to RememberIf you have any questions, call us at 1-800-783-5386. Superior HealthPlan’s (Superior) Member Servicesstaff will help you. Our staff is there from 8 a.m. to 5 p.m. Monday through Friday, excluding stateapproved holidays. You can reach a nurse 24 hours a day, 7 days a week at 1-800-783-5386. They cananswer your health questions after hours and on weekends. Our staff is bilingual in English and Spanish. Ifyou speak another language or are deaf/hard of hearing, call Member Services for help.Superior Member Services1-800-783-5386Texas STAR Program Helpline1-800-964-2777Ombudsman Managed Care Assistance Team1-866-566-898924-Hour Nurse Advice Line1-800-783-5386Relay Texas TTY Line (Deaf/Hard of Hearing)1-800-735-2989Pharmacy Helpline (Prescription Drugs)1-800-783-5386Superior Medical Ride Program Provided by SafeRide1-855-932-2318Teladoc (Telehealth Services)1-800-835-2362Eye Care (Envolve Vision Services)1-888-756-8768Dental Care1-800-516-0165 (DentaQuest)1-800-494-6262 (MCNA Dental)1-800-822-5353 (United Dental)Behavioral Health1-800-783-5386Alcohol/Drug Crisis Line1-800-783-5386Member Connections (Additional Community Services) 1-800-783-5386Member Advocate1-800-783-5386Behavioral Health ServicesYou can get behavioral health and/or substance use disorder help right away by calling 1-800-783-5386.You can call us 24 hours a day, 7 days a week. We will help you find the best provider for you/your child.You should call 911 if you/your child is having a life-threatening behavioral health emergency. You canalso go to a crisis center or the nearest emergency room. You do not have to wait for an emergency toget help. Our staff is bilingual in English and Spanish. If you speak another language or are deaf/hard ofhearing, call 1-800-783-5386 for help.Emergency CareCall 911 or go to the nearest hospital/emergency facility if you think you need emergency care. You cancall 911 for help in getting to the hospital emergency room. If you receive emergency services, call yourdoctor to schedule a follow up visit as soon as possible.Remember to call Superior at 1-800-783-5386 and let us know of the emergency care you/your child received.Superior defines an emergency as a condition in which you think you/your child has a serious medicalcondition, or not getting medical care right away will be a threat to your/your child’s life, limb or sight.IIMember Services 1-800-783-5386TTY 1-800-735-2989

Numbers to RememberSuperior Medical Ride ProgramNon-Emergency Medical Transportation (NEMT) ServicesSuperior's Medical Ride Program (NEMT services) provides transportation to non-emergency healthcare appointments for members who have no other transportation options. Transportation servicesfor Superior members are provided by SafeRide. Call 1-855-932-2318 (TTY 7-1-1), 8:00 a.m.-5:00 p.m.,Monday-Friday to request a ride. To find out where your ride is, call 1-855-932-2319, 5:00 a.m. to7:00 p.m., Monday-Saturday. SafeRide has staff that speak English and Spanish and can also provideinterpreter services if you speak another language. If you are deaf/hard of hearing, call TTY 7-1-1 for help.Superior HealthPlanSTAR Member HandbookIII

Statement of Non-DiscriminationSuperior HealthPlan complies with applicable Federal civil rights laws and does not discriminate on thebasis of race, color, national origin, age, disability, or sex. Superior does not exclude people or treat themdifferently because of race, color, national origin, age, disability, or sex.Superior: Provides free aids and services to people with disabilities to communicate effectively with us, such as:– Qualified sign language interpreters– Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as:– Qualified interpreters– Information written in other languagesIf you need these services, contact Superior at the number on the back of your Superior member ID card.(Relay Texas/TTY: 1-800-735-2989).If you believe that Superior has failed to provide these services or discriminated in another way on thebasis of race, color, national origin, age, disability, or sex, you can file a complaint with:Superior HealthPlanComplaints Department5900 E. Ben White Blvd.Austin, TX 78741OrCall the number on the back ofyour Superior member ID card.Relay Texas/TTY: 1-800-735-2989Fax: 1-866-683-5369You can file a complaint in person or by mail, fax, or email. If you need help filing a complaint, Superior isavailable to help you.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Officefor Civil Rights electronically through the Office for Civil Rights Complaint Portal, available athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:U.S. Department of Health and Human Services200 Independence Avenue SW., Room 509FHHH Building, Washington, DC 202011-800-368-1019, 1-800-537-7697 (TDD)Complaint forms are available at mber Services 1-800-783-5386TTY 1-800-735-2989

Language AssistanceLanguage assistance services, auxiliary aids andservices, and other alternative formats are available toENGLISH:you free of charge. To obtain this, call the number on theback of your Superior ID card (TTY: 1-800-735-2989).Servicios de asistencia de idiomas, ayudas y serviciosauxiliares, y otros formatos alternativos están disponiblesSPANISH: para usted sin ningún costo. Para obtener esto, llame alnumero al dorso de su tarjeta de identificación Superior(TTY: 1-800-735-2989).SPANISH:ATENCIÓN: Si usted habla español, disponemos de servicios lingüísticos gratuitos para usted.Llame al número al dorso de su tarjeta de identificación Superior (TTY: 1-800-735-2989).VIETNAMESE:XIN LƯU Ý: Nếu quý vị nói tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ được cung cấp hoàn toànmiễn phí cho quý vị. Hãy gọi số ở mặt sau trên thẻ ID thành viên Superior của quý vị(TTY: 림: 귀하께서 한국어를 사용하신다면, 언어 지원 서비스를 무료로 이용하실 수있습니다. Superior 회원 ID 카드 뒷면에 있는 번호로 전화하십시오(TTY: 1-800-735-2989). اتصل بالرقم الموجود على ظهر بطاقة . فلدينا خدمات معاونة لغوية مجانية من أجلك ، إذا كنت تتحدث اللغة العربية : تنبيه )1-800-735-2989 : الخاصة بك (جهاز االتصال للصم والبكم Superior عضوية تو زبان ميں معاونت کی خدمات آپ کو مفت ميں دستياب ہيں۔ ، اگر آپ اردو زبان بولتے ہيں : فرمائيں )۔ 1-800-735-2989 : ممبر آئی ڈی کارڈ کی پشت پر موجود نمبر پر کال کريں (ٹی ٹی وائی Superior اپنے TAGALOG:BIGYANG-PANSIN: kung nagsasalita ka ng Tagalog, may mga serbisyong pantulong sa wikana libre para sa iyo. Tawagan ang numero sa likod ng iyong ID card ng miyembro ng Superior(TTY: 1-800-735-2989).FRENCH:ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont offertsgratuitement. Appelez le numéro au dos de votre carte d’identification Superior(ATS : 1-800-735-2989).HINDI:ध्यानार्थ: यदि आप दिन्िी बोलते िैं, तो भाषा सिायता सेवाएं, आपके ललए ननिःशुल्क उपलब्ध िैं। आपकेSuperior सिस्य आईडी काडथ के पीछे दिए गए नंबर पर कॉल करें (TTY: 1-800-735-2989)।Superior HealthPlanSTAR Member HandbookV

(TTY: 1-800-735-2989).FRENCH:ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont offertsgratuitement. Appelez le numéro au dos de votre carte d’identification Superior(ATS : 1-800-735-2989).Language ��नार्थ: यदि आप दिन्िी बोलते िैं, तो भाषा सिायता सेवाएं, आपके ललए ननिःशुल्क उपलब्ध िैं। आपकेSuperior सिस्य आईडी काडथ के पीछे दिए गए नंबर पर कॉल करें (TTY: 1-800-735-2989)।. آماده خدمت رسانی به شما هستند ، به صورت رايگان ، خدمات کمک رسانی زبانی ، اگر به زبان فارسی صحبت می کنيد : توجه . ( تماس بگيريد TTY: 1-800-735-2989) خود Superior با شماره واقع در پشت کارت شناسايی عضويت HINWEIS: Wenn Sie Deutsch sprechen ist kostenlose Unterstützung in Ihrer Landessprache für Sieverfügbar. Rufen Sie die Nummer auf der Rückseite der Superior Mitgliedsausweiskarte an(TTY: 1-800-735-2989).ધ્યાન આપોોઃ જો તમે ગુજરાતી, ભાષા બોલતા હો તો સહાયતા સેવા, વવના મ ૂલ્યે, આપના માટે ઉપલબ્ધ છે . આપનાSuperior સભ્યપદ આઈડી કાડડ પાછળ આપેલા નંબર પર કોલ કરો (TTY: 1-800-735-2989)RUSSIAN:ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услугиперевода. Подзвоніть за номером, вказаним на зворотній стороні Вашої членської карткиSuperior (номер телетайпу: ��ださいLAOTIAN:ກາລຸ ນາໃຫ້ ຄວາມສ້ າທ່ ານເວ່ ອຍເຫ້ ທ່ ານໂດຍບໍ ເສຍຼື ອພາສາມີ ໃຫົ ນໃຈ: ຖົ ້ າພາສາ(ລາວ) ໍບິ ຣການຄວາມຊ່ີ ຢເງ້ ໂທຫາເລກທ່ ດ້ ານຫ່ ານ (1-800-735-2989)ີ ນ. ໃຫິ ກທຼັ ງຂອງ Superior ບຼັດຊະມາຊSHP 20163784CVIMember Services 1-800-783-5386TTY 1-800-735-2989

Table of ContentsIntroductionAbout Your Health Plan . 1Your Superior Member ID Card .2MedicaidYour Texas Benefits Medicaid Card .3Medicaid and Private Insurance .5Renewing Your Medicaid Coverage .5What to Do if You Move .5What to Do if You are a Member of the Adoption Assistance and Permanency Care Assistance(AAPCA) Program and Need to Change Your Address or Phone Number .5Loss of Medicaid Coverage . 6Medicaid Lock-in Program . 6Accessing Care - Primary Care ProvidersYour Primary Care Provider .7Changing Primary Care Providers .7Doctor Requested/Caused Changes in Primary Care Providers . 8Physician Incentive Plan . 8Accessing Specialty CareReferrals to Special Doctors . 9Services That Do Not Need a Referral . 9Getting Permission for Specialty Medical Services . 9Asking for a Second Opinion . 10Getting Admitted to a Hospital . 10Accessing Care - Just for WomenGetting OB/GYN Care for You or Your Daughter .11Choosing an OB/GYN .11Accessing Care - Pregnant Women and New MothersWhat to Do if You are Pregnant . 12Other Services and Education for Pregnant Women . 12Case Management for Children and Pregnant Women (CPW) . 12Choosing Your Baby’s Primary Care Provider . 12Enrolling Your Baby in a Health Plan . 13Changing Your Baby’s Health Plan . 13Getting Health Care After Your Baby is Born . 13Accessing Care - Special Health ProgramsHealthy Texas Women Program . 14DSHS Health Care and Family Planning Programs. 14Superior HealthPlanSTAR Member HandbookVII