Asthma and COPD Support

Individual care to help you control asthma or COPD symptoms.

Do you have trouble managing asthma or COPD symptoms? A nurse who specializes in breathing issues can really help. You’ll get a customized treatment plan and medicine to:

• Manage flare-ups.
• Reduce symptoms.
• Help you stay active.

Case Management

Do you or a loved one have a serious health problem or a high-risk pregnancy? If so, our case managers are in your corner. They will:

• Explain medical terms in plain language.
• Coordinate your doctor appointments.
• Provide your care team with your medical records.

Your case manager will stay with you on your medical journey. He or she will:

• Think beyond your medical needs.
• Make sure you have support at home.

So you can focus on getting better.

Choice of Doctor

You or your child gets a primary care physician (PCP) who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.

If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you. 

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

Choose a Birth Center

Where to deliver your child is an important choice. That's why you can pick from hundreds of hospitals across Texas.

We encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you’ll be more relaxed when you deliver your baby.

Dental Care

Checkups, routine and emergency care are covered.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well.

Equipment and Supplies

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor or case manager. This includes:

• Hospital bed.
• Oxygen tank.
• Walker or wheelchair.

Extra Benefits

Sports and school physicals at no cost to you.

Our plan covers up to two free physicals each year so your child can:

• Go to camp.
• Join a team.
• Play a school sport.

Healthy First Steps®

Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

We will help you:

• Choose a pregnancy provider and a pediatrician (child’s doctor).
• Schedule visits and exams and arrange rides to your visits.
• Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
• Get supplies, including breast pumps for nursing moms.
• Connect with community resources such as Women, Infants and Children (WIC) services.

Healthy Rewards

An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.

You can earn great gifts for things like:

• Getting your yearly wellness exam.
• Getting lab tests.
• Completing a program for weight management.

Hospitalization

This plan pays for all expenses related to a hospital stay, so you can rest and heal.

This includes:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointment.

We have people at our phone centers that speak more than one language. A service lets us connects with others that speak hundreds of languages.

Language Help

You can ask to receive information in another language. Then anything we write to you will only be in that language. This is provided at no cost to you.

Medicines

We make getting your medicine easy.

There are no copays for covered drugs. You can fill your prescriptions at:

• Local pharmacies.
• Services that deliver routinely right to your door.

We also cover over-the-counter medicines with a written order from your doctor.

Member Services

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call 24/7. We'll answer your questions simply and completely.

We can also help you find:

• Home care providers.
• Dentists and vision providers.
• Adult Day Health Centers.

Mental Health

Mental health is as important as physical health. That's why we have the same coverage for both.

Required care is 100% covered with no copay. This includes:

• Behavioral therapy.
• Substance abuse treatment.
• Medications.

No Copays

You pay nothing for covered services.

While your health care is low-cost or free, the care quality is high. You get: 

• Care from highly skilled and compassionate doctors.
• Treatments at respected hospitals and clinics.
• Home medical equipment and supplies to help you be at your best. 

NurseLine

Medical questions and situations come at inconvenient times. When you have questions about your health or your child's health, you can call a trained nurse 24 hours a day, 7 days a week.

Our NurseLine nurses will:  

• Listen to the symptoms.
• Guide you on self-care.
• Advise you about getting care at a doctor visit or an urgent care center.

Suggest you go right to the emergency department.

Prenatal Visits

Your pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

• Make sure both you and your baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

Programs for Kids and Teens

Kids with positive role models make more healthy choices. That's why we provide free memberships to the Boys & Girls Clubs in your area.

Along with fun and games, these clubs offer help with:

• Homework.
• Mentoring.
• Coaching.

Transportation

Whether you live in the city or in the country, rides are available. Our plan provides round trips to and from plan locations. This includes trips to and from the pharmacy to fill your prescriptions.

Vaccines and Immunizations

All of the immunizations your child needs are covered.

Vision Care

You'll get the care, eyeglasses and treatment that let you see life more clearly. Coverage includes $105 every two years toward frames or contact lenses.

This benefit is offered by certain stores and retailers.

Weight Control

Get 10 vouchers toward local Weight Watchers programs.

Weight Watchers encourages a healthy approach for eating and living. The program helps you change your eating habits and become more active. Weekly meetings give you advice and support. So you can stay on track and meet your goal.

Wellhop for Mom & Baby

Connect with other expectant moms. Get support and information during your pregnancy and after you deliver. This program is part of your health plan and there is no extra cost to you.
Here’s how it works:

• Join video conversations every other week with women who have similar due dates and a group leader.
• Chat and share experiences with moms from your group on the Wellhop app or website.
• Visit the Wellhop library. You’ll find articles, videos and more.