Click the links below for answers to frequently asked questions about
TexanPlus.
Once your enrollment application is processed, you will receive an Acknowledgement Letter. This letter will inform you to begin using
the plan on your Effective Date, which is typically the first day of the month following the date you submit your application.
If you enroll in a 2013 plan during October 15, 2012 – December 7, 2012, your coverage will be effective on January 1, 2013.
You should receive your ID card no later than 10 calendar days from when you receive confirmation of your enrollment from the Centers
for Medicare & Medicaid Services (CMS), or by the last day of the first month of your enrollment, whichever comes first.
You can make a premium payment in one of three ways:
- You can arrange for an automatic bank withdrawal from your checking or savings account, or
- We can send you a monthly bill, and you send us back a check or money order, or
- You can sign up for automatic deduction from your Social Security check. This process can take up to 90 days to become
effective, and you are responsible for paying any premiums during this time.
If you want to change how you pay your bill, we can accept a verbal request to change your method of payment over the phone for direct
bill or Social Security Administration (SSA) deduction. You must submit a signed request in writing; either by sending a fax
(1-713-558-7127) or a letter through the mail, if you are changing to automatic bank withdrawal from your bank account. You will need
to submit a copy of a voided check.
If you choose to pay your bill monthly through a check or money order, you will receive a monthly premium notice, but you will not
receive a coupon booklet. If you pay your premium by automatic bank withdraw, you will not receive a monthly premium notice.
As a TexanPlus member, you are required to select
an affiliated Primary Care Physician (PCP) to help manage your healthcare. Your PCP will collaborate with you, your
pharmacist and various medical specialists and professionals to help manage your medical care.
Click here to use our Provider Search tool to locate your physician.
To make PCP changes, call us at: 1-866-230-2513,
8:00 a.m. to 8:00 p.m.
in your local time zone (TTY users call
711)
7 days a week.
When specialty services are medically necessary, your PCP will direct you to a specialist (routine OB/GYN care does not require
PCP direction).
Your plan includes coverage for emergency services. You are covered anywhere in the United States. Simply go to the nearest emergency
room or call 911 for assistance.
If you are admitted to the hospital after an emergency, you'll need to contact us at the number on your ID card or contact your
Primary Care Physician (PCP).
Your plan includes coverage for urgent care services. Urgently Needed Care is a non-emergency situation when you need medical care right
away because of an illness, injury, or condition that you did not expect or anticipate, but your health is not in serious danger. You are
covered anywhere in the United States.
With TexanPlus, you will choose a doctor from our
broad network to coordinate your care.* If you wish to change your doctor, also called your Primary Care
Physician (PCP), you may do so at any time. Your PCP is your health advocate – he or she will send you to specialists or
hospitals when you need additional care.
Please note that with an HMO plan, you must use providers in the network. You will be responsible for any fees or services provided
by doctors or hospitals out of the network. Providers in the network can change at any time.
*You must use plan providers except in emergency or urgent care situations (or for out-of-area renal dialysis). If you obtain routine care
from out-of-network providers neither Medicare nor TexanPlus
will be responsible for the costs.
Questions regarding approval for services should be referred back to the doctor who ordered the services. Or, you can call us at
1-866-230-2513,
8:00 a.m. to 8:00 p.m.
in your local time zone (TTY users call
711)
7 days a week.
If you've visited your doctor or pharmacist, or if you’ve received some type of medical care, you have probably received an
Explanation of Benefits (EOB). This statement is from your plan about health services you’ve received. It provides complete
information about the health services you’ve received, payments, and any charges you are responsible for. It is important to
remember that the EOB is not a bill. This information is provided for your convenience.
If you have questions about how much you owe your provider, you should contact us at:
1-866-230-2513,
8:00 a.m. to 8:00 p.m.
in your local time zone (TTY users call
711)
7 days a week.
If your specific medicine is not on our formulary, there may be a similar, high-quality medicine available that offers the same
benefits. We’ll work with you and your doctor to find a covered medicine that best suits your condition. You may also request
a formulary exception.
If you have questions about your prescription medicine, you should contact us at
1-866-230-2513,
8:00 a.m. to 8:00 p.m.
in your local time zone (TTY users call
711)
7 days a week.
Yes, TexanPlus offers some materials in Spanish
that are available upon request. You may request any available Spanish materials by calling
1-866-230-2513,
8:00 a.m. to 8:00 p.m.
in your local time zone (TTY users call
711)
7 days a week. A
TexanPlus representative will be happy to help you.
We also offer materials in other alternate formats, such as Braille or large print. Materials may also be available in a non-English
language. For additional information, call us at the phone number listed above.
In an effort to measure our member's level of satisfaction with Member Services, we place a call the day after a member contacts us
to take a voluntary survey on his/her level of satisfaction. These calls help us monitor and improve the service we provide our members.