Health Plan Changes

You can change your health plan at any time. You might want or need to change your health plan if:

  • You feel a different health plan would better meet your needs, or the doctor you see is no longer in your current plan.
  • Your current health plan is leaving your service area.
  • A new health plan is added to your service area.

Find more information on the health plans in your service area and how to choose a new health plan.

We carefully review the health plans in your service area.

Health plan changes in service areas are usually the result of a formal business review we do every few years. This is one of the ways we ensure quality of services for members. Sometimes a health plan might decide to leave the program.

If your health plan is leaving your service area, you’ll have to pick a new plan. We will mail you a letter to explain the change and next steps you should take. There will be at least two plans to choose from. If you don’t choose a new plan, we will choose one for you.

If there’s been a change in your service area, you can find updates under “Upcoming changes” below.

We ensure a smooth transition if you change plans.

If you change plans, your current plan must continue to provide services as you transition to your new plan.

Your prior authorizations

If you have a prior authorization for services from the plan you’re leaving, your new plan must either:

  • Continue your services for up to six months, depending on the service.
  • Assess your needs and decide whether to provide a new prior authorization.

If prior authorization for a service wasn’t required under the plan you’re leaving but is required under your new plan, your new plan must treat you as if you had prior authorization for the service.

Your providers

If your current provider is out-of-network for your new plan, you may have to choose a new provider. Your new plan will ensure you can see your current provider until a new provider is available.

Pregnant members who are past the 24th week of pregnancy can continue to see their OB/GYN through their postpartum checkup, even if they’re out-of-network for their new plan.

Upcoming changes

New Statewide Dental Plan: United Healthcare Dental

  • Service Area: Statewide
  • Program: Dental
  • When: Sept. 1, 2020
  • What to Expect:
    • Members will have a new statewide dental plan option, United HealthCare Dental, in addition to Dentaquest and MCNA.
    • We will send a letter to members about the new plan in Summer 2020.

Plan Leaving Dallas Service Area: Children’s Medical Center Health Plan

  • Service Area: Dallas
  • Program: STAR Kids
  • When: Sept. 1, 2020
  • What to Expect:
    • Amerigroup remains a plan option and a new plan will be added.
    • Children’s Medical Center Health Plan members will have to choose a new plan.
    • We will send a letter to members in Summer 2020.

Need help?

If you have any questions or concerns about health plan changes, contact the Ombudsman Managed Care Assistance Team at OMCAT@hhsc.state.tx.us or 866-566-8989.