STAR+PLUS Member Benefits

Member Handbook

 
Member Handbook (English)
Member Handbook (Español)
Member Handbook for Nursing Facility Members (English)
Member Handbook for Nursing Facility Members (Español)

 

Texas Medicaid Program Benefits


The following services are benefits of the Texas Medicaid Program. Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM) and the bi-monthly Texas Medicaid Bulletins for a more inclusive listing of limitations and exclusions.
 
  • 72-hour supplies of emergency prescriptions

  • Accessing OB/GYN

  • Advanced Practice Nurse (APRNs)

  • Ambulance services

  • Audiology services, including hearing aids for adults; audiology services and hearing aids for children under age twenty-one (21) are a Non-Capitated Service. Non-Capitated Services are discussed in greater detail in the Provider Manual.

  • Behavioral health services

  • Birthing services provided by a Physician or Advanced Practice Nurse in a licensed birthing center

  • Chiropractic services

  • Dialysis

  • Disease Management Programs

  • Durable medical equipment and supplies

  • Emergency services

  • Employment assistance

  • Family planning services

  • Health education related to Obesity

  • Home health care services

  • Hospital services, outpatient (inpatient covered if due to a behavioral health issue)

  • Laboratory

  • Lock-In program outpatient drugs

  • Medical checkups and Comprehensive Care Program for children under age 21 through the THSteps Program

  • Oral evaluation and fluoride varnish in the Medical Home in conjunction with Texas Health Steps medical checkup for children 6 months through 35 months of age.

  • Optometry, glasses, and contact lenses, if medically necessary

  • Podiatry

  • Prenatal care

  • Primary care services

  • Preventive services including an annual adult well check for patients 21 years of age and over

  • Radiology, imaging, and X-rays

  • Service Coordination

  • Specialty physician services

  • Therapies – physical, occupational and speech

  • Transplantation of organs and tissues

  • Vision


Providers can verify benefits for a STAR+PLUS member online using the HealthSpring Provider Portal.

 

 

Community-Based Long-Term Care Benefits


Cigna-HealthSpring must provide all Long Term Support Services currently covered under the traditional, fee-for-service Medicaid program. The following non-inclusive list of community-based, long-term care services are included under Cigna-HealthSpring’s STAR+PLUS Program. Providers can refer to the STAR+PLUS Member Handbook for a more inclusive listing of the limitations and exclusions that apply to each benefit category.

 

Services Available to all STAR+PLUS Members

 

  • Personal Attendant Services *

  • Day Activity and Health Services (DAHS)

  • STAR+PLUS Waiver Members have a choice in service delivery options for attendant services, including any of the following:

  • (1) traditional agency option;
    (2) Consumer Directed Services (CDS) option; or
    (3) Service Responsibility Option (SRO).

 

 

HCBS STAR+PLUS Nursing Facility Waiver Services Available to Members who Qualify

 

  • Adaptive Aids

  • Adult Foster Care

  • Assisted Living and Residential Care Services

  • SPW Dental

  • Emergency Response Services

  • Home Delivered Meals

  • Medical Supplies not available under the HCBS STAR+PLUS Waiver program

  • Minor Home Modifications

  • Nursing Services, in-home

  • Respite Care, in-home or out-of-home

  • Therapy (Physical, Occupational and Speech)

  • Transition Assistance Services


Providers can verify benefits for a STAR+PLUS member online using the Cigna-HealthSpring Provider Portal.

 

 

Enhanced STAR+PLUS Benefits


Under the STAR+PLUS Program, members have access to two (2) enhanced benefits, above and beyond what is available under the traditional, fee-for-service Medicaid program. Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM) and the bi-monthly Texas Medicaid Bulletins for a more inclusive listing of limitations and exclusions.
 
Prescription Drug Coverage – Cigna-HealthSpring Members who are not covered by Medicare are eligible for unlimited prescription drug coverage as described under the Texas Medicaid Formulary and administered through the Texas Vendor Drug Program. Dual-eligible Members do not receive prescription drug coverage through the Texas Medicaid Program because coverage is available through Medicare Part D. Additional information about prescription drug coverage for STAR+PLUS Members is discussed in greater detail in Cigna-HealthSpring’s STAR+PLUS Provider Manual.
 
Providers can verify benefits for a STAR+PLUS member online using the Cigna-HealthSpring Provider Portal.

 

 

Cigna-HealthSpring Value-Added Benefits

 

In addition to traditional STAR+PLUS benefits, Cigna-HealthSpring offers certain “value-added” services to its Members. Value-added services are benefits that only Cigna-HealthSpring’s STAR+PLUS Members receive. These benefits have been added to Cigna-HealthSpring’s STAR+PLUS Program in order to promote healthy lifestyles and improve health outcomes for Members. Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM) and the bi-monthly Texas Medicaid Bulletins for a more inclusive listing of limitations and exclusions.


Medicaid ONLY Members ALL Members

Dental Services


Adults, age 21 and over
24-Hour Nurse Advice Line

Enhanced Vision Services


Adults only
Transportation Services

Good Health Reward


$20 gift card for annual well visit or Texas Health Steps checkup and certain labs or immunizations 
Over-the-Counter Medicines
Welcome Home! Home Health Visit for new moms Cigna-HealthSpring Fitness Plus-  
   Active&Fit Home Fitness Kit
Texas Health Steps Checkup

$30 gift card within 90 days of enrollment with Cigna-HealthSpring

Birth thru 20 years of age
AM/PM 7-day pill box

Respite Care

 
Medicaid Only OCC and Dual Members
Vinyl Gloves

Emergency Response Services


Medicaid Only and Dual Members
Box Fan
Cigna-HealthSpring Fitness Plus-Active&Fit Fitness Facility Membership
Bath Mat
Cold & Flu Kit
Pregnant and Infant Care Book for Expecting Moms
First Aid Kit
 


FOR NURSING FACILITY MEMBERS:
 
Medicaid ONLY Members ALL Members

Dental Services


Adults, age 21 and over
Cigna-HealthSpring Fitness Plus-  
   Active&Fit Home Fitness Kit

Enhanced Vision Services


Adults only
Box Fan

Good Health Reward


$20 gift card for annual well visit and certain labs or immunizations
Bath Mat
Cold & Flu Kit
Personal Hygiene Kit
 

Providers can verify benefits for a STAR+PLUS member online using the Cigna-HealthSpring Provider Portal.
 

Nursing Facility Recipients STAR+PLUS Benefits

The Nursing Facility (NF) recipient once the eligibility requirement is met can qualify for Unit Rate Services and Add-on Services. 

 
  • Nursing Facility Unit Rate means the types of services included in the DADS daily rate for nursing facility providers, such as room and board, medical supplies and equipment, personal needs items, social services, and over-the-counter drugs. The Nursing Facility Unit Rate also includes applicable nursing facility rate enhancements and professional and general liability insurance. Nursing Facility Unit Rates exclude Nursing Facility Add-on Services.


  • Nursing Facility Add-on Services means the types of services that are provided in the Facility setting by the Provider or another network provider, but are not included in the Nursing Facility Unit Rate, including but not limited to emergency dental services; physician-ordered rehabilitative services; customized power wheel chairs; and augmentative communication devices.