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Getting the most from my coverage. It's all part of my plan.

Get the Most from Your Coverage

You Deserve Quality Healthcare. And you also deserve to have the information you need to get the most from your coverage. Goals for quality are set and reviewed by Superior HealthPlan to make sure you get the care you need.

Feedback from members is reviewed throughout the year. If you get a survey from Superior, please complete it. Information from surveys helps us to continue to improve. Learn more about our Quality Program.

Review the helpful information below to learn more about your coverage and the many services available to you.

Know Your Rights

Being a member means there are things you should expect from Superior. We will tell you about your rights and responsibilities every year and you can make recommendations to them. These are some of your rights:

  • You should have access to information about Superior, our services and our providers.
  • You should be treated with courtesy and respect.
  • You should make decisions about your health care. Talk with your doctor, know about all treatment options regardless of cost.
  • You should know your race, ethnicity, language, and medical information will be kept private. There are policies in place to guard your health records and protected health information.

It’s also important to know what you can do to get the most from your coverage:

  • Give your doctors information they need about you and your health. Understand your health issues, participate and learn as much as you can. Follow treatment plans that you and your doctor agree on.
  • Keep your Member ID Card with you so you have it at appointments.
  • Tell your doctor if you have gotten care in an emergency room.

The full list of rights and responsibilities is in your Member Handbook.

Getting the Care You Need

Your PCP is the doctor you’ll see for routine checkups and care. Your PCP will help find other types of healthcare providers if you need one. Use our Find a Provider tool to search through our directory of high quality providers.

As children get older, they should change from seeing a pediatrician to seeing an adult doctor. Teens don’t need checkups as often as young kids do, but they should see their PCP at least once a year. Regular visits will help them stay up to date on vaccines. If teens have a condition such as diabetes or asthma, it’s very important that they keep seeing their doctors and not miss a visit. Call Superior if you need help finding an adult provider.

You should be able to schedule an appointment with your PCP and get medical care when you need it. You may have to wait a little longer to get in to see certain other types of providers, like specialists. Call Superior if you can’t get an appointment in a timely manner.

You should get high-quality medications and the right treatment for your conditions. But not all drugs are covered. And some may need to be approved before they’re covered. Please review the Preferred Drug List (PDL). It is updated regularly and lists drugs that are covered by insurance. Talk to your doctor or pharmacist to review the PDL and answer questions about your medications.

The Utilization Management (UM) Department looks at your health records and may also talk with your doctor to decide if a service you need is covered. These decisions are not based on financial reasons. Doctors and staff are not rewarded for saying no to care. All UM decisions are based on:

  • If the service is medically necessary.
  • If the service works well.
  • If the service is right for you.

New medicines, tests and procedures come out every year. A team of doctors and other experts decide if new medical care will be covered by Superior. Your plan covers care that is medically necessary. Not every new medical service is covered for all members.

If a service is denied, you have the right to appeal that decision. You will be sent a letter explaining how to make an appeal. All appeal requests are decided according to your request, condition and benefits.

Care Management is for members who may need extra help taking care of their health. Some people have several health conditions and see more than one doctor. Others need help arranging the services their doctors may have ordered. Working with a care manager lets you understand major health problems, work well with your doctors and get the care you need.

A full description of your rights and responsibilities and Notice of Privacy Practices (NOPP) can be found in your Member Handbook. You can also find Superior’s Provider Directories online by visiting Find a Provider. Contact Member Services to ask for a paper copy. Language assistance services, auxiliary aids and services, and other alternative formats are available to you free of charge. To obtain this, call the number on the back of your Superior ID card (TTY: 1-800-735-2989).

Get More Information

Your Member Handbook is a great source for information about your coverage and benefi ts. It also lists important phone numbers.

 

You can also contact Member Services 8 a.m. to 5 p.m. CST Monday through Friday. You can reach a nurse 24 hours a day, 7 days a week for after-hours questions and concerns. For additional help, call: 

  • STAR/CHIP: 1-800-783-5386
  • STAR Health: 1-866-912-6283
  • STAR Kids: 1-844-590-4883
  • STAR+PLUS: 1-877-277-9772

Call Member Services to get:

  • A paper copy of your Member Handbook, Privacy Notice, Provider Directory or anything on the Superior website.
  • Help finding a doctor and making an appointment.
  • Help seeking assistance in your preferred languages.
  • Help with a ride to your appointment.

The Superior HealthPlan website also has a lot of helpful information. Visit SuperiorHealthPlan.com, FosterCareTX.com (for STAR Health members) to find the Member Handbook, Find a Provider tool, and the Preferred Drug List. You can also use it to help you manage your health.

 

Creating an online member account is free and easy. With it, you can:

  • Find or change your PCP
  • Request a new Member ID Card or print a temporary ID Card
  • View and update your personal information

You can also send a message directly to Superior from your member account.