How much do I have to earn to qualify for CHIP or STAR?
1. Find your family size to the left side of this chart. Follow that row to the right.
2. Is your family's income less than the monthly or yearly income shown in the orange Medicaid section? If so, your children might get Medicaid.
3. If your income is higher, follow the row to the green CHIP section. Your children might get CHIP if your income is less than the monthly or yearly income shown in the green section. Children of families that earn higher incomes may also qualify in some cases. (Income is money you get paid before taxes are taken out.)
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| Find your family size here  |
May Qualify for Children's Medicaid |
May Qualify for CHIP | |||||||||
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| Family Members (Adults plus children) |
Monthly Family Income | |
Yearly Family Income | Monthly Family Income | |
Yearly Family Income | |||||
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| 1 |  |
 |
$908 | |
$10,890 |  |
$1,815 | |
$21,780 |  |
|
| 2 |  |
 |
$1,226 | $14,710 |  |
$2,452 | $29,420 |  |
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| 3 |  |
|
$1,545 | $18,530 | |
$3,089 | $37,060 | |
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| 4 |  |
|
$1,863 | $22,350 | |
$3,725 | $44,700 | |
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| 5 |  |
|
$2,181 | $26,170 | |
$4,302 | $52,340 | |
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| 6 |  |
|
$2,500 | $29,990 | |
$4,999 | $59,980 | |
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| 7 |  |
|
$2,818 | $33,810 | |
$5,635 | $67,620 | |
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| 8 |  |
|
$3,136 | $37,630 | |
$6,272 | $75,260 | |
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How much does CHIP coverage cost?
Your family will pay no more than $50 a year. Some families pay nothing.
| Enrollment Fees (for 12-month enrollment period): | |
|---|---|
| At or below 150% of FPL* | $0 |
| Above 150% up to and including 185% of FPL | $35 |
| Above 185% up to and including 200% of FPL | $50 |
How much do I pay to see the doctor?
What other services require a co-payment?
Depending on your income you may have co-payments for some services such as prescription drugs and visits to the doctor or emergency room. Co-payments range from $3 to $15 for doctor office visits.
| At or below 100% of FPL | Above 100% up to and including 150% FPL | Above 150% up to and including 185% FPL | Above 185% up to and including 200% FPL | |
|---|---|---|---|---|
| Office Visit | $3 | $5 | $20 | $25 |
| Non-Emergency ER | $3 | $5 | $75 | $75 |
| Generic Drug | $0 | $0 | $10 | $10 |
| Brand Drug | $3 | $5 | $35 | $35 |
| Facility Co-pay, Inpatient | $15 | $35 | $75 | $125 |
| Cost-sharing Cap | 5% (of family's income)** | 5% (of family's income)** | 5% (of family's income)** | 5% (of family's income)** |
How can I tell if my child’s current doctor, clinic or hospital accepts Seton Health Plan?
Check our Online Provider Search. If you don't see the doctor, clinic, or hospital you want please call Seton Health Plan member services at 1-877-451-5601.
What is the difference between Medicaid (STAR) and CHIP?
Families with lower incomes may qualify for Medicaid. If your income is a little higher than what Medicaid allows, then you might be eligible for CHIP. Medicaid families do not have to copay. Some CHIP families, depending on their income, might have to pay from $3 to $10 to receive services.
How do I check in the status of my application?
What if I never received my renewal packet?
| Call the program administrator at: | |
| CHIP | 1-800-647-6558 |
| STAR | 1-800-964-2777 |
What counties does Seton Health Plan cover?
Seton Health Plan offers CHIP & STAR in the following counties: Bastrop, Burnet, Caldwell, Fayette, Hays, Travis and Williamson.
I’m already a member, but I have questions about services, who do I call?
You can call our Member Services Department at 1-877-451-5601.
What if I have questions about my child's health?
You should always ask your doctor about your child’s health. If you don’t know who your doctor is then call the Member Services Department at 1-877-451-5601. If it is after your doctor’s office is closed and you don’t know what to do, you can call our 24 hour Nurse Help Line for CHIP 1-888-497-8989 and for STAR 1-855-782-4214.
What if I want to change my doctor?
You can call our Member Services Department at 1-877-451-5601.