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1. Inpatient and outpatient medical and health facility services

2. Inpatient and outpatient professional health care provider medical services

3. Diagnostic imaging, laboratory services, and other diagnostic and evaluative services

4. Medical equipment, appliances, and assistive technology, including:

   1. Prosthetics, (& the repair, technical support, and customization needed for individual use)

   2. Eyeglasses (& the repair, technical support, and customization needed for individual use)

   3. Hearing aids (& the repair, technical support, and customization needed for individual use)

5. Inpatient and outpatient rehabilitative care

6. Emergency care services

7. Emergency transportation

8. Necessary transportation for health care services for an individual with a disability or who may qualify as low income

9. Child and adult immunizations and preventive care

10. Health and wellness education

11. Hospice care

12. Care in a skilled nursing facility

13. Home health care, including health care provided in an assisted living facility

14. Mental health services

15. Substance abuse treatment

16. Dental care

17. Vision care

18. Prescription drugs

19. Pediatric care

20. Prenatal and postnatal care

21. Podiatric care

22. Chiropractic care

23. Acupuncture

24. Therapies that are shown by the National Institutes of Health, National Center for Complementary and Integrative Health to be safe and effective

25. Blood and blood products

26. Dialysis

27. Adult day care

28. Rehabilitative and habilitative services

29. Ancillary health care or social services covered by a local health care system before the effective date of the program

30. Ancillary health care or social services covered by a community center for persons with developmental disabilities under Chapter 534, Health and Safety Code, before the effective date of the program

31. Case management and care coordination

32. Language interpretation and translation for health care services, including sign language, Braille, or other services needed for individuals with communication barriers

33. Health care and long-term supportive services covered under Medicaid or the child health plan program before the effective date of the program

 

 

 

Covered health care benefits for a member also include all health care services required to be covered under any of the following programs or by the following providers, without regard to whether the member would otherwise be eligible for or covered by the program or source listed:

1. CHIP

2. Medicaid

3. Medicare

4. a health benefit plan issuer under this code

5. any additional health care service authorized to be added to the program's benefits by the board

6. all essential health benefits mandated by the Affordable Care Act