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Potential for Contract Termination

Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. Enrollment in Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) depends on contract renewal.

If one or more of the following situations happens, Medicare or Texas Medicaid must end your membership with Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP):

  • There is a break in your Medicare Part A and Part B coverage.
  • You no longer qualify for Texas Medicaid. Our plan is for people who qualify for both Medicare and Texas Medicaid.
  • You do not pay the amount needed for you to qualify for benefits (medical spend down).
  • You move out of our service area.
  • You go to jail.
  • You lie about or do not tell us information about other insurance you have for drugs.

If we learn from Medicare and/or Texas Medicaid that one or more of the following has occurred, we will disenroll you from our plan with permission from Medicare and Texas Medicaid:

  • You give us incorrect information on purpose when you are enrolling in our plan and that information made you eligible for our plan.
  • You continuously behave in a way that bothers others and makes it difficult for us to provide medical care for you and other members of our plan.
  • You let someone else use your ID card to get medical care.
    •  If we end your membership because of this reason, Medicare may turn your case over to the Inspector General.

Your Rights upon Disenrollment:

If we ask Medicare and Medicaid to end your membership, we must tell you why in writing. We will also tell you how to make a complaint about ending your membership. See the Appeals and Grievances section of this website for information about how to make a complaint.,,,,,,,,,