Publications and Forms

Summer Enrollment Information

• 2018 Summer Enrollment Online Brochure
• 2018 Summer Enrollment Downloadable Brochure
• 2018 Summer Enrollment Presentation 
• Get the Most from Your Health Plan Flier 
• Where to Go for Care Flier 
• Virtual Visits Flier 

Fliers, Handouts and Participant Information

• 2018 Guide to Medical Benefits 

• Blue Points^SM Flier 
• Fitness Program Flier 
• Fitness Program and Weight Management Programs Flier 
• Health Assessment Flier 
• Well onTarget^® Flier 

Forms

• Domestic Claim Form 
• International Claim Form 
• Magellan Mental Health Claim Form 

• HIPAA Disclosure Authorization Form 
• Nominate a Provider 
• Transition of Care Form 

• Benefit/Wellness Fair Presentation Request Form

Master Benefit Plan Documents (MBPDs)

• 2018 HealthSelect of Texas (In-Area) MBPD
• 2018 HealthSelect of Texas Out-of-State MBPD
• 2018 Consumer Directed HealthSelect MBPD

• 2017 HealthSelect of Texas (In-Area) MBPD
• 2017 Consumer Directed HealthSelect MBPD

Summary of Benefits and Coverage (SBC) Documents

• PY 2019 HealthSelect of Texas SBC 
• PY 2019 HealthSelect Out-of-State SBC 
• PY 2019 Consumer Directed HealthSelect SBC 
• PY 2019 HealthSelect Secondary SBC 
• SBC Glossary of Health Coverage and Medical Terms PY2019 

• PY 2018 HealthSelect of Texas SBC 
• PY 2018 HealthSelect Out-of-State SBC 
• PY 2018 Consumer Directed HealthSelect SBC 
• PY 2018 HealthSelect Secondary SBC 
• SBC Glossary of Health Coverage and Medical Terms 

Vea estos documentos en español en la versión en español de esta página.