Publications and Forms

Fliers, Handouts and Presentations

• 2019 Guide to Medical Benefits Digital Copy
• 2019 Guide to Medical Benefits Downloadable Copy 

• Blue Points^SM Flier 
• Childhood Immunization Schedule Flier 
• Fitness Program Flier 
• Fitness Program and Weight Management Programs Flier 
• Get the Most from Your Health Plan Flier 
• Health Assessment Flier 
• Virtual Visits Flier 
• Well onTarget^® Flier 
• Where to Go for Care Flier 
• Adult Wellness Guidelines Flier 
• Preventive Services Flier 

• Plan Year 2019 Presentation 

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)

• 2019 HealthSelect of Texas (In-Area) MBPD
• 2019 HealthSelect of Texas Out-of-State MBPD
• 2019 Consumer Directed HealthSelect MBPD
• 2019 HealthSelect Secondary MBPD

• Archived MBPDs:
  • 2018 HealthSelect of Texas (In-Area) MBPD (6/20/2018 revision)
  • 2018 HealthSelect of Texas Out-of-State MBPD (6/20/2018 revision)
  • 2018 Consumer Directed HealthSelect MBPD (3/20/2018 revision)
  • 2018 HealthSelect Secondary MBPD (1/11/2019 revision)
  • 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