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2017 Individual HMO Application | Spanish2017 Individual PPO Application | Spanish
2017 Individual Plans Overview
Bronze 6550 H.S.A. HMO | SpanishBronze 6850 HMO | Spanish
Silver 4500 HMO | Spanish
Gold 001 HMO | SpanishGold 1000 HMO | SpanishGold 2500 HMO | Spanish
Silver 2850 H.S.A. PPO | SpanishSilver 4500 PPO | Spanish
Large Group HMO Plan OverviewLarge Group PPO Plan Overview
Small Group HMO Plan OverviewSmall Group PPO Plan Overview
Small Group HMO Employee Application | SpanishSmall Group HMO Employer Application
Small Group PPO Employee Application | SpanishSmall Group PPO Employer Application
Large Group HMO Employee Application | SpanishLarge Group HMO Employer Application
Large Group PPO Employee Application | SpanishLarge Group PPO Employer Application
2017 HMO Select Bronze 6550 HSA | Spanish2017 HMO Select Bronze 6850 | Spanish2017 HMO Select Silver 002 | Spanish2017 HMO Select Silver 3000 | Spanish2017 HMO Select Silver 4000 HSA | Spanish2017 HMO Select Gold 001 | Spanish2017 HMO Select Gold 1500 | Spanish2017 HMO Select Gold 2000 | Spanish
2017 PPO Select Bronze 5000 HSA | Spanish2017 PPO Select Bronze 6550 HSA | Spanish2017 PPO Select Bronze 6850 | Spanish2017 PPO Select Silver 3000 | Spanish2017 PPO Select Silver 4000 HSA | Spanish2017 PPO Select Silver 4500 | Spanish2017 PPO Select Silver 5000 | Spanish2017 PPO Select Gold 1000 | Spanish2017 PPO Select Gold 1500 | Spanish2017 PPO Select Gold 2000 | Spanish2017 PPO Select Gold 2000-3500 | Spanish2017 PPO Select Gold Copay | Spanish2017 PPO Select Platinum 500 | Spanish
2017 HMO Select 001 | Spanish2017 HMO Select 002 | Spanish2017 HMO Select 2000-100 | Spanish2017 HMO Select 3000-100 HSA | Spanish2017 HMO Select 3000-80 | Spanish2017 HMO Select 5000-100 | Spanish2017 HMO Select 6550-100 HSA | Spanish2017 HMO Select 6600-100 Standard | Spanish
2017 PPO Select 002 | Spanish2017 PPO Select 500-80 | Spanish2017 PPO Select 1000-80 | Spanish2017 PPO Select 1500-80 | Spanish2017 PPO Select 2000-100 | Spanish2017 PPO Select 2000-80 | Spanish2017 PPO Select 2500-70 | Spanish2017 PPO Select 2500-80 | Spanish2017 PPO Select 3000-100 | Spanish2017 PPO Select 3000-100 HSA | Spanish2017 PPO Select 3000-80 | Spanish2017 PPO Select 3000-80 HSA | Spanish2017 PPO Select 5000-100 | Spanish2017 PPO Select 5000-100 HSA | Spanish2017 PPO Select 5000-70 | Spanish2017 PPO Select 5000-80 HSA | Spanish2017 PPO Select 6550-100 HSA | Spanish2017 PPO Select 6600-100 Standard | Spanish2017 PPO Select Standard Copay | Spanish
Late Submission FormDeductible Credit FormEmployee Verification FormCobra and Medicare SurveyGroup Data Submission Agreement
Small Group PPO Certificate of CoverageSmall Group Evidence of Coverage Large Group PPO Certificate of CoverageLarge Group Evidence of CoverageIndividual PPO PolicyIndividual Evidence of Coverage
2016 Individual Elect HMO Plan Overview2016 Individual Elect PPO Plan Overview
Bronze 5000 H.S.A. HMOBronze 5500 H.S.A. HMOBronze 6850 HMO
Silver 2250 HMOSilver 2500 HMO
Gold 001 HMOGold 2500 HMO
Bronze 5000 H.S.A. PPOBronze 5250 H.S.A. PPOBronze 6850 PPO
Silver 2600 H.S.A. PPOSilver 3000 PPOSilver 4000 PPO
Gold 1250 PPOGold 2000 PPO
Platinum 500 PPO
Small Group HMO Employee Application
Small Group PPO Employee Application
Large Group HMO Employee Application
Large Group PPO Employee Application
Select Bronze 6850 HMOSelect Silver 2500-100 HMOSelect Gold 001 HMO
Select Bronze 4000 HSA PPOSelect Bronze 5000 PPOSelect Bronze 5500 HSA PPOSelect Bronze 6850 PPOSelect Silver 2000 PPOSelect Silver 2500-5500 PPOSelect Silver 2600 HSA PPOSelect Silver 3000 HSA PPOSelect Silver 3000 PPOSelect Silver 3500 HSA PPOSelect Silver 4500 PPOSelect Silver 4500-100 PPOSelect Silver Copay PPOSelect Gold 1000 PPOSelect Gold 1500 PPOSelect Gold 2000-2500 PPOSelect Gold 2000-3500 PPOSelect Gold Copay PPOSelect Platinum 500 PPO
Select 001 HMOSelect 002 HMOSelect 2000-100 HMOSelect 3000-80 HMOSelect 3000-80 HSA HMOSelect 3000-100 HSA HMOSelect 5000-50 HMOSelect 5000-80 HSA HMOSelect 5000-100 HMOSelect 6550-100 HSA HMOSelect 6600-100 HMO
Select Bronze 5500 HSA HMOSelect Bronze 6450 HSA HMOSelect Gold 001 HMOSelect Gold 2000-100 HMOSelect Silver 2500-100 HMO
Select Bronze 3000 HSA PPOSelect Bronze 5000 PPOSelect Bronze 5250 PPOSelect Bronze 5500 HSA PPOSelect Bronze 6600 PPOSelect Gold 1000 PPOSelect Gold 1500 PPOSelect Gold 2000-2500 PPOSelect Gold 2000-3500 PPOSelect Gold Copay PPOSelect Platinum 500 PPOSelect Silver 2000 HSA PPOSelect Silver 2000 PPOSelect Silver 2500 HSA PPOSelect Silver 3000 HSA PPOSelect Silver 3000 PPOSelect Silver 4000 PPOSelect Silver Copay PPO
Select 001 HMOSelect 2000-100 HMOSelect 3000-80 HMOSelect 3000-80 HSA HMOSelect 3000-100 HSA HMOSelect 5000-80 HMOSelect 5000-80 HSA HMOSelect 5000-100 HMOSelect 6450-100 HSA HMOSelect 6600-100 Premier HMOSelect 6600-100 Standard HMOSelect Premier Copay HMOSelect Standard Copay HMO
Select 250-80 PPOSelect 500-80 PPOSelect 500-85 PPOSelect 1000-80 PPOSelect 1500-80 PPOSelect 1500-100 HSA PPOSelect 1500-100 PPOSelect 2000-80 PPOSelect 2000-100 HSA PPOSelect 2000-100 PPOSelect 2500-70 PPOSelect 2500-80 PPOSelect 3000-50 HSA PPOSelect 3000-80 HSA PPOSelect 3000-80 PPOSelect 3000-100 HSA PPOSelect 3000-100 PPOSelect 5000-50 HSA PPOSelect 5000-70 PPOSelect 5000-80 HSA PPOSelect 5000-80 PPOSelect 5000-100 HSA PPOSelect 5000-100 PPOSelect 6450-100 HSA PPOSelect 6600-100 Premier PPOSelect 6600-100 Standard PPOSelect Premier Copay PPOSelect Standard Copay PPO
Successful Returns Fact SheetOutcomesDirections to the Facility
WorkLink Fact SheetQuick Reference GuideProviders Process GuideWork Status FormPre-Authorization Form
Texas Department of Insurance; Division of Workers' CompensationTexas Association of Responsible Nonsubscribers (TXANS)Overview of Nonsubscriber ProgramsNonsubscriber FAQ
Department of Labor (DOL)DOL Longshore First Report of InjuryDOL Division of Longshore & Harbor Workers' Compensation (DLHWC) Longshore FAQ