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Resource Center

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2017 Group Brochures

Large Group HMO Plan Overview
Large Group PPO Plan Overview

Small Group HMO Plan Overview
Small Group PPO Plan Overview

2017 Small Group Applications

Small Group HMO Employee Application | Spanish
Small Group HMO Employer Application

Small Group PPO Employee Application | Spanish
Small Group PPO Employer Application

2017 Large Group Applications

Large Group HMO Employee Application | Spanish
Large Group HMO Employer Application

Large Group PPO Employee Application | Spanish
Large Group PPO Employer Application

2017 Small Group HMO Plans

2017 HMO Select Bronze 6550 HSA | Spanish
2017 HMO Select Bronze 6850 | Spanish
2017 HMO Select Silver 002 | Spanish
2017 HMO Select Silver 3000 | Spanish
2017 HMO Select Silver 4000 HSA | Spanish
2017 HMO Select Gold 001 | Spanish
2017 HMO Select Gold 1500 | Spanish
2017 HMO Select Gold 2000 | Spanish

2017 Small Group PPO Plans

2017 PPO Select Bronze 5000 HSA | Spanish
2017 PPO Select Bronze 6550 HSA | Spanish
2017 PPO Select Bronze 6850 | Spanish
2017 PPO Select Silver 3000 | Spanish
2017 PPO Select Silver 4000 HSA | Spanish
2017 PPO Select Silver 4500 | Spanish
2017 PPO Select Silver 5000 | Spanish
2017 PPO Select Gold 1000 | Spanish
2017 PPO Select Gold 1500 | Spanish
2017 PPO Select Gold 2000 | Spanish
2017 PPO Select Gold 2000-3500 | Spanish
2017 PPO Select Gold Copay | Spanish
2017 PPO Select Platinum 500 | Spanish

2017 Large Group HMO Plans

2017 HMO Select 001 | Spanish
2017 HMO Select 002 | Spanish
2017 HMO Select 2000-100 | Spanish
2017 HMO Select 3000-100 HSA | Spanish
2017 HMO Select 3000-80 | Spanish
2017 HMO Select 5000-100 | Spanish
2017 HMO Select 6550-100 HSA | Spanish
2017 HMO Select 6600-100 Standard | Spanish

2017 Large Group PPO Plans

2017 PPO Select 002 | Spanish
2017 PPO Select 500-80 | Spanish
2017 PPO Select 1000-80 | Spanish
2017 PPO Select 1500-80 | Spanish
2017 PPO Select 2000-100 | Spanish
2017 PPO Select 2000-80 | Spanish
2017 PPO Select 2500-70 | Spanish
2017 PPO Select 2500-80 | Spanish
2017 PPO Select 3000-100 | Spanish
2017 PPO Select 3000-100 HSA | Spanish
2017 PPO Select 3000-80 | Spanish
2017 PPO Select 3000-80 HSA | Spanish
2017 PPO Select 5000-100 | Spanish
2017 PPO Select 5000-100 HSA | Spanish
2017 PPO Select 5000-70 | Spanish
2017 PPO Select 5000-80 HSA | Spanish
2017 PPO Select 6550-100 HSA | Spanish
2017 PPO Select 6600-100 Standard | Spanish
2017 PPO Select Standard Copay | Spanish

2016 Brochures

Large Group HMO Plan Overview
Large Group PPO Plan Overview

Small Group HMO Plan Overview
Small Group PPO Plan Overview

2016 Small Group Applications

Small Group HMO Employee Application
Small Group HMO Employer Application

Small Group PPO Employee Application
Small Group PPO Employer Application

2016 Large Group Applications

Large Group HMO Employee Application
Large Group HMO Employer Application

Large Group PPO Employee Application
Large Group PPO Employer Application

2016 Small Group HMO Plans

Select Bronze 6850 HMO
Select Silver 2500-100 HMO
Select Gold 001 HMO

2016 Small Group PPO Plans

Select Bronze 4000 HSA PPO
Select Bronze 5000 PPO
Select Bronze 5500 HSA PPO
Select Bronze 6850 PPO
Select Silver 2000 PPO
Select Silver 2500-5500 PPO
Select Silver 2600 HSA PPO
Select Silver 3000 HSA PPO
Select Silver 3000 PPO
Select Silver 3500 HSA PPO
Select Silver 4500 PPO
Select Silver 4500-100 PPO
Select Silver Copay PPO
Select Gold 1000 PPO
Select Gold 1500 PPO
Select Gold 2000-2500 PPO
Select Gold 2000-3500 PPO
Select Gold Copay PPO
Select Platinum 500 PPO

2016 Large Group HMO Plans

Select 001 HMO
Select 002 HMO
Select 2000-100 HMO
Select 3000-80 HMO
Select 3000-80 HSA HMO
Select 3000-100 HSA HMO
Select 5000-50 HMO
Select 5000-80 HSA HMO
Select 5000-100 HMO
Select 6550-100 HSA HMO
Select 6600-100 HMO

2016 Large Group PPO Plans

Select 250-80 PPO
Select 500-80 PPO

2015 Brochures

Large Group Select HMO Plan Overview
Large Group Select PPO Plan Overview

Small Group Select HMO Plan Overview
Small Group Select PPO Plan Overview

2015 Small Group HMO Applications

2015 Small Group HMO Plan Employer Application
2015 Small Group HMO Plan Employee Application - English
2015 Small Group HMO Plan Employee Application - Spanish

2015 Small Group PPO Applications

2015 Small Group PPO Plan Employer Application
2015 Small Group PPO Plan Employee Application - English
2015 Small Group PPO Plan Employee Application - Spanish

2015 Large Group HMO Applications

2015 Large Group HMO Plan Employer Application
2015 Large Group HMO Plan Employee Application - English
2015 Large Group HMO Plan Employee Application - Spanish

2015 Large Group PPO Applications

2015 Large Group PPO Plan Employer Application
2015 Large Group PPO Plan Employee Application - English
2015 Large Group PPO Plan Employee Application - Spanish

2015 Small Group HMO Plans

Select Bronze 5500 HSA HMO
Select Bronze 6450 HSA HMO
Select Gold 001 HMO
Select Gold 2000-100 HMO
Select Silver 2500-100 HMO

2015 Small Group PPO Plans

Select Bronze 3000 HSA PPO
Select Bronze 5000 PPO
Select Bronze 5250 PPO
Select Bronze 5500 HSA PPO
Select Bronze 6600 PPO
Select Gold 1000 PPO
Select Gold 1500 PPO
Select Gold 2000-2500 PPO
Select Gold 2000-3500 PPO
Select Gold Copay PPO
Select Platinum 500 PPO
Select Silver 2000 HSA PPO
Select Silver 2000 PPO
Select Silver 2500 HSA PPO
Select Silver 3000 HSA PPO
Select Silver 3000 PPO
Select Silver 4000 PPO
Select Silver Copay PPO

2015 Large Group HMO Plans

Select 001 HMO
Select 2000-100 HMO
Select 3000-80 HMO
Select 3000-80 HSA HMO
Select 3000-100 HSA HMO
Select 5000-80 HMO
Select 5000-80 HSA HMO
Select 5000-100 HMO
Select 6450-100 HSA HMO
Select 6600-100 Premier HMO
Select 6600-100 Standard HMO
Select Premier Copay HMO
Select Standard Copay HMO

2015 Large Group PPO Plans

Select 250-80 PPO
Select 500-80 PPO
Select 500-85 PPO
Select 1000-80 PPO
Select 1500-80 PPO
Select 1500-100 HSA PPO
Select 1500-100 PPO
Select 2000-80 PPO
Select 2000-100 HSA PPO
Select 2000-100 PPO
Select 2500-70 PPO
Select 2500-80 PPO
Select 3000-50 HSA PPO
Select 3000-80 HSA PPO
Select 3000-80 PPO
Select 3000-100 HSA PPO
Select 3000-100 PPO
Select 5000-50 HSA PPO
Select 5000-70 PPO
Select 5000-80 HSA PPO
Select 5000-80 PPO
Select 5000-100 HSA PPO
Select 5000-100 PPO
Select 6450-100 HSA PPO
Select 6600-100 Premier PPO
Select 6600-100 Standard PPO
Select Premier Copay PPO
Select Standard Copay PPO

Successful Returns©

Successful Returns Fact Sheet
Outcomes
Directions to the Facility

WorkLink©

WorkLink Fact Sheet
Quick Reference Guide
Providers Process Guide
Work Status Form
Pre-Authorization Form

Employer Account Setup

Employer Access Request Form

Nonsubscribers

Texas Department of Insurance; Division of Workers' Compensation
Texas Association of Responsible Nonsubscribers (TXANS)
Overview of Nonsubscriber Programs
Nonsubscriber FAQ

Longshore

Department of Labor (DOL)
DOL Longshore First Report of Injury
DOL Division of Longshore & Harbor Workers' Compensation (DLHWC)
Longshore FAQ

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