Forms and Documents

These forms and documents are available as PDF files. Just click on a form or document to download it. To view these files, you may need to install a PDF reader program. One option is Adobe® Reader®; this can be downloaded free of charge at Adobe's site.

Handbooks and Directories

If you need a printed copy of our member handbook, provider directory or other materials that will help you better understand your benefits, please call Customer Service. Your request will be fulfilled at no cost within five business days.

STAR Kids Member Handbook
Provider Directory – Central Service Area
Provider Directory – Travis Service Area
Pharmacy Directory – Central Service Area
Pharmacy Directory – Travis Service Area

Forms

Appeal Request Form
Complaint Form
Electronic Visit Verification Form
Fair Hearing Request Form
Prenatal Incentive Options (Car Seat or Pack and Play) Form
Prescription Drug Claim Form
Mail Service Registration and Prescription Order Form
Primary Care Provider (PCP) Selection Form
Request to Access PHI Form

Value-Added Services and Program Brochures

Blue Access for MembersSM Brochure
Value-Added Services Brochure
Screening and Assessment Instrument (SAI)
Service Coordination Brochure
Farmworkers Brochure
Special Beginnings Brochure
Transportation Benefits Brochure

LifeTimes® Newsletter

Summer 2024
Spring 2024
Winter 2024 
Fall 2023

Important Notices

Annual Notices
HIPAA Notice of Privacy Practices
Your Rights for Appeal of an Adverse Determination

Find additional prescription drug forms.

Additional Resources

ARC of the Capital Area
Children with Special Health Care Needs Program
Coalition of Texans with Disabilities
Consumer Rights and Services
Department of Assistive and Rehabilitative Services (ECI Program for children age 3 and under)
Guide to Financial Literacy and Education Resources (from the Office of Consumer Credit Commissioner)
Healthy Texas Women
National Early Childhood Technical Assistance Center
Navigate Life Texas
STAR Kids Advisory Committee
Texas Health and Human Services Commission
Texas Parent to Parent
Texas Project First
Coronavirus (COVID-19) Information for Medicaid and CHIP Members

 

Learn How Your Plan Works

To learn more about Forms and Documents, check the Member Handbook.

Find a Doctor or Hospital

Use our Provider Finder® to search for doctors and other health care providers near you.

Contact Us