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.
If you would like to have 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.
Handbooks and Directories
CHIP and CHIP Perinatal Member Handbook
Provider Directory
Pharmacy Directory
Dental Provider Directory (adult CHIP Perinate members only)
Forms
Appeal Request Form
Complaint 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
Find additional prescription drug forms.
Value-Added Services and Program Brochures
Blue Access for MembersSM Brochure
Value-Added Services Brochure
Transportation Benefit Brochure
Service Coordination Brochure
Special Beginnings Brochure
Value-Added Dental Services Brochure
Evidence of Coverage Schedule
Evidence of Coverage
CHIP Schedule of Benefits, Excluded Services and Covered Health Services A
CHIP Schedule of Benefits, Excluded Services and Covered Health Services B
CHIP Schedule of Benefits, Excluded Services and Covered Health Services C
CHIP Schedule of Benefits, Excluded Services and Covered Health Services D
LifeTimes® Newsletter
Spring 2025
Winter 2025
Fall 2024
Summer 2024
Important Notices
Annual Notices
BCBSTX Quality Performance Results for 2024
Health Assessment Questionnaire
HIPAA Notice of Privacy Practices
Your Rights for Appeal of an Adverse Determination
Additional Resources
Texas Health and Human Services Commission
Texas Department of State Health Services
Texas Department of Family and Protective Services
Texas Department of State Health Services, Women, Infants, and Children Program (WIC)
Texas Juvenile Justice Department
Children Advocacy Centers of Texas, Inc.
Your Texas Benefits (from the Texas Health and Human Services Commission)
Healthy Texas Women
Coronavirus (COVID-19) Information for Medicaid and CHIP Members