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TDI-Required Consumer Disclosures and Notices

Required Disclosure Notice for All Individual HMO Consumer Choice Benefit Plans Issued in Texas-
Required form from the Texas Department of Insurance (TDI) that must be reviewed and signed by you. The form must be mailed back to us. You have the right to a copy of the written disclosure statement free of charge. 

Bronze Consumer Disclosure Form

Gold/Silver Consumer Disclosure Form 

Zero CSV Consumer Disclosure Form
 

Notice of Certain Mandatory Benefits
This notice provides information on certain benefits that must be covered under the plan as required by Texas law. 

Important Notice to Persons on Medicare
This plan is not Medicare Supplemental Insurance. This notice describes how you can find out more about Medicare and Medicare Supplemental Insurance. 

Facility-based Physicians and Practitioners Notice
Facility-based physicians or other health care providers may not be included as part of the plan’s network. This notice is to inform you that providers may balance bill you for amounts not paid by this plan. 

Notice of Privacy Practices
Explains your rights regarding your protected health information. Also explains how we may use and disclose your information to administer your plan. 

Disclosure of Terms and Conditions
This document provides an overview of plan terms and limitations to help current or prospective enrollees compare and make informed decisions before selecting among plans.

HMO

PPO 

Preferred Provider Network Access (PPO Only)
You have the right to an adequate network of preferred providers (also known as "network providers"). This notices outlines your rights.