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Health
Care Forms and Information
Employee Retirement System
of Texas
The
Employee Retirement System of Texas has several
forms available on its web site at http://www.ers.state.tx.us/forms/default.htm#EmployeeForms,
including:
- Application for Disability Benefits
- Application for Refund
- Application for Retirement Benefits
- Blue Cross Blue Shield Transitional Benefits
form
- Death Benefit Plan and Beneficiary Designation
- Dependent Child Certification
- Employee Insurance Multipurpose form
- Life Insurance Beneficiary Designation Form
- Medical Support Order Dependent Information
form
- Request for Account Balance form
- Retirement Beneficiary Designation form
- State Kids Insurance Program Application
Medicare (U.S. Government
Medicare Web Site)
The U. S. Government Medicare
web site has the following forms on its site at
http://www.medicare.gov/:
Social Security Administration
Use
online forms to apply for the following benefits
on the Social Security Administration web site at
http://www.ssa.gov/
by clicking on the appropriate topic and then the
online form:
- Disability
- Retirement
- Spouse or Widow(er)
- Help with Medicare Prescription Drug Costs
(click on new Medicare Prescription Drug Plan)
Texas Department on Aging
and Disability Services
The Texas Department of Aging
and Disability Services has advanced directive forms
on its web site at http://www.dads.state.tx.us/news_info/publications/handbooks/index.html,
including:
- Consent to Medical Treatment (English &
Spanish)
- Declaration for Mental Health Treatment (English
& Spanish)
- Directive to Physicians and Family or Surrogates
(English & Spanish)
- Medical Power of Attorney (English & Spanish)
- Out-of-Hospital Do Not Resuscitate (English
only)
Texas Department of Assistive
& Rehabilitative Services
The Texas Department of Assistive
& Rehabilitative Services has a few forms on
their site under Deaf and Hard of Hearing Services
at http://www.dars.state.tx.us/dhhs/dhhsforms.shtml,
including an application for telephone access and
a form to file a complaint against an interpreter
certified by DHHS.
Texas Department of Insurance
The Texas Department of Insurance
(TDI) has various consumer complaint forms. Visit
the TDI site at http://www.tdi.state.tx.us/forms/index.html
and click on consumer or fraud forms, then the form
you need, including:
- Auto/Home/Life/Health Complaint Form
- Physician Provider Complaint Form
- Real Estate Title Complaint Form
- Worker Compensation Forms for Employee
- Insurance Fraud Complaint Form
The site also has a lot of information
on automobiles, consumer fraud, insurance scams,
and disability rights.
Texas Health and Human Services
Commission
An application form for Medicaid
is available on the Texas Health and Human Services
Commission website at http://www.dads.state.tx.us/forms/1010-B/1010-B.pdf.
TexCare Partnership
If you care for a child who does
not have health insurance (you do not have to be
a biological parent or step-parent), or are a child
living alone, apply online for Medicaid or the Children’s
Health Insurance Program (low-cost health insurance)
through the TexCare Partnership at http://www.texcarepartnership.com/CHIP-Main-Page.htm
and click on Apply Now.
The State of Texas Assistance
and Referral System (STARS)
Apply for the following benefits
at https://www.yourtexasbenefits.com/wps/portal
by clicking on Apply for Services for an online
application or by clicking on Request An Application
to have an application sent to you to complete.
- Food Stamps
- Long-Term Care and Support
- Medical Assistance, including Children’s
Health Insurance and Medicaid
- Medicare Savings Programs
- Temporary Assistance for Needy Families (cash
assistance)
Other Sources
- TexasLawHelp:
Other health information can be found at www.TexasLawHelp.org.
- See Links section of our website for more
information resources.
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