2025 Plan Year

ENGLISH

• CHRISTUS American Indian Zero Cost Sharing 2025
• CHRISTUS American Indian Zero Cost Sharing Plus Dental Vision 2025
• CHRISTUS American Indian Zero Cost Sharing Plus Fitness 2025
• CHRISTUS American Indian Zero Cost Sharing Plus Fitness Dental Vision 2025
• CHRISTUS Bronze 2025
• CHRISTUS Bronze Essential 2025
• CHRISTUS Bronze Essential Limited 2025
• CHRISTUS Bronze Essential Plus 2025
• CHRISTUS Bronze Essential Plus Limited 2025
• CHRISTUS Bronze Limited 2025
• CHRISTUS Bronze Plus 2025
• CHRISTUS Bronze Plus Limited 2025
• CHRISTUS Gold 2025
• CHRISTUS Gold Essential 2025
• CHRISTUS Gold Essential Limited 2025
• CHRISTUS Gold Essential Plus 2025
• CHRISTUS Gold Essential Plus Limited 2025
• CHRISTUS Gold Limited 2025
• CHRISTUS Gold Plus 2025
• CHRISTUS Gold Plus Limited 2025
• CHRISTUS Silver 2025
• CHRISTUS Silver 73 2025
• CHRISTUS Silver 87 2025
• CHRISTUS Silver 94 2025
• CHRISTUS Silver Essential 2025
• CHRISTUS Silver Essential 73 2025
• CHRISTUS Silver Essential 87 2025
• CHRISTUS Silver Essential 94 2025
• CHRISTUS Silver Essential Limited 2025
• CHRISTUS Silver Essential Plus 2025
• CHRISTUS Silver Essential Plus 73 2025
• CHRISTUS Silver Essential Plus 87 2025
• CHRISTUS Silver Essential Plus 94 2025
• CHRISTUS Silver Essential Plus Limited 2025
• CHRISTUS Silver Limited 2025
• CHRISTUS Silver Plus 2025
• CHRISTUS Silver Plus 73 2025
• CHRISTUS Silver Plus 87 2025
• CHRISTUS Silver Plus 94 2025
• CHRISTUS Silver Plus Limited 2025
• CHRISTUS Standard Expanded Bronze 2025
• CHRISTUS Standard Expanded Bronze Limited 2025
• CHRISTUS Standard Gold 2025
• CHRISTUS Standard Gold Limited 2025
• CHRISTUS Standard Silver 2025
• CHRISTUS Standard Silver 73 2025
• CHRISTUS Standard Silver 87 2025
• CHRISTUS Standard Silver 94 2025
• CHRISTUS Standard Silver Limited 2025

English

• Louisiana Off-Exchange Evidence of Coverage (PDF)
• Louisiana On-Exchange Evidence of Coverage (PDF)

Spanish

• Louisiana Off-Exchange Evidence of Coverage en español (PDF)
• Louisiana On-Exchange Evidence of Coverage en español (PDF)

English

• Louisiana American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Fitness Schedule of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Fitness Dental Vision Schedule of Benefits (PDF)
• Louisiana Bronze Schedule of Benefits (PDF)
• Louisiana Bronze Essential Schedule of Benefits (PDF)
• Louisiana Bronze Essential Limited Schedule of Benefits (PDF)
• Louisiana Bronze Essential Plus Schedule of Benefits (PDF)
• Louisiana Bronze Essential Plus Limited Schedule of Benefits (PDF)
• Louisiana Bronze Limited Schedule of Benefits (PDF)
• Louisiana Bronze Plus Schedule of Benefits (PDF)
• Louisiana Bronze Plus Limited Schedule of Benefits (PDF)
• Louisiana Gold Schedule of Benefits (PDF)
• Louisiana Gold Essential Schedule of Benefits (PDF)
• Louisiana Gold Essential Limited Schedule of Benefits (PDF)
• Louisiana Gold Essential Plus Schedule of Benefits (PDF)
• Louisiana Gold Essential Plus Limited Schedule of Benefits (PDF)
• Louisiana Gold Limited Schedule of Benefits (PDF)
• Louisiana Gold Plus Schedule of Benefits (PDF)
• Louisiana Gold Plus Limited Schedule of Benefits (PDF)
• Louisiana Silver 73 Schedule of Benefits (PDF)
• Louisiana Silver 87 Schedule of Benefits (PDF)
• Louisiana Silver 94 Schedule of Benefits (PDF)
• Louisiana Silver Schedule of Benefits (PDF)
• Louisiana Silver Essential 73 Schedule of Benefits (PDF)
• Louisiana Silver Essential 87 Schedule of Benefits (PDF)
• Louisiana Silver Essential 94 Schedule of Benefits (PDF)
• Louisiana Silver Essential Schedule of Benefits (PDF)
• Louisiana Silver Essential Limited Schedule of Benefits (PDF)
• Louisiana Silver Essential Plus 73 Schedule of Benefits (PDF)
• Louisiana Silver Essential Plus 87 Schedule of Benefits (PDF)
• Louisiana Silver Essential Plus 94 Schedule of Benefits (PDF)
• Louisiana Silver Essential Plus Schedule of Benefits (PDF)
• Louisiana Silver Essential Plus Limited Schedule of Benefits (PDF)
• Louisiana Silver Limited Schedule of Benefits (PDF)
• Louisiana Silver Plus 73 Schedule of Benefits (PDF)
• Louisiana Silver Plus 87 Schedule of Benefits (PDF)
• Louisiana Silver Plus 94 Schedule of Benefits (PDF)
• Louisiana Silver Plus Schedule of Benefits (PDF)
• Louisiana Silver Plus Limited Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Louisiana Standard Gold Schedule of Benefits (PDF)
• Louisiana Standard Gold Limited Schedule of Benefits (PDF)
• Louisiana Standard Silver 73 Schedule of Benefits (PDF)
• Louisiana Standard Silver 87 Schedule of Benefits (PDF)
• Louisiana Standard Silver 94 Schedule of Benefits (PDF)
• Louisiana Standard Silver Schedule of Benefits (PDF)
• Louisiana Standard Silver Limited Schedule of Benefits (PDF)

Spanish

• Louisiana American Indian Zero Cost Sharing Schedule of Benefits SPA
• Louisiana American Indian Zero Cost Sharing Plus Dental Vision Schedule of Benefits SPA
• Louisiana American Indian Zero Cost Sharing Plus Fitness Schedule of Benefits SPA
• Louisiana American Indian Zero Cost Sharing Plus Fitness Dental Vision Schedule of Benefits SPA
• Louisiana Bronze Schedule of Benefits SPA
• Louisiana Bronze Essential Schedule of Benefits SPA
• Louisiana Bronze Essential Limited Schedule of Benefits SPA
• Louisiana Bronze Essential Plus Schedule of Benefits SPA
• Louisiana Bronze Essential Plus Limited Schedule of Benefits SPA
• Louisiana Bronze Limited Schedule of Benefits SPA
• Louisiana Bronze Plus Schedule of Benefits SPA
• Louisiana Bronze Plus Limited Schedule of Benefits SPA
• Louisiana Gold Schedule of Benefits SPA
• Louisiana Gold Essential Schedule of Benefits SPA
• Louisiana Gold Essential Limited Schedule of Benefits SPA
• Louisiana Gold Essential Plus Schedule of Benefits SPA
• Louisiana Gold Essential Plus Limited Schedule of Benefits SPA
• Louisiana Gold Limited Schedule of Benefits SPA
• Louisiana Gold Plus Schedule of Benefits SPA
• Louisiana Gold Plus Limited Schedule of Benefits SPA
• Louisiana Silver Schedule of Benefits SPA
• Louisiana Silver 73 Schedule of Benefits SPA
• Louisiana Silver 87 Schedule of Benefits SPA
• Louisiana Silver 94 Schedule of Benefits SPA
• Louisiana Silver Essential Schedule of Benefits SPA
• Louisiana Silver Essential 73 Schedule of Benefits SPA
• Louisiana Silver Essential 87 Schedule of Benefits SPA
• Louisiana Silver Essential 94 Schedule of Benefits SPA
• Louisiana Silver Essential Limited Schedule of Benefits SPA
• Louisiana Silver Essential Plus Schedule of Benefits SPA
• Louisiana Silver Essential Plus 73 Schedule of Benefits SPA
• Louisiana Silver Essential Plus 87 Schedule of Benefits SPA
• Louisiana Silver Essential Plus 94 Schedule of Benefits SPA
• Louisiana Silver Essential Plus Limited Schedule of Benefits SPA
• Louisiana Silver Limited Schedule of Benefits SPA
• Louisiana Silver Plus Schedule of Benefits SPA
• Louisiana Silver Plus 73 Schedule of Benefits SPA
• Louisiana Silver Plus 87 Schedule of Benefits SPA
• Louisiana Silver Plus 94 Schedule of Benefits SPA
• Louisiana Silver Plus Limited Schedule of Benefits SPA
• Louisiana Standard Expanded Bronze Schedule of Benefits SPA
• Louisiana Standard Expanded Bronze Limited Schedule of Benefits SPA
• Louisiana Standard Gold Schedule of Benefits SPA
• Louisiana Standard Gold Limited Schedule of Benefits SPA
• Louisiana Standard Silver Schedule of Benefits SPA
• Louisiana Standard Silver 73 Schedule of Benefits SPA
• Louisiana Standard Silver 87 Schedule of Benefits SPA
• Louisiana Standard Silver 94 Schedule of Benefits SPA
• Louisiana Standard Silver Limited Schedule of Benefits SPA

English

• Louisiana American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Fitness Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Fitness Dental Vision Summary of Benefits (PDF)
• Louisiana Bronze Summary of Benefits (PDF)
• Louisiana Bronze Essential Summary of Benefits (PDF)
• Louisiana Bronze Essential Limited Summary of Benefits (PDF)
• Louisiana Bronze Essential Plus Summary of Benefits (PDF)
• Louisiana Bronze Essential Plus Limited Summary of Benefits (PDF)
• Louisiana Bronze Limited Summary of Benefits (PDF)
• Louisiana Bronze Plus Summary of Benefits (PDF)
• Louisiana Bronze Plus Limited Summary of Benefits (PDF)
• Louisiana Gold Summary of Benefits (PDF)
• Louisiana Gold Essential Summary of Benefits (PDF)
• Louisiana Gold Essential Limited Summary of Benefits (PDF)
• Louisiana Gold Essential Plus Summary of Benefits (PDF)
• Louisiana Gold Essential Plus Limited Summary of Benefits (PDF)
• Louisiana Gold Limited Summary of Benefits (PDF)
• Louisiana Gold Plus Summary of Benefits (PDF)
• Louisiana Gold Plus Limited Summary of Benefits (PDF)
• Louisiana Silver 73 Summary of Benefits (PDF)
• Louisiana Silver 87 Summary of Benefits (PDF)
• Louisiana Silver 94 Summary of Benefits (PDF)
• Louisiana Silver Summary of Benefits (PDF)
• Louisiana Silver Essential 73 Summary of Benefits (PDF)
• Louisiana Silver Essential 87 Summary of Benefits (PDF)
• Louisiana Silver Essential 94 Summary of Benefits (PDF)
• Louisiana Silver Essential Summary of Benefits (PDF)
• Louisiana Silver Essential Limited Summary of Benefits (PDF)
• Louisiana Silver Essential Plus 73 Summary of Benefits (PDF)
• Louisiana Silver Essential Plus 87 Summary of Benefits (PDF)
• Louisiana Silver Essential Plus 94 Summary of Benefits (PDF)
• Louisiana Silver Essential Plus Summary of Benefits (PDF)
• Louisiana Silver Essential Plus Limited Summary of Benefits (PDF)
• Louisiana Silver Limited Summary of Benefits (PDF)
• Louisiana Silver Plus 73 Summary of Benefits (PDF)
• Louisiana Silver Plus 87 Summary of Benefits (PDF)
• Louisiana Silver Plus 94 Summary of Benefits (PDF)
• Louisiana Silver Plus Summary of Benefits (PDF)
• Louisiana Silver Plus Limited Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Summary of Benefits (PDF)
• Louisiana Standard Gold Summary of Benefits (PDF)
• Louisiana Standard Gold Limited Summary of Benefits (PDF)
• Louisiana Standard Silver 73 Summary of Benefits (PDF)
• Louisiana Standard Silver 87 Summary of Benefits (PDF)
• Louisiana Standard Silver 94 Summary of Benefits (PDF)
• Louisiana Standard Silver Summary of Benefits (PDF)
• Louisiana Standard Silver Limited Summary of Benefits (PDF)

Spanish

• Louisiana American Indian Zero Cost Sharing Summary of Benefits SPA
• Louisiana American Indian Zero Cost Sharing Plus Dental Vision Summary of Benefits SPA
• Louisiana American Indian Zero Cost Sharing Plus Fitness Summary of Benefits SPA
• Louisiana American Indian Zero Cost Sharing Plus Fitness Dental Vision Summary of Benefits SPA
• Louisiana Bronze Summary of Benefits SPA
• Louisiana Bronze Essential Summary of Benefits SPA
• Louisiana Bronze Essential Limited Summary of Benefits SPA
• Louisiana Bronze Essential Plus Summary of Benefits SPA
• Louisiana Bronze Essential Plus Limited Summary of Benefits SPA
• Louisiana Bronze Limited Summary of Benefits SPA
• Louisiana Bronze Plus Summary of Benefits SPA
• Louisiana Bronze Plus Limited Summary of Benefits SPA
• Louisiana Gold Summary of Benefits SPA
• Louisiana Gold Essential Summary of Benefits SPA
• Louisiana Gold Essential Limited Summary of Benefits SPA
• Louisiana Gold Essential Plus Summary of Benefits SPA
• Louisiana Gold Essential Plus Limited Summary of Benefits SPA
• Louisiana Gold Limited Summary of Benefits SPA
• Louisiana Gold Plus Summary of Benefits SPA
• Louisiana Gold Plus Limited Summary of Benefits SPA
• Louisiana Silver Summary of Benefits SPA
• Louisiana Silver 73 Summary of Benefits SPA
• Louisiana Silver 87 Summary of Benefits SPA
• Louisiana Silver 94 Summary of Benefits SPA
• Louisiana Silver Essential Summary of Benefits SPA
• Louisiana Silver Essential 73 Summary of Benefits SPA
• Louisiana Silver Essential 87 Summary of Benefits SPA
• Louisiana Silver Essential 94 Summary of Benefits SPA
• Louisiana Silver Essential Limited Summary of Benefits SPA
• Louisiana Silver Essential Plus Summary of Benefits SPA
• Louisiana Silver Essential Plus 73 Summary of Benefits SPA
• Louisiana Silver Essential Plus 87 Summary of Benefits SPA
• Louisiana Silver Essential Plus 94 Summary of Benefits SPA
• Louisiana Silver Essential Plus Limited Summary of Benefits SPA
• Louisiana Silver Limited Summary of Benefits SPA
• Louisiana Silver Plus Summary of Benefits SPA
• Louisiana Silver Plus 73 Summary of Benefits SPA
• Louisiana Silver Plus 87 Summary of Benefits SPA
• Louisiana Silver Plus 94 Summary of Benefits SPA
• Louisiana Silver Plus Limited Summary of Benefits SPA
• Louisiana Standard Expanded Bronze Summary of Benefits SPA
• Louisiana Standard Expanded Bronze Limited Summary of Benefits SPA
• Louisiana Standard Gold Summary of Benefits SPA
• Louisiana Standard Gold Limited Summary of Benefits SPA
• Louisiana Standard Silver Summary of Benefits SPA
• Louisiana Standard Silver 73 Summary of Benefits SPA
• Louisiana Standard Silver 87 Summary of Benefits SPA
• Louisiana Standard Silver 94 Summary of Benefits SPA
• Louisiana Standard Silver Limited Summary of Benefits SPA

2025 Plan Year

ENGLISH

• CHRISTUS American Indian Zero Cost Sharing 2025
• CHRISTUS American Indian Zero Cost Sharing Plus Dental Vision 2025
• CHRISTUS American Indian Zero Cost Sharing Plus Dental Vision Fitness 2025
• CHRISTUS American Indian Zero Cost Sharing Plus Fitness 2025
• CHRISTUS Bronze 2025
• CHRISTUS Bronze Essential 2025
• CHRISTUS Bronze Essential Limited 2025
• CHRISTUS Bronze Essential Plus 2025
• CHRISTUS Bronze Essential Plus Limited 2025
• CHRISTUS Bronze Limited 2025
• CHRISTUS Bronze Plus 2025
• CHRISTUS Bronze Plus Limited 2025
• CHRISTUS Catastrophic 2025
• CHRISTUS Gold 2025
• CHRISTUS Gold Essential 2025
• CHRISTUS Gold Essential Limited 2025
• CHRISTUS Gold Essential Plus 2025
• CHRISTUS Gold Essential Plus Limited 2025
• CHRISTUS Gold Limited 2025
• CHRISTUS Gold Plus 2025
• CHRISTUS Gold Plus Limited 2025
• CHRISTUS Silver 2025
• CHRISTUS Silver 73 2025
• CHRISTUS Silver 87 2025
• CHRISTUS Silver 94 2025
• CHRISTUS Silver Essential 2025
• CHRISTUS Silver Essential 73 2025
• CHRISTUS Silver Essential 87 2025
• CHRISTUS Silver Essential 94 2025
• CHRISTUS Silver Essential Limited 2025
• CHRISTUS Silver Essential Plus 2025
• CHRISTUS Silver Essential Plus 73 2025
• CHRISTUS Silver Essential Plus 87 2025
• CHRISTUS Silver Essential Plus 94 2025
• CHRISTUS Silver Essential Plus Limited 2025
• CHRISTUS Silver Limited 2025
• CHRISTUS Silver Plus 2025
• CHRISTUS Silver Plus 73 2025
• CHRISTUS Silver Plus 87 2025
• CHRISTUS Silver Plus 94 2025
• CHRISTUS Silver Plus Limited 2025
• CHRISTUS Standard Expanded Bronze 2025
• CHRISTUS Standard Expanded Bronze Limited 2025
• CHRISTUS Standard Gold 2025
• CHRISTUS Standard Gold Limited 2025
• CHRISTUS Standard Silver 2025
• CHRISTUS Standard Silver 73 2025
• CHRISTUS Standard Silver 87 2025
• CHRISTUS Standard Silver 94 2025
• CHRISTUS Standard Silver Limited 2025

English

• Texas Gold Complete Off-Exchange Evidence of Coverage (PDF)
• Texas Off-Exchange Evidence of Coverage (PDF)
• Texas On-Exchange Evidence of Coverage (PDF)

Spanish

• Texas Gold Complete Off-Exchange Evidence of Coverage en español (PDF)
• Texas Off-Exchange Evidence of Coverage en español (PDF)
• Texas On-Exchange Evidence of Coverage en español (PDF)

English

• Texas American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Dental Vision Schedule of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Dental Vision Fitness Schedule of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Fitness Schedule of Benefits (PDF)
• Texas Bronze Schedule of Benefits (PDF)
• Texas Bronze Essential Schedule of Benefits (PDF)
• Texas Bronze Essential Limited Schedule of Benefits (PDF)
• Texas Bronze Essential Plus Schedule of Benefits (PDF)
• Texas Bronze Essential Plus Limited Schedule of Benefits (PDF)
• Texas Bronze Limited Schedule of Benefits (PDF)
• Texas Bronze Plus Schedule of Benefits (PDF)
• Texas Bronze Plus Limited Schedule of Benefits (PDF)
• Texas Catastrophic Schedule of Benefits (PDF)
• Texas Gold Schedule of Benefits (PDF)
• Texas Gold Essential Schedule of Benefits (PDF)
• Texas Gold Essential Limited Schedule of Benefits (PDF)
• Texas Gold Essential Plus Schedule of Benefits (PDF)
• Texas Gold Essential Plus Limited Schedule of Benefits (PDF)
• Texas Gold Limited Schedule of Benefits (PDF)
• Texas Gold Plus Schedule of Benefits (PDF)
• Texas Gold Plus Limited Schedule of Benefits (PDF)
• Texas Silver 73 Schedule of Benefits (PDF)
• Texas Silver 87 Schedule of Benefits (PDF)
• Texas Silver 94 Schedule of Benefits (PDF)
• Texas Silver Schedule of Benefits (PDF)
• Texas Silver Essential 73 Schedule of Benefits (PDF)
• Texas Silver Essential 87 Schedule of Benefits (PDF)
• Texas Silver Essential 94 Schedule of Benefits (PDF)
• Texas Silver Essential Schedule of Benefits (PDF)
• Texas Silver Essential Limited Schedule of Benefits (PDF)
• Texas Silver Essential Plus 73 Schedule of Benefits (PDF)
• Texas Silver Essential Plus 87 Schedule of Benefits (PDF)
• Texas Silver Essential Plus 94 Schedule of Benefits (PDF)
• Texas Silver Essential Plus Schedule of Benefits (PDF)
• Texas Silver Essential Plus Limited Schedule of Benefits (PDF)
• Texas Silver Limited Schedule of Benefits (PDF)
• Texas Silver Plus 73 Schedule of Benefits (PDF)
• Texas Silver Plus 87 Schedule of Benefits (PDF)
• Texas Silver Plus 94 Schedule of Benefits (PDF)
• Texas Silver Plus Schedule of Benefits (PDF)
• Texas Silver Plus Limited Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Texas Standard Gold Schedule of Benefits (PDF)
• Texas Standard Gold Limited Schedule of Benefits (PDF)
• Texas Standard Silver 73 Schedule of Benefits (PDF)
• Texas Standard Silver 87 Schedule of Benefits (PDF)
• Texas Standard Silver 94 Schedule of Benefits (PDF)
• Texas Standard Silver Schedule of Benefits (PDF)
• Texas Standard Silver Limited Schedule of Benefits (PDF)

Spanish

• Texas American Indian Zero Cost Sharing Schedule of Benefits SPA
• Texas American Indian Zero Cost Sharing Plus Dental Vision Schedule of Benefits SPA
• Texas American Indian Zero Cost Sharing Plus Dental Vision Fitness Schedule of Benefits SPA
• Texas American Indian Zero Cost Sharing Plus Fitness Schedule of Benefits SPA
• Texas Bronze Schedule of Benefits SPA
• Texas Bronze Essential Schedule of Benefits SPA
• Texas Bronze Essential Limited Schedule of Benefits SPA
• Texas Bronze Essential Plus Schedule of Benefits SPA
• Texas Bronze Essential Plus Limited Schedule of Benefits SPA
• Texas Bronze Limited Schedule of Benefits SPA
• Texas Bronze Plus Schedule of Benefits SPA
• Texas Bronze Plus Limited Schedule of Benefits SPA
• Texas Catastrophic Schedule of Benefits SPA
• Texas Gold Schedule of Benefits SPA
• Texas Gold Essential Schedule of Benefits SPA
• Texas Gold Essential Limited Schedule of Benefits SPA
• Texas Gold Essential Plus Schedule of Benefits SPA
• Texas Gold Essential Plus Limited Schedule of Benefits SPA
• Texas Gold Limited Schedule of Benefits SPA
• Texas Gold Plus Schedule of Benefits SPA
• Texas Gold Plus Limited Schedule of Benefits SPA
• Texas Silver Schedule of Benefits SPA
• Texas Silver 73 Schedule of Benefits SPA
• Texas Silver 87 Schedule of Benefits SPA
• Texas Silver 94 Schedule of Benefits SPA
• Texas Silver Essential Schedule of Benefits SPA
• Texas Silver Essential 73 Schedule of Benefits SPA
• Texas Silver Essential 87 Schedule of Benefits SPA
• Texas Silver Essential 94 Schedule of Benefits SPA
• Texas Silver Essential Limited Schedule of Benefits SPA
• Texas Silver Limited Schedule of Benefits SPA
• Texas Silver Plus Schedule of Benefits SPA
• Texas Silver Plus 73 Schedule of Benefits SPA
• Texas Silver Plus 87 Schedule of Benefits SPA
• Texas Silver Plus 94 Schedule of Benefits SPA
• Texas Silver Plus Limited Schedule of Benefits SPA
• Texas Standard Expanded Bronze Schedule of Benefits SPA
• Texas Standard Expanded Bronze Limited Schedule of Benefits SPA
• Texas Standard Gold Schedule of Benefits SPA
• Texas Standard Gold Limited Schedule of Benefits SPA
• Texas Standard Silver Schedule of Benefits SPA
• Texas Standard Silver 73 Schedule of Benefits SPA
• Texas Standard Silver 87 Schedule of Benefits SPA
• Texas Standard Silver 94 Schedule of Benefits SPA
• Texas Standard Silver Limited Schedule of Benefits SPA

English

• Texas American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Dental Vision Summary of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Dental Vision Fitness Summary of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Fitness Summary of Benefits (PDF)
• Texas Bronze Summary of Benefits (PDF)
• Texas Bronze Essential Summary of Benefits (PDF)
• Texas Bronze Essential Limited Summary of Benefits (PDF)
• Texas Bronze Essential Plus Summary of Benefits (PDF)
• Texas Bronze Essential Plus Limited Summary of Benefits (PDF)
• Texas Bronze Limited Summary of Benefits (PDF)
• Texas Bronze Plus Summary of Benefits (PDF)
• Texas Bronze Plus Limited Summary of Benefits (PDF)
• Texas Catastrophic Summary of Benefits (PDF)
• Texas Gold Summary of Benefits (PDF)
• Texas Gold Essential Summary of Benefits (PDF)
• Texas Gold Essential Limited Summary of Benefits (PDF)
• Texas Gold Essential Plus Summary of Benefits (PDF)
• Texas Gold Essential Plus Limited Summary of Benefits (PDF)
• Texas Gold Limited Summary of Benefits (PDF)
• Texas Gold Plus Summary of Benefits (PDF)
• Texas Gold Plus Limited Summary of Benefits (PDF)
• Texas Silver 73 Summary of Benefits (PDF)
• Texas Silver 87 Summary of Benefits (PDF)
• Texas Silver 94 Summary of Benefits (PDF)
• Texas Silver Summary of Benefits (PDF)
• Texas Silver Essential 73 Summary of Benefits (PDF)
• Texas Silver Essential 87 Summary of Benefits (PDF)
• Texas Silver Essential 94 Summary of Benefits (PDF)
• Texas Silver Essential Summary of Benefits (PDF)
• Texas Silver Essential Limited Summary of Benefits (PDF)
• Texas Silver Essential Plus 73 Summary of Benefits (PDF)
• Texas Silver Essential Plus 87 Summary of Benefits (PDF)
• Texas Silver Essential Plus 94 Summary of Benefits (PDF)
• Texas Silver Essential Plus Summary of Benefits (PDF)
• Texas Silver Essential Plus Limited Summary of Benefits (PDF)
• Texas Silver Limited Summary of Benefits (PDF)
• Texas Silver Plus 73 Summary of Benefits (PDF)
• Texas Silver Plus 87 Summary of Benefits (PDF)
• Texas Silver Plus 94 Summary of Benefits (PDF)
• Texas Silver Plus Summary of Benefits (PDF)
• Texas Silver Plus Limited Summary of Benefits (PDF)
• Texas Standard Expanded Bronze Summary of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Summary of Benefits (PDF)
• Texas Standard Gold Summary of Benefits (PDF)
• Texas Standard Gold Limited Summary of Benefits (PDF)
• Texas Standard Silver 73 Summary of Benefits (PDF)
• Texas Standard Silver 87 Summary of Benefits (PDF)
• Texas Standard Silver 94 Summary of Benefits (PDF)
• Texas Standard Silver Summary of Benefits (PDF)
• Texas Standard Silver Limited Summary of Benefits (PDF)

Spanish

• Texas American Indian Zero Cost Sharing Summary of Benefits SPA
• Texas American Indian Zero Cost Sharing Plus Dental Vision Summary of Benefits SPA
• Texas American Indian Zero Cost Sharing Plus Dental Vision Fitness Summary of Benefits SPA
• Texas American Indian Zero Cost Sharing Plus Fitness Summary of Benefits SPA
• Texas Bronze Summary of Benefits SPA
• Texas Bronze Essential Summary of Benefits SPA
• Texas Bronze Essential Limited Summary of Benefits SPA
• Texas Bronze Essential Plus Summary of Benefits SPA
• Texas Bronze Essential Plus Limited Summary of Benefits SPA
• Texas Bronze Limited Summary of Benefits SPA
• Texas Bronze Plus Summary of Benefits SPA
• Texas Bronze Plus Limited Summary of Benefits SPA
• Texas Catastrophic Summary of Benefits SPA
• Texas Gold Summary of Benefits SPA
• Texas Gold Essential Summary of Benefits SPA
• Texas Gold Essential Limited Summary of Benefits SPA
• Texas Gold Essential Plus Summary of Benefits SPA
• Texas Gold Essential Plus Limited Summary of Benefits SPA
• Texas Gold Limited Summary of Benefits SPA
• Texas Gold Plus Summary of Benefits SPA
• Texas Gold Plus Limited Summary of Benefits SPA
• Texas Silver Summary of Benefits SPA
• Texas Silver 73 Summary of Benefits SPA
• Texas Silver 87 Summary of Benefits SPA
• Texas Silver 94 Summary of Benefits SPA
• Texas Silver Essential Summary of Benefits SPA
• Texas Silver Essential 73 Summary of Benefits SPA
• Texas Silver Essential 87 Summary of Benefits SPA
• Texas Silver Essential 94 Summary of Benefits SPA
• Texas Silver Essential Limited Summary of Benefits SPA
• Texas Silver Essential Plus Summary of Benefits SPA
• Texas Silver Essential Plus 73 Summary of Benefits SPA
• Texas Silver Essential Plus 87 Summary of Benefits SPA
• Texas Silver Essential Plus 94 Summary of Benefits SPA
• Texas Silver Essential Plus Limited Summary of Benefits SPA
• Texas Silver Limited Summary of Benefits SPA
• Texas Silver Plus Summary of Benefits SPA
• Texas Silver Plus 73 Summary of Benefits SPA
• Texas Silver Plus 87 Summary of Benefits SPA
• Texas Silver Plus 94 Summary of Benefits SPA
• Texas Silver Plus Limited Summary of Benefits SPA
• Texas Standard Expanded Bronze Summary of Benefits SPA
• Texas Standard Expanded Bronze Limited Summary of Benefits SPA
• Texas Standard Gold Summary of Benefits SPA
• Texas Standard Gold Limited Summary of Benefits SPA
• Texas Standard Silver Summary of Benefits SPA
• Texas Standard Silver 73 Summary of Benefits SPA
• Texas Standard Silver 87 Summary of Benefits SPA
• Texas Standard Silver 94 Summary of Benefits SPA
• Texas Standard Silver Limited Summary of Benefits SPA

Provider & Pharmacy Directory

ENGLISH

• 2025 Louisiana Provider & Pharmacy Directory (PDF)
• 2025 Texas Provider & Pharmacy Directory (PDF)

SPANISH

• 2025 Louisiana Provider & Pharmacy Directory (PDF)
• 2025 Texas Provider & Pharmacy Directory (PDF)

Provider Search Tool

• Online Searchable Provider Directories

English

• 2024 Louisiana Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Louisiana Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

Spanish

• 2024 Louisiana Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Louisiana Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

English

• Louisiana Silver HD Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Louisiana Silver HD Limited Summary of Benefits (PDF)
• Louisiana Silver HD 73% Summary of Benefits (PDF)
• Louisiana Silver HD 87% Summary of Benefits (PDF)
• Louisiana Silver HD 94% Summary of Benefits (PDF)
• Louisiana Gold Summary of Benefits (PDF)
• Louisiana Gold Limited Summary of Benefits (PDF)
• Louisiana Bronze Summary of Benefits (PDF)
• Louisiana Bronze Limited Summary of Benefits (PDF)
• Louisiana Silver Summary of Benefits (PDF)
• Louisiana Silver Limited Summary of Benefits (PDF)
• Louisiana Silver 73% Summary of Benefits (PDF)
• Louisiana Silver 87% Summary of Benefits (PDF)
• Louisiana Silver 94% Summary of Benefits (PDF)
• Louisiana Gold Plus Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Summary of Benefits (PDF)
• Louisiana Gold Plus Limited Summary of Benefits (PDF)
• Louisiana Bronze Basic Summary of Benefits (PDF)
• Louisiana Bronze Basic Limited Summary of Benefits (PDF)
• Louisiana Standard Silver Summary of Benefits (PDF)
• Louisiana Standard Silver Limited Summary of Benefits (PDF)
• Louisiana Standard Silver 73% Summary of Benefits (PDF)
• Louisiana Standard Silver 87% Summary of Benefits (PDF)
• Louisiana Standard Silver 94% Summary of Benefits (PDF)
• Louisiana Standard Gold Summary of Benefits (PDF)
• Louisiana Standard Gold Limited Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Summary of Benefits (PDF)

Spanish

• Louisiana Silver HD Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Louisiana Silver HD Limited Summary of Benefits (PDF)
• Louisiana Silver HD 73% Summary of Benefits (PDF)
• Louisiana Silver HD 87% Summary of Benefits (PDF)
• Louisiana Silver HD 94% Summary of Benefits (PDF)
• Louisiana Gold Summary of Benefits (PDF)
• Louisiana Gold Limited Summary of Benefits (PDF)
• Louisiana Bronze Summary of Benefits (PDF)
• Louisiana Bronze Limited Summary of Benefits (PDF)
• Louisiana Silver Summary of Benefits (PDF)
• Louisiana Silver Limited Summary of Benefits (PDF)
• Louisiana Silver 73% Summary of Benefits (PDF)
• Louisiana Silver 87% Summary of Benefits (PDF)
• Louisiana Silver 94% Summary of Benefits (PDF)
• Louisiana Gold Plus Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Summary of Benefits (PDF)
• Louisiana Gold Plus Limited Summary of Benefits (PDF)
• Louisiana Bronze Basic Summary of Benefits (PDF)
• Louisiana Bronze Basic Limited Summary of Benefits (PDF)
• Louisiana Standard Silver Summary of Benefits (PDF)
• Louisiana Standard Silver Limited Summary of Benefits (PDF)
• Louisiana Standard Silver 73% Summary of Benefits (PDF)
• Louisiana Standard Silver 87% Summary of Benefits (PDF)
• Louisiana Standard Silver 94% Summary of Benefits (PDF)
• Louisiana Standard Gold Summary of Benefits (PDF)
• Louisiana Standard Gold Limited Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Summary of Benefits (PDF)

English

• Louisiana American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Louisiana Bronze Schedule of Benefits (PDF)
• Louisiana Bronze Basic Schedule of Benefits (PDF)
• Louisiana Bronze Basic Limited Schedule of Benefits (PDF)
• Louisiana Bronze Limited Schedule of Benefits (PDF)
• Louisiana Gold Schedule of Benefits (PDF)
• Louisiana Gold Limited Schedule of Benefits (PDF)
• Louisiana Gold Plus Schedule of Benefits (PDF)
• Louisiana Gold Plus Limited Schedule of Benefits (PDF)
• Louisiana Silver Schedule of Benefits (PDF)
• Louisiana Silver 73% Schedule of Benefits (PDF)
• Louisiana Silver 87% Schedule of Benefits (PDF)
• Louisiana Silver 94% Schedule of Benefits (PDF)
• Louisiana Silver HD Limited Schedule of Benefits (PDF)
• Louisiana Silver Limited Schedule of Benefits (PDF)
• Louisiana Silver HD Schedule of Benefits (PDF)
• Louisiana Silver HD 73% Schedule of Benefits (PDF)
• Louisiana Silver HD 87% Schedule of Benefits (PDF)
• Louisiana Silver HD 94% Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Louisiana Standard Gold Schedule of Benefits (PDF)
• Louisiana Standard Gold Limited Schedule of Benefits (PDF)
• Louisiana Standard Silver Schedule of Benefits (PDF)
• Louisiana Standard Silver 73% Schedule of Benefits (PDF)
• Louisiana Standard Silver 87% Schedule of Benefits (PDF)
• Louisiana Standard Silver 94% Schedule of Benefits (PDF)
• Louisiana Standard Silver Limited Schedule of Benefits (PDF)

Spanish

• Louisiana American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Louisiana Bronze Basic Limited Schedule of Benefits (PDF)
• Louisiana Bronze Basic Schedule of Benefits (PDF)
• Louisiana Bronze Limited Schedule of Benefits (PDF)
• Louisiana Bronze Schedule of Benefits (PDF)
• Louisiana Gold Limited Schedule of Benefits (PDF)
• Louisiana Gold Plus Limited Schedule of Benefits (PDF)
• Louisiana Gold Plus Schedule of Benefits (PDF)
• Louisiana Gold Schedule of Benefits (PDF)
• Louisiana Silver 73% Schedule of Benefits (PDF)
• Louisiana Silver 87% Schedule of Benefits (PDF)
• Louisiana Silver 94% Schedule of Benefits (PDF)
• Louisiana Silver Limited Schedule of Benefits (PDF)
• Louisiana Silver Schedule of Benefits (PDF)
• Louisiana Silver HD 73% Schedule of Benefits (PDF)
• Louisiana Silver HD 87% Schedule of Benefits (PDF)
• Louisiana Silver HD 94% Schedule of Benefits (PDF)
• Louisiana Silver HD Limited Schedule of Benefits (PDF)
• Louisiana Silver HD Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Schedule of Benefits (PDF)
• Louisiana Standard Gold Limited Schedule of Benefits (PDF)
• Louisiana Standard Gold Schedule of Benefits (PDF)
• Louisiana Standard Silver 73% Schedule of Benefits (PDF)
• Louisiana Standard Silver 87% Schedule of Benefits (PDF)
• Louisiana Standard Silver 94% Schedule of Benefits (PDF)
• Louisiana Standard Silver Limited Schedule of Benefits (PDF)
• Louisiana Standard Silver Schedule of Benefits (PDF)

English

• 2024 Texas Health Insurance Exchange - Platinum Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

Spanish

• 2024 Texas Health Insurance Exchange - Platinum Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

English

• Texas American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Summary of Benefits (PDF)
• Texas Bronze Summary of Benefits (PDF)
• Texas Bronze Limited Summary of Benefits (PDF)
• Texas Bronze Plus Summary of Benefits (PDF)
• Texas Bronze Plus Limited Summary of Benefits (PDF)
• Texas Catastrophic Summary of Benefits (PDF)
• Texas Gold Summary of Benefits (PDF)
• Texas Gold Limited Summary of Benefits (PDF)
• Texas Gold Plus Summary of Benefits (PDF)
• Texas Gold Plus Limited Summary of Benefits (PDF)
• Texas Platinum Summary of Benefits (PDF)
• Texas Silver Summary of Benefits (PDF)
• Texas Silver 73% Summary of Benefits (PDF)
• Texas Silver 87% Summary of Benefits (PDF)
• Texas Silver 94% Summary of Benefits (PDF)
• Texas Silver HD Summary of Benefits (PDF)
• Texas Silver HD 73% Summary of Benefits (PDF)
• Texas Silver HD 87% Summary of Benefits (PDF)
• Texas Silver HD 94% Summary of Benefits (PDF)
• Texas Silver HD Limited Summary of Benefits (PDF)
• Texas Silver Limited Summary of Benefits (PDF)
• Texas Standard Expanded Bronze Summary of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Summary of Benefits (PDF)
• Texas Standard Gold Summary of Benefits (PDF)
• Texas Standard Gold Limited Summary of Benefits (PDF)
• Texas Standard Silver Summary of Benefits (PDF)
• Texas Standard Silver 73% Summary of Benefits (PDF)
• Texas Standard Silver 87% Summary of Benefits (PDF)
• Texas Standard Silver 94% Summary of Benefits (PDF)
• Texas Standard Silver Limited Summary of Benefits (PDF)

Spanish

• Texas American Indian Zero Cost Sharing Summary of Benefits - Spanish (PDF)
• Texas American Indian Zero Cost Sharing Plus Summary of Benefits - Spanish (PDF)
• Texas Bronze Summary of Benefits - Spanish (PDF)
• Texas Bronze Limited Summary of Benefits - Spanish (PDF)
• Texas Bronze Plus Summary of Benefits - Spanish (PDF)
• Texas Bronze Plus Limited Summary of Benefits - Spanish (PDF)
• Texas Catastrophic Summary of Benefits - Spanish (PDF)
• Texas Gold Summary of Benefits - Spanish (PDF)
• Texas Gold Limited Summary of Benefits - Spanish (PDF)
• Texas Gold Plus Summary of Benefits - Spanish (PDF)
• Texas Gold Plus Limited Summary of Benefits - Spanish (PDF)
• Texas Platinum Summary of Benefits - Spanish (PDF)
• Texas Silver Summary of Benefits - Spanish (PDF)
• Texas Silver 73% Summary of Benefits - Spanish (PDF)
• Texas Silver 87% Summary of Benefits - Spanish (PDF)
• Texas Silver 94% Summary of Benefits - Spanish (PDF)
• Texas Silver HD Summary of Benefits - Spanish (PDF)
• Texas Silver HD 73% Summary of Benefits - Spanish (PDF)
• Texas Silver HD 87% Summary of Benefits - Spanish (PDF)
• Texas Silver HD 94% Summary of Benefits - Spanish (PDF)
• Texas Silver HD Limited Summary of Benefits - Spanish (PDF)
• Texas Silver Limited Summary of Benefits - Spanish (PDF)
• Texas Standard Expanded Bronze Summary of Benefits - Spanish (PDF)
• Texas Standard Expanded Bronze Limited Summary of Benefits - Spanish (PDF)
• Texas Standard Gold Summary of Benefits - Spanish (PDF)
• Texas Standard Gold Limited Summary of Benefits - Spanish (PDF)
• Texas Standard Silver Summary of Benefits - Spanish (PDF)
• Texas Standard Silver 73% Summary of Benefits - Spanish (PDF)
• Texas Standard Silver 87% Summary of Benefits - Spanish (PDF)
• Texas Standard Silver 94% Summary of Benefits - Spanish (PDF)
• Texas Standard Silver Limited Summary of Benefits - Spanish (PDF)

English

• Texas American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Texas Bronze Schedule of Benefits (PDF)
• Texas Bronze Limited Schedule of Benefits (PDF)
• Texas Bronze Plus Schedule of Benefits (PDF)
• Texas Bronze Plus Limited Schedule of Benefits (PDF)
• Texas Catastrophic Schedule of Benefits (PDF)
• Texas Gold Schedule of Benefits (PDF)
• Texas Gold Limited Schedule of Benefits (PDF)
• Texas Gold Plus Schedule of Benefits (PDF)
• Texas Gold Plus Limited Schedule of Benefits (PDF)
• Texas Platinum Schedule of Benefits (PDF)
• Texas Silver Schedule of Benefits (PDF)
• Texas Silver 73% Schedule of Benefits (PDF)
• Texas Silver 87% Schedule of Benefits (PDF)
• Texas Silver 94% Schedule of Benefits (PDF)
• Texas Silver HD Limited Schedule of Benefits (PDF)
• Texas Silver Limited Schedule of Benefits (PDF)
• Texas Silver HD Schedule of Benefits (PDF)
• Texas Silver HD 73% Schedule of Benefits (PDF)
• Texas Silver HD 87% Schedule of Benefits (PDF)
• Texas Silver HD 94% Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Texas Standard Gold Schedule of Benefits (PDF)
• Texas Standard Gold Limited Schedule of Benefits (PDF)
• Texas Standard Silver Schedule of Benefits (PDF)
• Texas Standard Silver 73% Schedule of Benefits (PDF)
• Texas Standard Silver 87% Schedule of Benefits (PDF)
• Texas Standard Silver 94% Schedule of Benefits (PDF)
• Texas Standard Silver Limited Schedule of Benefits (PDF)

Spanish

• Texas American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Schedule of Benefits (PDF)
  
• Texas Bronze Limited Schedule of Benefits (PDF)
  
• Texas Bronze Plus Limited Schedule of Benefits (PDF)
  
• Texas Bronze Plus Schedule of Benefits (PDF)
  
• Texas Bronze Schedule of Benefits (PDF)
  
• Texas Catastrophic Schedule of Benefits (PDF)
  
• Texas Gold Plus Schedule of Benefits (PDF)
  
• Texas Gold Limited Schedule of Benefits (PDF)
  
• Texas Gold Plus Limited Schedule of Benefits (PDF)
  
• Texas Gold Schedule of Benefits (PDF)
• Texas Platinum Schedule of Benefits (PDF)
• Texas Silver 73% Schedule of Benefits (PDF)
• Texas Silver 87% Schedule of Benefits (PDF)
• Texas Silver 94% Schedule of Benefits (PDF)
• Texas Silver Limited Schedule of Benefits (PDF)
• Texas Silver Schedule of Benefits (PDF)
• Texas Silver HD 73% Schedule of Benefits (PDF)
• Texas Silver HD 87% Schedule of Benefits (PDF)
• Texas Silver HD 94% Schedule of Benefits (PDF)
• Texas Silver HD Limited Schedule of Benefits (PDF)
• Texas Silver HD Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Schedule of Benefits (PDF)
• Texas Standard Gold Limited Schedule of Benefits (PDF)
• Texas Standard Gold Schedule of Benefits (PDF)
• Texas Standard Silver 73% Schedule of Benefits (PDF)
• Texas Standard Silver 87% Schedule of Benefits (PDF)
• Texas Standard Silver 94% Schedule of Benefits (PDF)
• Texas Standard Silver Limited Schedule of Benefits (PDF)
• Texas Standard Silver Schedule of Benefits (PDF)

If you choose to go out-of-network for your dental care, you may be reimbursed for your treatment. Complete the patient and subscriber information on the Delta Dental Claims Form.

Mail the completed form and a copy of the dentist’s Statement of Treatment (or detailed receipt) to:
Delta Dental Insurance Company
PO Box 1809
Alpharetta, GA 30023

The Statement of Treatment or detailed receipt must include:

• Name, address, and complete phone number of dentist
• Date each service was performed
• Description, procedure code, and fee of each service performed
• List of affected teeth
• Total cost of services performed
• Dentist’s National Provider Identifier (NPI)
• Dentist’s Tax Identification Number (TIN)
• State license number
• Specialty code

Important note: If the Statement of Treatment or similar document you receive from your dentist is missing any of the information listed above, please enter it on the claim form. A dental office staff member can provide you with the dentist and treatment information.

Be sure to make a copy of the completed claim form and the dentist’s Statement of Treatment or detailed receipt for your records.

2025 - Plus Members

Your fitness benefit for 2025 is offered through the Active&Fit Enterprise™ program and does not require reimbursement.

Please visit ActiveandFit.com to register for your account and to find one of the thousands of fitness centers near you.

Bronze Plus, Silver Plus, and Gold Plus Members only.

• Glossary of Terms (PDF)
  
  
• Online Glossary of Terms

• Payment Authorization Form (PDF)

Provider & Pharmacy Directory

ENGLISH

• 2025 Louisiana Provider & Pharmacy Directory (PDF)
• 2025 Texas Provider & Pharmacy Directory (PDF)

SPANISH

• 2025 Louisiana Provider & Pharmacy Directory (PDF)
• 2025 Texas Provider & Pharmacy Directory (PDF)

Provider Search Tool

• Online Searchable Provider Directories

• Medical Reimbursement Form

• RX Claim Form (PDF)

• Transplant Travel Claim Form