Claim Forms

Aetna
> Aetna Medical Claim Form
> Aetna Dental Claim Form
> Aetna RX Claim Form
> Aetna Vision Claim Form

Humana
Claim forms can only be obtained by calling the phone number listed on the medical ID card. The Claim Forms are color coded. Please do not duplicate. Use original forms only.

Blue Cross Blue Shield
> BCBS Medical & RX Claim Form
> BCBS Dental Claim Form

United HealthCare
> UHC Medical Claim Form
> UHC RX Claim Form
> UHC Dental Claim Form

Downloadable Forms

SMALL GROUP

Small Group Quote Request
(Now quoting multiple carriers. Used for quoting Health, Dental and Life.)

Enrollment Forms

If you have received a quote and are interested in enrolling, please contact the State Bar of Texas Insurance Trust for a Small Group Enrollment Packet.

For Small Groups who need to request a quote, please complete the Small Group Quote Request form found on this page.

If you are currently enrolled with a carrier thru the State Bar of Texas Insurance Trust and need to add or change an employee's status, please complete the appropriate form listed to the left and fax to our office at 512-479-4109.

> Aetna Employee Enrollment Form / Change Request

> BCBS Employee Enrollment Form / Change Request

> Humana Enrollment Form / Change Request

> United HealthCare Enrollment Form / Change Request

INDIVIDUAL

› Prudential Application Form - for Life Products

> Prudential Change of Beneficiary Form

› Individual Health Application for State Bar Plans

› Individual Quote Request for Multiple Carriers

Links to Apply for Individual Coverage On-line:
(Application Fees Apply)

Individual Aetna Advantage Plan (not to be confused with the SBOTIT sponsored Aetna plans)	Individual and Short Term Medical Coverage:

To apply for Golden Rule:	To apply for Humana One:
To apply for BCBS:

Plan information request | Get a quote now | Send this link to a friend

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