Texas Rx Application

To obtain an application packet:

• Download an application packet.
• Or request an application packet to be mailed to you.
• Or call 1-888-333-3980 or visit the Scott & White Health Plan.

After we receive your application, we will send your request for coverage to the Centers for Medicare and Medicaid Services (CMS) for final approval. You will be notified in writing regarding your acceptance and starting date to Texas Rx within seven to ten business days. Do not cancel any other coverage until you have received confirmation in writing of your acceptance to the Texas Rx plan.

The above information is current as of November 2007.

Texas Rx is offered by Scott & White Health Plan, a Medicare Prescription Drug Plan that contracts with Medicare.

S5915_WEBD_APP_2008

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