Forms & Documents

Individual & Family Health Insurance Exchange Forms

Health Risk Assessment

We are glad to have you as a member of our health plan and value your participation with us. In partnership with your primary care physician, we want to help you stay as healthy as possible. One way we do this is by asking you some questions about your health and lifestyle. We hope you will help us determine how we can best serve you by answering the questions in the form by clicking the links provided below.

Health Risk Assessment Form - English (PDF)
Health Risk Assessment Form - Spanish (PDF)

If you need guidance on completing the form, please call a Member Services Representative toll-free at 1-844-282-3025. They will be glad to answer any questions you may have. TTY users, please call 1-800-659-8331 for New Mexico, and 1-800-735-2989 Texas.

Please mail or fax the completed form to:

CHRISTUS Health Plan
Attn: Member Services Department
919 Hidden Ridge
Irving, TX 75038
HRA Fax Number: 1-800-277-4926



2017 & 2018 Evidence of Coverage – Texas & New Mexico

2018 New Mexico Health Insurance Exchange - Evidence of Coverage Off Exchange (PDF)
2018 New Mexico Health Insurance Exchange - Evidence of Coverage Off Exchange Catastrophic (PDF)
2018 New Mexico Health Insurance Exchange - Qualified Health Plan (PDF)
2018 New Mexico Health Insurance Exchange - Catastrophic Evidence of Coverage (PDF)
2018 Texas Health Insurance Exchange - Evidence of Coverage Complete Plan (PDF)
2018 Texas Health Insurance Exchange - Evidence of Coverage Off Exchange (PDF)
2018 Texas Health Insurance Exchange - Evidence of Coverage (PDF)
2017 New Mexico Health Insurance Exchange - Evidence of Coverage Off Exchange (PDF)
2017 New Mexico Health Insurance Exchange - Evidence of Coverage Off Exchange Catastrophic (PDF)
2017 New Mexico Health Insurance Exchange - Qualified Health Plan (PDF)
2017 New Mexico Health Insurance Exchange - Catastrophic Evidence of Coverage (PDF)
2017 Texas Health Insurance Exchange - Evidence of Coverage (PDF)


Glossary of Terms

Glossary of Terms (PDF)
Online Glossary of Terms


Paper Enrollment Applications

2017 & 2018 CHP Health Insurance Exchange Enrollment Application (PDF)
2017 & 2018 Federal Marketplace Application for Individuals & Families (PDF)


Payment Authorization

Payment Authorization Form (PDF)


Provider & Pharmacy Directory

Provider Search Tool

Online Searchable Provider Directories


Rx Claim Form

RX Claim Form (PDF)


Summary of Benefits

2017 & 2018 Summaries of Benefits

2018 New Mexico Summary of Benefits
2018 Texas Summary of Benefits
2017 New Mexico Summary of Benefits
2017 Texas Summary of Benefits



If you don’t see what you’re looking for, please contact us. We can help you find the plans, forms and resources you need.


MM161 & MM162
Last Updated: 2/23/17