Forms & Documents

New Mexico and Texas Medicare Advantage 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 1-844-282-3026. 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

Claim, Request & Appeal Forms

Appointment of Representative Form (PDF)
Spanish Appointment of Representative Form (PDF)
Consent Form (PDF)
Grievance and Appeal Request Form (PDF)
Mail Order Form (PDF)
Medicare Complaint Form (PDF)
Part D Coverage Determination Request Form (PDF)
Payment Authorization Form (PDF)
Prior Authorization Request Form (PDF)
Rx Claim Form - English (PDF)
Rx Claim Form - Spanish (PDF)
Vaccine Claim Form (PDF)


Ways to Enroll

We provide 3 enrollment options: Online, Application (fax or mail) and through Medicare.gov.

Enroll online - Enroll Now

2018 Enrollment application (fax or email) - 2018 New Mexico Enrollment Application (PDF) or 2018 Texas Enrollment Application (PDF)

2017 Enrollment application (fax or email) - 2017 Enrollment Application (PDF)

Enroll online through Medicare.gov - Enroll now through Medicare.gov


Evidence of Coverage

Annual Notice of Change / Evidence of Coverage (PDF)
2017 Medicare Annual Notice of Change/Evidence of Coverage (ANOC/EOC) - Spanish (PDF)
2018 Generations Evidence of Coverage (EOC) - New Mexico (PDF)
2018 Generations Evidence of Coverage (EOC) - Texas (PDF)
2018 Generations Annual Notice of Changes/Evidence of Coverage (ANOC/EOC) - New Mexico (PDF)
2018 Generations Plus Evidence of Coverage (EOC) – New Mexico (PDF)
2018 Generations Plus Evidence of Coverage (EOC) - Texas (PDF)


Interpreter Services

Multilanguage Interpreter Services (PDF)


Provider & Pharmacy Directory

PROVIDER SEARCH TOOL

Online Searchable Provider Directory

PROVIDER & PHARMACY Directory

2018 Provider & Pharmacy Directory - Texas (PDF)
2018 Provider & Pharmacy Directory New Mexico - English (PDF)
2018 Provider & Pharmacy Directory New Mexico - Spanish (PDF)
2017 Provider & Pharmacy Directory (PDF)


Provider Policies & Tables

2017 Low Income Subsidy
Acknowledgement of Receipt Notice of Privacy Practices (PDF)
Privacy Notice (PDF)
Transition Policy (PDF)


Summary of Benefits

2018 Generations Summary of Benefits - New Mexico (PDF)
2018 Generations Summary of Benefits - Texas (PDF)
2018 Generations Plus Summary of Benefits - New Mexico (PDF)
2018 Generations Plus Summary of Benefits - Texas (PDF)
2017 Summary of Benefits Information (PDF)


Disclaimer:

CHRISTUS Health Plan Generations is an HMO plan with a Medicare contract. Enrollment in CHRISTUS Health Plan Generations depends on contract renewal. You must continue to pay your Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Other pharmacies/physicians/providers are available in our network. Medicare beneficiaries may also enroll in CHRISTUS Health Plan Generations (HMO) through the CMS Medicare Online Enrollment Center located at www.medicare.gov. A sales person will be present with information and applications. This information is available for free in other languages. For accommodations of persons with special needs at sales meetings, call 1-844-282-3026, TTY call 1-800-659-8331. Open seven days a week, 8:00 a.m. to 8:00 p.m., local time, from October 1 – February 14, and Monday – Friday, 8:00 a.m. to 8:00 p.m., local time, from February 15 – September 30. A voice response system is available after hours. Messages left will be responded to within one business day. CHRISTUS Health Plan Generations (HMO) Contract #H1189.


H1189_MM143 pending approval
Last Updated: 2/23/17