Important Member Documents
As a valued member of TIHP in Texas, you can access your important documents at any time by clicking on the links below.
Member Materials
- 2026 Annual Notice of Change
- 2026 Annual Notice of Change (Spanish)
- 2026 Summary of Benefits
- 2026 Summary of Benefits (Spanish)
- 2026 Evidence of Coverage
- 2026 Evidence of Coverage (Spanish)
- 2026 Star Ratings
- 2026 Star Ratings (Spanish)
- 2026 LIS Summary
- 2026 LIS Summary (Spanish)
- Appointment of Representative Form CMS-1696
- Appointment of Representative Form CMS-1696 (Spanish)
- 2026 Member Reimbursement Form
- 2026 Member Reimbursement Form (Spanish)
- Beauty and Barbershop Benefit Reimbursement Form
- Beauty and Barbershop Benefit Reimbursement Form (Spanish)
- Participating Providers
- Participating Pharmacies
- Appeals, Organizational Determinations, Coverage Determinations, Grievances
- Over The Counter (OTC) Catalog
- Over The Counter (OTC) Catalog (Spanish)
- 2026 Authorization Form
- 2026 Authorization Form (Spanish)
Enrollment
Pharmacy Materials
Formulary 2026
- 2026 Formulary (List of Covered Drugs)
(last updated 10/1/2025) - 2026 Formulary (List of Covered Drugs) (Spanish)
(last updated 10/1/2025) - 2026 Prior Authorization Criteria
(last updated 10/1/2025) - 2026 Step Therapy Criteria
(last updated 10/1/2025) - 2026 Formulary (Prescription Drugs) Search Tool
Additional Pharmacy Information
- Coverage Determination, Appeals, and Grievances Information
- 2026 Request for Medicare Prescription Drug Coverage Determination Form
- 2026 Request for Medicare Prescription Drug Coverage Determination Form (Spanish)
- 2026 Request for Medicare Prescription Drug Coverage Appeal (Redetermination) Form
- 2026 Request for Medicare Prescription Drug Coverage Appeal (Redetermination) Form (Spanish)
- Online Medicare Prescription Drug Coverage Determination/Appeal (Redetermination)
- 2026 Medicare Prescription Drug Coverage Transition Policy
- 2026 Medicare Prescription Drug Coverage Transition Policy (Spanish)
- 2026 Medication Therapy Management Program Description
- 2026 Pharmacy Reimbursement Form
- 2026 Pharmacy Reimbursement Form (Spanish)