Scott & White Health Plan

Forms

Material Request Form for Coordinators - submit this form to order additional Provider Directories or Fact Sheets.

Prescription Mail Order Form (pdf, 189kb) - Download, complete, and submit form to a network pharmacy to have your prescription delivered by mail.

Prescription Refill Form - Order your prescription refills on-line.

Supplemental Information Form for Employees (pdf, 368kb) - This form is for providing other insurance information and selecting a primary care physician.

Transition of Care (pdf, 91kb) - The information requested on this form will help us to assist you as needed during your transition period onto coverage under your Scott and White Health Plan (SWHP) Health Care Agreement.

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