PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form H2053-B
for the current year.
Form H2053-B Health Plan Selection - Texas
What Is Form H2053-B?
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the H2053-B Health Plan Selection form?
A: The H2053-B Health Plan Selection form is a document used in Texas to select a health plan.
Q: Who needs to fill out the H2053-B Health Plan Selection form?
A: Individuals in Texas who are applying for or renewing their Medicaid coverage need to fill out the H2053-B Health Plan Selection form.
Q: What information do I need to provide on the H2053-B Health Plan Selection form?
A: You will need to provide personal information, such as your name, address, and Social Security number, as well as information about your preferred health plan.
Q: Can I change my health plan after submitting the H2053-B Health Plan Selection form?
A: Yes, you can change your health plan at any time by contacting the Texas Health and Human Services Commission.
Form Details:
- Released on September 1, 2017;
- The latest edition provided by the Texas Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form H2053-B by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.
