After completing the PCP selection form, you can submit it by mail to Blue Cross and Blue Shield of Texas, P.O. Box 650712, Dallas, Texas 75265-0712. Alternatively, you can call Customer Service at 1-888-657-6061 to provide the information over the phone. For individuals with hearing or speech loss, contact the TTY line at 7-1-1. My advice is to submit the form promptly to avoid any delays in receiving your updated ID card and to ensure your healthcare services are appropriately coordinated.

Important dates for this form include the initial submission deadline within 30 days of receiving the form. New ID cards are sent within five days after processing the completed form. Ensure to submit the form promptly to avoid delays in receiving your new ID card.

The primary purpose of this form is to allow BlueCross BlueShield of Texas CHIP and STAR members to select or change their Primary Care Provider (PCP). This selection is crucial for ensuring that members receive appropriate and coordinated healthcare services. By choosing a PCP, members can build a lasting relationship with their healthcare provider, which can lead to better health outcomes and a more personalized healthcare experience. This form also facilitates the issuance of new ID cards reflecting the chosen PCP. It is essential for new enrollees, members who are changing their PCP, and those who have recently moved. Additionally, expectant mothers can use this form to designate a PCP who will provide prenatal care. Overall, the form is a vital tool for managing and updating healthcare provider information within the BlueCross BlueShield of Texas network.

• 1. Member Name: Enter the first and last name of the member selecting or changing the PCP.
• 2. Member ID Number: Provide the unique identification number associated with the member's health plan.
• 3. 1st Choice PCP Name: Enter the full name of the primary choice for the PCP.
• 4. 2nd Choice PCP Name: Enter the full name of the secondary choice for the PCP in case the first choice is unavailable.
• 5. Your Address: Fill in the complete address of the member, including street, city, state, and ZIP code.
• 6. Your Daytime Telephone Number: Enter a contact number where the member can be reached during the day.
• 7. Your Name: Print the name of the person completing the form, if different from the member.
• 8. Your Signature: Provide a signature to validate the form.

If you fail to submit this form, you may experience delays or disruptions in receiving healthcare services. Updating your PCP information is crucial for coordinated care and timely services.

• Delayed ID Card: Without submitting the form, your new ID card reflecting your chosen PCP will not be issued.
• Inconsistent Care: Not selecting a PCP can lead to discrepancies in your healthcare services and hinder personalized care.
• Missed Appointments: Without a designated PCP, scheduling appointments and referrals can become challenging.

• 1. New Enrollment: For new members who need to choose their initial PCP.
• 2. Changing PCP: For existing members who wish to change their current PCP.
• 3. Moved: For members who have recently moved and need to update their PCP information.
• 4. Expectant Mothers: For pregnant members needing to select a PCP for prenatal care.