Memorial Hermann Health Network Provider

Enrollment Form

Eligibility Update Form

Claim Form

Continuity of Care Form

Medical Plan Overview

Physicians & Provider Directory

Caremark Prescription Drug Claim Form

Vision Insurance

Superior Vision

(800) 507-3800

SVContacts

Enrollment Form

Change/Adjustment Form

Schedule of Benefits

Flexible Benefits

WageWorks

(877) 924-3967

Plan Overview

Post Enrollment Guide Information

Plan Brochure

Enrollment Form

Dependent Care Claim Form

Health Care Claim Form

Insurance Rates/Changes

Rate Tables

Qualifying Events

COBRA Applications

UT Employee Assistance Program

UTEAP

Delta Dental Insurance

(800) 893-3582

Group ID 44-3633 (Premiere)

Summary of Dental Benefits

Enrollment & Changes Form

Claim Form

Dentist & Provider Directory

Life & Disability Insurance

TMAIT

(800) 880-8181

Enrollment Form

Change of Beneficiary

Change Form

TMAIT Application

Summary of Benefits

Supplemental Disability

Richard Cunningham-Physician's Resource Services

(713) 522-5313

Summary of Benefit

Application for Final Year House Staff to Exercise $3k Increase

Application for Exercising Any or All of $6,000 Increase Options

Bank Draft Authorization

Claim Form/Instructions

403(b) Contribution

TIAA Cref

(800) 842-2776

Salary Agreement Form