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Texas Counties Deliver
Insurance
Benefits Coordinator
(Health Benefits and Workers Comp)
HIPAA Contact

1010 East Eighth Street, Suite 126
Odessa, TX 79761
Phone:(432)498-4011
Fax:(432)498-4097
 My Premise Health logo

 Ector County Provider Networks:

UHC Choice Plus In Network Physicians (90% after $441.00 Deductible)
Specialist & Other In Network Facilities (80% after $441.00 deductible)
Out of Network (60% after $441.00 deductible)
Vision Provider Network

Insurance Department Forms

Eligibility for Health Benefits in Retirement

Health and Dental Enrollment Form

Health Care Claim Form

Worker Comp Forms

Worker's Compensation Procedure

Injured Employee First Response Forms

Injured Employee Notices

Injured Employee's Statement

Witness Statement

Supervisor Statement

PSWCA Driver


Notary Commissions

Notary Application

Notary Training

Insurance Notices

CHIP Notice

Insurance Marketplace Notice

HIPAA Privacy Notice

Summary of Benefits

Life Insurance Enrollment Form


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