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Insurance Pool
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Company Assessment




Pharmacy Program

Medical Providers

About the Pool


Texas Health Insurance Pool

Enrollment  Package

Important Notice: The Pool now offers premium payment only on a monthly basis, either by automatic bank draft or a mailed billing statement.  Quarterly, semi-annual, and annual premium payment methods are no longer available.  Please disregard the non-monthly payment methods shown on p. 6 of the Application form. 

The Pool’s Enrollment package is provided below in downloadable Adobe Reader files.  The Application Form and Checklist are fillable forms that can be completed online and then printed for mailing.  Or you can still print the blank forms and hand write or type your answers. 

It is very important that you carefully review the Outlines of Coverage before completing your Application so that you select the Pool plan that best suits your needs. 

You should familiarize yourself with the Pool’s deductible plans and policy benefits and exclusions, including the preexisting condition exclusion period for prescription drugs and medical services.

Please review the Enrollment package documents in the following order:

In order to access the application and employment verification forms, please click on the "Agree" button acknowledging the following statement:

I have read the Pool’s Outlines of Coverage and understand the various deductibles, coinsurance, copayments and exclusions, including the preexisting condition exclusion, that apply to the Pool plan I have selected.


  • Application Form and Checklist—All Plans  
  • Employment & Self-Employment Verification Forms

Please refer to the “Premium Rates” page of this web site for current premium rates and instructions.  After you have completed all required forms (Application, Employment/Self-Employment forms, and Checklist), mail or deliver your forms and your check for the required premium to the Pool’s Administrator at the address shown on the Application.  Please allow at least 8 business days for processing, following receipt of your complete application.  Incomplete applications will delay processing and your coverage effective date.  Should you have any questions regarding the Application, please contact the Pool’s Administrator at 1-888-398-3927.

TAA/PBGC Eligibles:  If you have been certified as a TAA/PBGC-eligible and wish to enroll in the Pool to claim your tax credit, contact the Pool’s Administrator at 1-888-398-3927 to request a TAA application package. 




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