TX HHS Form H1253. Verification of Health Insurance Policy

The TX HHS Form H1253, Verification of Health Insurance Policy, helps determine eligibility for medical assistance by gathering information about an individual's health insurance policies. This form is typically completed by HHSC staff or an insurance company representative in situations where an individual is being considered for medical assistance.

This form requires the completion of two sections: Section 1, which collects information from the HHSC staff, and Section 2, which is completed by the insurance company representative. The key features of this form include the verification of prescription drug coverage, Medicare skilled facility coverage, other nursing home coverage, and whether the policy is assignable to providers.

By completing this form, HHSC staff can ensure that they have accurate information about an individual's health insurance policies, which helps determine their eligibility for medical assistance. The form also includes space for the insurance company representative to sign and date it, as well as provide their contact information.

• This form is used in situations where an individual is being considered for medical assistance.
• The form requires verification of prescription drug coverage, Medicare skilled facility coverage, other nursing home coverage, and whether the policy is assignable to providers.