TEXAS EMPLOYEES GROUP BENEFITS PROGRAM (GBP) SUPPLEMENTAL 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with SECTION A: EMPLOYEE DATA. Fill in your name, birthdate, and contact information. Indicate if you are a new employee.
3. Move to SECTION B: OTHER INSURANCE DATA. Specify any other health or dental coverage you or your family members have. Include the policyholder's name and ID number.
4. In SECTION C: MEDICARE COVERAGE INFORMATION, provide details if you or any family member is covered under Medicare Part A and/or B.
5. Proceed to SECTION D: PRIMARY CARE PROVIDER SELECTION. Select your primary care provider from the HealthSelect directory and fill in their details for each dependent.
6. Complete SECTION E if applicable, providing information for dependents living out-of-area.
7. Finally, review all sections for accuracy, sign, date the form, and mail it to your health plan as instructed.

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