Forms - Health Plan - WEHP Forms

For the forms noted below, you will need to print out and complete the selected form. Please note those which require originals for processing and those which can be faxed.

Mail To: WellMed Employee Health Plan, 8637 Fredericksburg Rd., Suite 360, San Antonio, TX 78240

Fax To: WellMed Employee Health Plan, (210) 617- 4090.

Interoffice To: WEHP

Forms Questions: call (210)-949-4147

The Enrollment Forms must be completed by all new employees and the original sent to WEHP for processing.
» 2009 Plan A or B Benefit Enrollment Form
» 2009 Plan C Benefit Enrollment Form

The Member Change Forms must be completed if you have any status changes such as a change of address, new baby, newly married, divorced, etc.
» 2009 Plan A&B Change Form
» 2009 Plan C Change Form

The PCP Change Form must be completed if you or one of your dependents decides to change your Primary Care Physician.

The Transition of Care form must be completed for all new employees who are in the middle of a treatment plan upon joining the WellMed Employee Health Plan. For additional examples please refer to the Transition of Care Explanation.

The Provider Nomination Form may be completed if you would like to request a specific provider who is not currently listed in our contracted Provider Directory. This is simply a request form which will be reviewed by the Utilization Management Committee for possible approval.

The Medical, Dental, or Rx Complaint Form should be completed if you or your family members experience any problems regarding health care or benefits provided to you. For confidentiality purposes, this form should be faxed directly to WEHP (210) 617-4090.

We offer three Aflac plans through Wellmed and they are, Cancer, Short Term Disability, and Accident. To obtain an Aflac packet, contact WEHP. To sign up for Aflac, please complete the Aflac Deduction form. If you have an Aflac Accident policy and need to file a claim, fill out the Aflac Accident Disability Claim Form. To terminate a policy, complete the Aflac Termination form. Forward all forms to WEHP.

To file a Health Claim or a Dependent Care claims against your Flexible Spending Account, complete the Flexible Spending Account Claim Form and forward the form to Benefit Management Administrators. You must have a Flexible Spending Account and an eligible expense in order to receive reimbursement.