How to Become a Patient with CommuniCare
Patient Registration Forms
Please print and fill out our Patient Registration form. Then, please bring the form to your next appointment.
Patient Registration Form (English)
Patient Registration Form (Spanish)
Patients with Private/Commercial Health Insurance
(1) You will need your insurance card and a picture ID. If you do not have a current insurance card, you can provide a letter from your insurance company that contains information about your healthcare coverage.
(2) If you wish to become a patient and want to learn more about our additional services and programs, please call us at (210) 233-7000. For your convenience, you may also book your appointment online.
Patients with Medicaid, CHIP, or Medicare
(1) Parents of children with Medicaid and CHIP will need to provide a valid picture ID (see below for acceptable forms of identification) and the child’s Medicaid/CHIP card:
(a) State issued ID or Drivers License (foreign licenses are acceptable)
(b) School IDs (must include picture and name)
(c) Passport IDs
(d) Citizenship certificate with picture and name
(2) Persons with Medicaid, CHIP or Medicare who wish to take advantage of services not covered by their insurance plan such as dental services can apply to see if you qualify for our “discount program.”
(3) If you wish to become a patient, you must first visit with a Member Services Representative. The purpose of this visit is so that our Member Services Representative can assist you in understanding what your health benefits cover and do not cover, see if you qualify for our “discount program” for services that your benefits do not cover, show you all of our available services and programs, and to help coordinate your next appointment with a provider/doctor.
Patients using Self-Pay (No Insurance)
(1) We highly recommend that you check to see if you’re eligible for the Health Insurance Marketplace. We have Certified Application Counselors at select campuses that can assist you with this process. You can also visit with one of our Member Services Representative to see if you qualify for our “discount program” if you’re not eligible for the Health Insurance Marketplace, (please see the section on “Discount Program” for more information). We use an income sliding fee scale set by the Health Resources and Service Administration to determine the percentage amount to be discounted for our services.
(2) If you wish to become a patient you must first visit with a Member Services Representative. The purpose of this visit is so that our Member Services Representative can assist you with our “discount program,” show you all of our available services and programs, and to help coordinate your next appointment with a provider/doctor.
To qualify for the discount program, you must have a total family income that is less than 200% of the Federal Poverty Income Guidelines. To assist us in assessing your eligibility for the program, you will need to provide the following required documents at your initial member registration: proof of identification, income, and residency as described below. We use an income sliding fee scale set by the Health and Human Services Commission to determine the percentage amount to be discounted for our services.
(1) Proof of Identity:
(a) For Adults, one identification is required with a picture ID: current driver’s license, Texas identification card, legal resident documents, passport, or consulate card
(b) If you do not have a picture ID, bring two (2) of the following: birth certificate, social security card, voter registration card, school record, marriage license, selective service card, checkbook, etc.
(c) For Children: birth certificate and social security card (if applicable), birth-verification letter from hospital of child’s birth, or an immunization record
(2) Proof of Income (as applicable):
(a) Earned income: copy of most recent paycheck stubs within 30 days, tax return, or statement from employer with company’s information
(b) Unearned income: Recent TANF letter from Texas Department of Human Services, Social Security Administration and/or Social Security Supplement Child support award letter from Attorney General, Retirement Pension award letter, Veteran’s pension letter, or Unemployment award letter from Texas Workforce Commission
(c) Self-employment: self-employment declaration forms/letter from the last 2 months or 1040 Income Tax forms with W2 form
(3) Proof of Residency:
Utility bills (for example: telephone bill, electric bill, etc.), food stamp letter, mail received by applicant, or lease from dwelling (house, apartment, etc.).
(4) Eligibility Period:
Eligibility for our “discount program” is only good for one year. If you wish to maintain eligibility under our “discount program,” the eligibility information must be updated every year or whenever there are changes in household size, household income or if someone in the household obtains or loses medical coverage. If the eligibility information is not updated by your expiration date, your account will be charged at the full fee of any services used.
Do you have questions? Email us at PatientInquiry@CommuniCareSA.org!