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You are here: www.tdi.texas.gov . forms . form10other

Life and Health Other Forms

This is one of several pages linking to a central repository of forms used by TDI customers. Use the search or Forms by Type links on the Forms Home Page or scan through our form listings.

Life Health Main Forms Page

Life and Health Other Forms
TDI Form Number Description File FormatLanguage
LHL616 Health Care Claims Reimbursement Rate Report
Instructions for Annual Data Call Pursuant to 28 TAC ยง21.4506
PDFEnglish
LHL657 Mandated Benefits Data Call
Annual reporting form for Mandated Benefits Data Call
PDFEnglish
LHL050 Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010
Revised date 06/09
PDFEnglish
LHL050 Outline of Medicare Supplement Coverage
Outline of Coverage - Rev. 12/04
PDFEnglish
LHL251 Individual Indemnity Consumer Choice Benefit Plans
CCP Figure 1
PDFEnglish
LHL253 Group Indemnity Consumer Choice Benefit Plans
CCP Figure 1
PDFEnglish
LHL258 HGC-1, Health Group Cooperative-1 Annual Health Group Cooperatives Report to TDI
Statement of Amounts Collected and Expense Incurred
PDFEnglish
LHL318 Index-Linked Crediting Features
Equity Indexed checklists
PDFEnglish
LHL351 Nonprofit Legal Services Contracts
PDFEnglish
LHL356 Company Licensing (Business Changes) Form Filings
PDFEnglish
LHL366 Notice and Consent for HIV Testing
Consent Form
PDFEnglish
LHL401 Prepaid Funeral Filings
PDFEnglish
LHL414 Fraternal Filings
PDFEnglish
LHL415 Private Placement Filings
PDFEnglish
LHL560 Long-Term Care Insurance Personal Worksheet
PDFEnglish
LHL560 Long-Term Care Insurance Personal Worksheet
LTC Personal Worksheet
PDFEnglish
LHL562 Long-Term Care Insurance Replacement and Lapse Reporting Form
Replacement and Lapse Reporting
PDFEnglish
LHL563 Rescission Reporting Form for Long-Term Care Policies
LTC Rescission Reporting
PDFEnglish
LHL564 Long-Term Care Insurance Claim Denials Reporting Form
LTC Claim Denials Reporting
PDFEnglish
LHL565 Long-Term Care Policies Sold Reporting Form
LTC Policies Sold Reporting
PDFEnglish
LHL566 Long-Term Care Suitability Reporting Form
LTC Suitability Reporting
PDFEnglish
LHL567 Things To Know Before You Buy LTC Insurance
Things You Should Know Before You Buy
PDFEnglish
LHL568 LTC Insurance Suitability Letter
Long-Term Care Insurance Suitability Letter
PDFEnglish
LHL569 Partnership Status Disclosure Notice for LTC Partnership Policies/Certificates
PDFEnglish
LHL570 Long-Term Care Partnership Program Insurer Certification Form
LTC Partnership Program Insurer Certification
PDFEnglish
LHL571 Long-Term Care Partnership Agent Training Certification
LTC Partnership Agent Training Certification
PDFEnglish
LHL572 LTC Partnership Agent Training Certification Form
Long-Term Care Partnership Agent Training Certification Form
PDFEnglish
LHL573 Insurer Certification of Association Compliance With Marketing Standards for LTC Partnership and Non-Partnership
Policies and Certificates
PDFEnglish
LHL607 Noninsurance Benefits
PDFEnglish
LHL608 Health Benefit Plan/Provider Contracting Practices Survey
Health Benefit Plan Survey
PDFEnglish
LHL609 Health Benefit Plan Issuer Hospital Grid
Health Benefit Plan Survey
PDFEnglish
LHL651 OPTIONAL - Health Insurance Pools - Notice of Availability of Coverage under the Texas Health Insurance Pool or Under the Pre-Existing Condition Insurance Plan
PDFEnglish
LHL659 LIFE AND ANNUITY RIDERS, ENDORSEMENTS, AND AMENDMENTS CHECKLIST
General Checklist
PDFEnglish


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Last updated: 09/19/2014

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