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Life & Health Other Forms Listing

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 | Other Forms | Optional Forms

   

Other Forms

TDI Form Number	Description	File Format	Language
LHL050	Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 Revised date 06/09	PDF	English
LHL050	Outline of Medicare Supplement Coverage Outline of Coverage - Rev. 12/04	PDF	English
LHL251	Life/Health Individual Indemnity Consumer Choice Benefit Plans CCP Figure 1	PDF	English
LHL253	Life/Health Group Indemnity Consumer Choice Benefit Plans CCP Figure 1	PDF	English
LHL258	Life/Health HGC-1, Health Group Cooperative-1 Annual Health Group Cooperatives Report to TDI Statement of Amounts Collected and Expense Incurred	PDF	English
LHL265	Discretionary Group Checklist	PDF	English
LHL318	Life/Health Equity Indexed Equity Indexed checklists	PDF	English
LHL351	Life/Health Nonprofit Legal Services Contracts Nonprofit legal services checklist	PDF	English
LHL356	Life/Health Checklists for Assumption/Merger Certificates Life, Annuity and Credit/Accident and Health	PDF	English
LHL366	Notice and Consent for HIV Testing Consent Form	PDF	English
LHL401	Prepaid Funeral Insurance Policies/Contracts Checklist	PDF	English
LHL407	Employer Market Form Filing Checklist	PDF	English
LHL414	Fraternal Filings Checklist	PDF	English
LHL415	Private Placement Filings Checklist LHL415 Private Placement Filings Checklist	PDF	English
LHL431	30-DAY FREE LOOK CHECKLIST	PDF	English
LHL560	Long-Term Care Insurance Personal Worksheet LTC Personal Worksheet	PDF	English
LHL561	Long-Term Care Insurance Potential Rate Increase Disclosure Form LTC Potential Rate Increase	PDF	English
LHL562	Long-Term Care Insurance Replacement and Lapse Reporting Form Replacement and Lapse Reporting	PDF	English
LHL563	Rescission Reporting Form for Long-Term Care Policies LTC Rescission Reporting	PDF	English
LHL564	Long-Term Care Insurance Claim Denials Reporting Form LTC Claim Denials Reporting	PDF	English
LHL565	Long-Term Care Policies Sold Reporting Form LTC Policies Sold Reporting	PDF	English
LHL566	Long-Term Care Suitability Reporting Form LTC Suitability Reporting	PDF	English
LHL567	Things To Know Before You Buy LTC Insurance Things You Should Know Before You Buy	PDF	English
LHL568	LTC Insurance Suitability Letter Long-Term Care Insurance Suitability Letter	PDF	English
LHL569	Partnership Status Disclosure Notice for LTC Partnership Policies/Certificates	PDF	English
LHL570	Long-Term Care Partnership Program Insurer Certification Form LTC Partnership Program Insurer Certification	PDF	English
LHL571	Long-Term Care Partnership Agent Training Certification LTC Partnership Agent Training Certification	PDF	English
LHL572	LTC Partnership Agent Training Certification Form Long-Term Care Partnership Agent Training Certification Form	PDF	English
LHL573	Insurer Certification of Association Compliance With Marketing Standards for LTC Partnership and Non-Partnership Policies and Certificates	PDF	English
LHL604	AGENT REPLACEMENT OF LIFE INSURANCE OR ANNUITIES NOTICE	PDF	English
LHL605	COMPANY REPLACEMENT OF LIFE INSURANCE OR ANNUITIES NOTICE	PDF	English
LHL606	NOTICE REPLACEMENT OF LIFE INSURANCE OR ANNUITIES	PDF	English
LHL607	NONINSURANCE BENEFIT CHECKLIST	PDF	English
LHL608	Health Benefit Plan/Provider Contracting Practices Survey Health Benefit Plan Survey	PDF	English
LHL609	Health Benefit Plan Issuer Hospital Grid Health Benefit Plan Survey	PDF	English
LHL651	OPTIONAL - Health Insurance Pools - Notice of Availability of Coverage under the Texas Health Insurance Pool or Under the Pre-Existing Condition Insurance Plan	PDF	English
LHL657	Will be available in October 2013. Annual reporting form for Mandated Benefits Data Call		English