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

Life and Health Other Forms

Life Health Main Forms Page

Life and Health Other Forms
TDI Form Number Description File FormatLanguage
LAC010
Fraternal Filings Checklist
PDF English
LAC011
Nonprofit Legal Services Contracts Checklist
PDF English
LAC012
Private Placement Filings Checklist
PDF English
LAC014
Life and Annuity Riders, Endorsements, and Amendments Checklist
PDF English
LAC018
Index-Linked Crediting Features Checklist
PDF English
LAC020
Life Illustration Certification and Notification Checklist
PDF English
LAC022
Prepaid Funeral Filings Checklist
PDF English
LAH301
Noninsurance Benefits Checklist
PDF English
LAH302
Total and Partial Assumptions, Mergers, Name Changes, Redomestication, and Demutualization Form Filings Checklist
PDF English
LAHR324
Notice and Consent for HIV-Related Testing
PDF English
LAHR339
CCP Figure 1 - Individual Indemnity Consumer Choice Benefit Plans Disclosure Notice
PDF English
LAHR340
CCP Figure 1 - Group Indemnity Consumer Choice Benefit Plans Disclosure Notice
PDF English
LHL050Rev0609
Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010
PDF English
LHL050Rev1204
Outline of Medicare Supplement Coverage
PDF English
LHL560
Long-Term Care Insurance Personal Worksheet
PDF English
LHL561
Long-Term Care Insurance Potential Rate Increase Disclosure Form
PDF English
LHL562
Long-Term Care Insurance Replacement and Lapse Reporting Form
PDF English
LHL563
Long-Term Care Insurance Recission Reporting Form
PDF English
LHL564
Long-Term Care Insurance Claim Denials Reporting Form
PDF English
LHL565
Long-Term Care Insurance Policies Sold Reporting Form
PDF English
LHL566
Long-Term Care Insurance Suitability Reporting Form
PDF English
LHL567
Things To Know Before You Buy Long-Term Care Insurance
PDF English
LHL568
Long-Term Care Insurance Suitability Letter
PDF English
LHL569
Partnership Status Disclosure Notice for Long-Term Care Partnership Policies/Certificates
PDF English
LHL570
Long-Term Care Partnership Program Insurer Certification Form
PDF English
LHL571
Long-Term Care Partnership Agent Training Certification Initial Reporting Form
PDF English
LHL572
Long-Term Care Partnership Agent Training Certification Form Annual Report
PDF English
LHL573
Insurer Certification of Association Compliance with Marketing Standards for Long-Term Care Partnership and Non-Partnership Policies and Certificates
PDF English
LHL657
Mandated Benefits Data Call
Annual reporting form for Mandated Benefits Data Call
PDF English
NOFR001
Prior Authorization of Health Care Services
PDF English
NOFR002
Prior Authorization of Prescription Drugs
PDF English

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