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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
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
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
LHL616
Health Care Claims Reimbursement Rate Report
Instructions for Annual Data Call Pursuant to 28 TAC ยง21.4506
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
LHL657
Mandated Benefits Data Call
Annual reporting form for Mandated Benefits Data Call
PDFEnglish
LHL659
LIFE AND ANNUITY RIDERS, ENDORSEMENTS, AND AMENDMENTS CHECKLIST
General Checklist
PDFEnglish
LHL560
Long-Term Care Insurance Personal Worksheet
PDFEnglish


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Last updated: 09/19/2014

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