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Discount Health Care Program Operator Forms

Discount Health Care Program Operator Forms
TDI Form Number Description File FormatLanguage
FIN524
Discount Health Care Program Operator Marketers Form
Use this form to provide a list of the marketers authorized to sell or distribute the program operator's program under the program operator's name, and a list of the marketing entities authorized to private label the program operator's programs.
EXCEL English
FIN525
Discount Health Care Program Operator Surety Bond Form
Use this form of an original surety bond in the principal amount of $50,000 to show Financial Responsibility.
PDF English
FIN526
Discount Health Care Program Operator Biographical Certificate Form
Discount Health Care Program Operator Biographical Certificates. Follow the instructions within the form for completion. Rev 12/2015
PDF English
FIN527
Discount Health Care Program Operator Registration Form
Form for Registration as a Discount Health Care Program Operator.
PDF English

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