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Texas Department of Insurance
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Health Care Collaboratives - Company Licensing and Registration

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TDI Form Number Description File Format Language
FIN321

Company Licensing Fee Transmittal Form

Company Licensing and Registration Fee Transmittal Form to be submitted with filings.

PDF English
FIN491

Health Care Collaborative (HCC) Acquisition Form

Department notification of an acquisition of a Health Care Collaborative

PDF English
FIN492

Application for Certificate of Authority to do the business of a Health Care Collaborative in the state of Texas

Health Care Collaborative application for initial or renewal of certificate of authority

PDF English
FIN493

Health Care Collaboratives Officers and Directors Page

Health Care Collaborative Officer and Director Information

PDF English
FIN494

Health Care Collaborative Payor Information Form

Form used to provide HCC market power information

PDF English
FIN495

Request to Convert to Renewal of Certificate of Authority (to do the business of a Health Care Collaborative)

Used to request that the Department convert an examination to an early renewal application

PDF English
FIN496

Transmittal Checklist for Health Care Collaborative (HCC) Filings

Health Care Collaborative Filing Transmittal Checklist

PDF English

For more information, contact: CompanyLicense@tdi.texas.gov