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Health Maintenance Organizations

The Company Licensing and Registration Office is responsible for licensing and related activities of Health Maintenance Organizations.  HMO applications are reviewed pursuant to Chapter 843 of the Texas Insurance Code and Title 28, Part 1, Chapter 11 of the Texas Administrative Code.

New HMO   

An original and 2 copies of the application is required.  The HMO must file organizational documents with the Texas Secretary of State's Office prior to submitting the application.  Please read Licensure of HMOs in Texas which includes detailed information about filing requirements.

DBAs, Trade Marks or Service Marks   

Documents must be filed with the Texas Secretary of State's Office prior to submitting to this department.

Officers and Directors   

Biographical Affidavits are required for ALL Officers:  Chief Executive Officer, President, Executive Director, Secretary, Treasurer, Chief Financial Officer/Controller, Chief Operating Officer and Medical Director (if applicable).  We DO NOT require biographical affidavits for Vice Presidents or Assistant-officers.  Documentation must be submitted with Admissions application, and when changes occur. A $50 filing fee is required when submitting amended Officers and Directors Page.

Statutory Deposits   

Depending on the type of HMO, the product it offers and the level of uncovered expenses, some operations will be required to place funds on deposit.   See TIC Chapter 843 or 28 TAC, Chapter 11.

Placing initial securities on deposit with the department:

  • TDI Form FIN435  (Initial Statutory Deposit Checklist).  Checklist for an insurance company to initially place security funds on deposit.
  • TDI Form FIN451  (Instructions for Placing Securities on Deposit).  Instructions for Health Maintenance Organizations when placing securities on deposit
  • TDI Form FIN452  (HMO Pledge Letter Example).  Template for Health Maintenance Organizations to use when pledging assets, as required by statute.  The pledge letter must be drafted on the bank’s letterhead.
  • TDI Form FIN441  (Securities Deposit Form 120).  Securities Deposit Form 120, to be used by insurance companies. Refer to FIN440 for instructions in completing this form.
  • TDI Form FIN439  (Texas Comptroller's Wiring Instructions).   Wiring instructions for securities held on deposit for TDI.

Withdrawing securities on deposit with the department:

  • TDI Form FIN444   (Instructions for Completing Form 121).  Instructions for completing securities withdrawn Form 121
  • TDI Form FIN445  (Form 121 Securities Withdrawn).  Securities Withdrawn Form 121, to be used by insurance companies. Refer to FIN444 for instructions in completing this form.
  • TDI Form FIN438  (Withdrawal of Statutory Deposit Checklist).  Instructions outlining documents required for an insurance company to withdraw securities on deposit, due to a reduction, dissolution, merger, or cancellation of company’s Certificate of Authority

Substituting securities on deposit with the department:

  • TDI Form FIN437  (Substitution of Securities on Deposit Checklist).  Checklist outlining documents required for an insurance company to substitute securities held on deposit.

Name Change   

Amended Articles of Incorporation must be filed with the Texas Secretary of State's Office prior to submitting transaction with this department.

Home Office Change   

Amended Articles of Incorporation must be filed with the Texas Secretary of State's Office prior to submitting transaction with this department.

Administrative Office Change   

Written notification is required to change the HMO's mailing address.  An email to CompanyLicense@tdi.texas.gov will suffice. 

By-Laws and Amended By-Laws   

All HMOs must file a copy of any amendments to its By-Laws with a notarized certification, bearing the original signature of the corporate secretary, that is a true, accurate and complete copy of the original.  A $50 filing fee is required when submitting Amended By-Laws.

Service Area Expansion   

An original and two copies of the application is required. 

Total and Partial Assumption Agreements   

  • TDI Form FIN345 TDI Form FIN345  (Total and Partial Assumption Reinsurance Agreements Involving a Domestic Company).
  • NAIC UCAA Form 15 (Affidavit of Lost Certificate of Authority).  TDI will not issue a “replacement” Certificate of Authority.  This form to be submitted in conjunction with a required filing, if the HMOs original Certificate of Authority is lost.
  • Refer to the Rate and Form Review Office for additional requirements.  In particular, see  TDI Form LHL356  (Checklist for Total and Partial Assumptions, Mergers, Name Changes, Redomestication, and Demutualization Policy Endorsements).  All inquiries relating to TDI Form LHL356 should be directed to the phone numbers as stated in that form’s header.

Merger   

After receiving TDI approval, the HMO must file with the Texas Secretary of State's Office.

Cancel HMO license/Certificate of Authority   

An HMO must have zero claims activity prior to officially filing to cancel its license.

Other transactions for HMOs   

The following transactions are handled by the Financial Analysis Section.  Direct all inquiries and submit the following to FATransactions@tdi.texas.gov

  • Agreements with Affiliates
  • Books and Records – Moving out of Texas (TIC 803.001)
  • Cancellation/Fidelity Bonds of Management
  • Capital Commitment Letters, Stock Subscription Agreements
  • Changes in Affiliate Chart
  • Contracts with Officers and Directors
  • Dividends – Filings not currently required
  • Exclusive Agency Contracts
  • Exemption from Change in Control of Affiliates
  • Fidelity Bonds of HMO
  • Form As (Acquisitions)
  • Management / Administrative Service / Marketing / Data Processing / Claims Agreement
  • Material Transaction Filings
  • Modification of Compensation Arrangements / Provider Contracts
  • Parental Guarantees
  • Stop Loss Reinsurance
  • Surplus Debenture Filings

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Last updated: 07/07/2014



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