Forms required to become registered as a Discount Health Care Program Operator:
Initial Registration Form: Please complete the FIN527, Discount Health Care Program Operator Registration form, following the instructions provided within the form.
Attachments to submit along with the FIN527, Discount Health Care Program Operator Registration form:
- Biographical Certificates: Attach a separate completed FIN526, Discount Health Care Program Operator Biographical Certificate for each of the individuals responsible for conducting the discount health care card program affairs including:
- Each member of the board of directors;
- Each member of the board of trustees;
- Each member of the executive committee;
- Each member of any other governing board or committee;
- The officers of the program operator; and
- Any contracted management company personnel; and
- Any person owning or having the right to acquire 10% or more of the voting securities of the program operator.
- Surety Bond: Attach an original surety bond in the amount of $50,000 in compliance with Texas Insurance Code 562.103(f) on a form prescribed by the Department. The FIN525, Discount Health Care Program Operator Surety Bond form is acceptable.
- Contracts: When applying for registration as a Discount Health Care Program Operator, attach a copy of the form of all contracts made or to be made between the program operator and any providers or provider networks regarding the provision of health care services or products to members. After the initial registration, if the form of these contracts change, the program operator must file the modified contract with the department not later than the 30th day after the change in the contract(s). The discount health care program operator may not use the modified contracts before filing them with the Texas Department of Insurance.
- List of Marketers: Please 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, using the FIN524, Discount Health Care Program Operator Marketers form. An updated list of marketers is due on March 31, June 30, September 30, and December 31 of each year.
NOTE: The FIN524, Discount Health Care Program Operator Marketers form must be submitted to the Texas Department of Insurance with the initial registration application, as well as quarterly thereafter via email. The quarterly submission should be emailed to TDI-DiscountHealth@tdi.texas.gov.
Mailing Address: The initial registration form with fee and required attachments must be mailed to:
Texas Department of Insurance
Agent and Adjuster Licensing Office, MC CO-AAL
PO Box 12030
Austin, TX 78711-2030