Discount Health Care Program Operator Forms
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| TDI form number | Description | Format | Language |
|---|---|---|---|
| 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. Rev. 01/2019 |
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 01/2019 |
English | |
| FIN527 |
Discount Health Care Program Operator Registration Form Form for Registration as a Discount Health Care Program Operator. Rev. 01/2019 |
English |
For more information, contact: License@tdi.texas.gov