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Texas Department of Insurance
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URA Original Application Instructions

  1. Read applicable laws and rules.
  2. Read all instructions on the application.
  3. Submit complete application Do not leave blanks.
  4. Complete pages one and two.
  5. Read the required application exhibits on pages three and four of the application under “Original Application Only – Required Application Exhibits.”
  6. Submit the required application exhibits. Do not submit substitute documents.
  7. Submit all required application exhibits. You are responsible for functions you delegate to other entities or individuals.
  8. We do not refund original application fees.
  9. Texas Insurance Code Sections 4201.151, 4201.152, 4201.453, and 4201.454 require a Texas licensed physician or applicable specialty for specialty URAs. Do not submit the application without a Texas licensed physician or licensed in the applicable URA specialty.
  10. Additional instruction for Exhibit 1, Attachment C and Exhibit 3: submit required template letters and policies and procedures. The remaining exhibits require policies and procedures.  See sample initial adverse determination template letters.
  11. Additional instruction for Exhibit 6: requires a biographical affidavit and fingerprint receipts for each executive, officer, and director in Exhibit 5
    1. Biographical affidavits must reference the applicant company. They cannot reference affiliated companies or any other company name.
    2. Fingerprint receipts must include the unique identification.
    3. Do not submit fingerprint cards or fingerprint impressions.


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Last updated: 8/14/2023