| (a) The forms identified in §21.2103 of this title (relating to Mandatory Benefit Notices) for notices of mandatory benefits are included in subsection (b) of this section in their entirety and have been filed with the Office of the Secretary of State. The forms can be obtained from the Texas Department of Insurance, Life/Health Division, MC 106-1A, P.O. Box 149104, Austin, Texas 78714-9104, or from the department's Web site, www.tdi.state.tx.us. (b) The forms referenced in this chapter are as follow: (1) Figure Number 1: Form Number 349 Mastectomy: Attached Graphic (2) Figure Number 2: Form Number 1764 Reconstructive Surgery After Mastectomy-Enrollment: Attached Graphic (3) Figure Number 3: Form Number 1764 Reconstructive Surgery After Mastectomy-Annual: Attached Graphic (4) Figure Number 4: Form Number 258 Prostate: Attached Graphic (5) Figure Number 5: Form Number 102 Maternity: Attached Graphic (6) Figure Number 6: Form Number 1467 Colorectal Cancer Screening: Attached Graphic (7) Figure Number 7: Form Number LHL391 Human Papillomavirus and Cervical Cancer Screening: Attached Graphic |
| Source Note: The provisions of this §21.2106 adopted to be effective March 29, 1998, 23 TexReg 3009; amended to be effective April 14, 1999, 24 TexReg 3356; amended to be effective January 8, 2001, 26 TexReg 202; amended to be effective April 2, 2002, 27 TexReg 2506; amended to be effective January 19, 2006, 31 TexReg 295 |
