(a) All HCC filings for original or renewal application
as required by this subchapter must be made to Company Licensing &
Registration, Mail Code 305-2C, Texas Department of Insurance, P.O.
Box 149104, Austin, Texas 78714-9104, and copies of all HCC forms
are available through that address. All forms also are available on
the department website at www.tdi.texas.gov.
(b) All HCC forms for an original or renewal application
filing may be submitted electronically in a format permitted by the
department.
(c) Paragraphs (1) - (7) of this subsection identify
the forms specified for use with the rules adopted under this subchapter.
Forms identified in paragraphs (1) and (4) - (7) have a June 2012
revision date. Forms identified in paragraphs (2) and (3) have a March
2013 revision date. Each HCC or other individual or entity must use
the form(s) as required by this title in accord with the form's instructions
and content requirements and as appropriate to particular activities.
The commissioner adopts by reference the following forms:
(1) Original/Renewal Application for Certificate of
Authority to do the Business of a Health Care Collaborative (HCC)
in the State of Texas;
(2) Health Care Collaborative Officers and Directors
Page;
(3) Biographical Affidavit;
(4) Request to Convert to Renewal of Certificate of
Authority to do the Business of a Health Care Collaborative (HCC)
in the State of Texas;
(5) Financial Authorization and Release Form;
(6) Health Care Collaborative Payor Information Form;
and
(7) Health Care Collaborative (HCC) Acquisition Form.
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