The Texas Department of Insurance adopts by reference standard forms for use in the administrative regulation of multiple-employer welfare arrangements. Applicants and licensed multiple-employer welfare arrangements are required to utilize these forms in preparing applications, statements, notices of required information, and other submissions required under the Insurance Code, Articles 3.95-1-3.95-15, and this subchapter. These forms are published by the Texas Department of Insurance and may be obtained from the Insurer Services Section, Mail Code 305-2C, Texas Department of Insurance, 333 Guadalupe, Austin, Texas 78701. These forms are more specifically identified as follows: (1) Form Number 1, Name Application; (2) Form A-120M--MEWA, Application for Initial Certificate of Authority; (3) Form A-120--MEWA, Application for Permanent Certificate of Authority; (4) Form Number 2--MEWA, Application to do
Business as a Multiple Employer Welfare Arrangement; (5) Officers, Directors or Trustees Page; (6) Biographical Affidavit; (7) Form MEWA--SOP (Service of Process).
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