Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter M - MANDATORY BENEFIT NOTICE REQUIREMENTS
Section 21.2106 - Forms

Universal Citation: 28 TX Admin Code § 21.2106

Current through Reg. 50, No. 13; March 28, 2025

(a) The forms identified in § 21.2103 of this title (relating to Mandatory Benefit Notices) are included in subsection (b) of this section in their entirety. The forms can be obtained from the TDI website, www.tdi.texas.gov.

(b) The forms referenced in this chapter are:

(1) Figure Number 1: Form Number 349 Mastectomy:

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(2) Figure Number 2: Form Number 1764 Reconstructive Surgery After Mastectomy-Enrollment:

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(3) Figure Number 3: Form Number 1764 Reconstructive Surgery After Mastectomy-Annual:

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(4) Figure Number 4: Form Number 258 Prostate:

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(5) Figure Number 5: Form Number 102 Maternity:

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(6) Figure Number 6: Form Number 1467 Colorectal Cancer Screening:

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(7) Figure Number 7: Form Number LHL391 Human Papillomavirus, Ovarian Cancer, and Cervical Cancer Screening:

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