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Home > Title 28 > Part 1 > Chapter 21 >Subchapter M > Rule 21.2106
TITLE 28 - INSURANCE
PART 1 - TEXAS DEPARTMENT OF INSURANCE
CHAPTER 21 - TRADE PRACTICES
SUBCHAPTER M - MANDATORY BENEFIT NOTICE REQUIREMENTS
SECTION/RULE §21.2106 - Forms
Chapter Review Date 06/08/2021

(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: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, Ovarian Cancer, 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; amended to be effective November 2, 2016, 41 TexReg 8609; amended to be effective November 7, 2021, 46 TexReg 7408.

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