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Texas Department of Insurance
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Health Care Collaboratives - Company Licensing and Registration

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TDI form number Description Format Language
FIN321 Company Licensing Fee Transmittal Form
 PDF English
FIN491 Health Care Collaborative (HCC) Acquisition Form
Department notification of an acquisition of a Health Care Collaborative 		PDF English
FIN492 Application for Certificate of Authority to do the business of a Health Care Collaborative in the state of Texas
Health Care Collaborative application for initial or renewal of certificate of authority 		PDF English
FIN493 Health Care Collaboratives Officers and Directors Page
Health Care Collaborative Officer and Director Information 		PDF English
FIN494 Health Care Collaborative Payor Information Form
Form used to provide HCC market power information 		PDF English
FIN495 Request to Convert to Renewal of Certificate of Authority (to do the business of a Health Care Collaborative)
Used to request that the Department convert an examination to an early renewal application 		PDF English
FIN496 Transmittal Checklist for Health Care Collaborative (HCC) Filings
Health Care Collaborative Filing Transmittal Checklist 		PDF English

For more information, contact: CompanyLicense@tdi.texas.gov