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Texas Department of Insurance
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Managed Care Quality Assurance Other Forms

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TDI Form Number Description File Format Language
FIN306

Officers and Directors Page

Complete Listing of all Current Officers and Directors

PDF English
LHL658

Application for Approval Exclusive Provider Benefit Plan (EPO) and Preferred Provider Benefit Plan (PPO)

PDF English
LHL707

HMO Network Access Plan Requirements

PDF English
LHL715

Provider Network Contracting Entity Registration and Exemption of Affiliates Form

PNCE Registration and Exemption Form

PDF English
LHL716

Health Maintenance Organization Annual Network Adequacy Report and Access Plan Checklist

PDF English
LHL719

HMO Delegation Agreement Checklist

PDF English

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