Form LHL573 "Insurer Certification of Association Compliance With Marketing Standards for Long-Term Care Partnership and Non-partnership Policies and Certificates" - Texas

What Is Form LHL573?

This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2021;
  • The latest edition provided by the Texas Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form LHL573 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.

ADVERTISEMENT
ADVERTISEMENT

Download Form LHL573 "Insurer Certification of Association Compliance With Marketing Standards for Long-Term Care Partnership and Non-partnership Policies and Certificates" - Texas

Download PDF

Fill PDF online

Rate (4.5 / 5) 44 votes
Page background image
LHL573(LTC) | 0121
Figure: 28 TAC §3.3849(e)(1)(F)
Insurer Certification of Association Compliance With Marketing Standards for
Long-Term Care Partnership and Non-Partnership Policies and Certificates
Due annually between January 1 and January 31 for the preceding calendar year
Company Name
NAIC ID Number
For Calendar Year
Date Submitted
TDI ID Number
I hereby certify that:
Each association as defined in the Insurance Code §1251.052 to whom (company name)
has issued a long-term care partnership policy or certificate or non-partnership policy
or certificate during (calendar year) has met the requirements of the Texas
Administrative Code §3.3849 (relating to Requirements for Insurers that Issue Long-
Term Care Policies to Associations and Marketing Standards for Associations that
Market the Policies).
Signature:
Name:
Title:
Address:
City/State/Zip Code:
Phone Number:
EXT
E-mail Address:
1/1
LHL573(LTC) | 0121
Figure: 28 TAC §3.3849(e)(1)(F)
Insurer Certification of Association Compliance With Marketing Standards for
Long-Term Care Partnership and Non-Partnership Policies and Certificates
Due annually between January 1 and January 31 for the preceding calendar year
Company Name
NAIC ID Number
For Calendar Year
Date Submitted
TDI ID Number
I hereby certify that:
Each association as defined in the Insurance Code §1251.052 to whom (company name)
has issued a long-term care partnership policy or certificate or non-partnership policy
or certificate during (calendar year) has met the requirements of the Texas
Administrative Code §3.3849 (relating to Requirements for Insurers that Issue Long-
Term Care Policies to Associations and Marketing Standards for Associations that
Market the Policies).
Signature:
Name:
Title:
Address:
City/State/Zip Code:
Phone Number:
EXT
E-mail Address:
1/1