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 July 1, 2015;
  • 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.

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

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T
D
I
EXAS
EPARTMENT OF
NSURANCE
Regulatory Policy Division - Accident and Health Program (106-1D)
333 Guadalupe, Austin, Texas 78701 PO Box 149104, Austin, Texas 78714-9104
(512) 676-6630 | F: (512) 490-1017 | (800) 578-4677 | TDI.texas.gov | @TexasTDI
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:
Form Number LHL573(LTC)
1/1
LHL573(LTC) | 0715
T
D
I
EXAS
EPARTMENT OF
NSURANCE
Regulatory Policy Division - Accident and Health Program (106-1D)
333 Guadalupe, Austin, Texas 78701 PO Box 149104, Austin, Texas 78714-9104
(512) 676-6630 | F: (512) 490-1017 | (800) 578-4677 | TDI.texas.gov | @TexasTDI
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:
Form Number LHL573(LTC)
1/1
LHL573(LTC) | 0715