Form FIN525 "Discount Health Care Program Operator Surety Bond" - Texas

What Is Form FIN525?

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, 2019;
  • 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 FIN525 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.

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Download Form FIN525 "Discount Health Care Program Operator Surety Bond" - Texas

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FIN525 | 0119
DISCOUNT HEALTH CARE PROGRAM OPERATOR SURETY BOND
Bond No. ___________________________________________
Know All Persons by These Presents:
That we, _____________________________________________________________________________________________________________________________,
as Principal, whose address is ___________________________________________________________________________________________________, and
____________________________________________________ , as Surety, being a surety company authorized to do business in the State of
Texas, are bound to the Texas Department of Insurance in the penal sum of Fifty Thousand Dollars ($50,000.00) in accordance
with the Texas Insurance Code §562.103(f). Said money is payable to the Texas Department of Insurance in acceptable currency
of the United States. By this instrument, we jointly and severally firmly bind ourselves, our heirs, executors, administrators,
successors and assignees.
The conditions of the above obligations are:
WHEREAS the above-named Principal has applied to the Texas Department of Insurance for a registration as a Discount Health
Care Program Operator to engage in or continue the business of operating a discount health care program in accordance with
all applicable provisions of the Texas Insurance Code and applicable rules of the Texas Department of Insurance;
WHEREAS, PRINCIPAL is required to provide this bond as a condition to obtaining or maintaining such a registration pursuant
to the Texas Insurance Code §562.103(f).
NOW, THEREFORE, the condition of this Bond is that if the Principal shall pay to the Texas Department of Insurance all funds
necessary for the payment of eligible member claims:
(1) on the determination by the Texas Department of Insurance that funds are necessary for the payment of such claims
following compliance with all applicable provisions of the Texas Insurance Code and applicable rules of the Texas
Department of Insurance; or
(2) upon final judgment against the Principal arising from such a claim.
then this obligation shall be null and void. If this obligation is not void, it remains in full force and effect, subject to the
following conditions:
1. As of ________________________, 20______, this bond will be in full force and effect for the time period Principal is registered
as a Discount Health Care Program Operator unless earlier terminated. Continuation or renewal certificates are un-
necessary.
2. This bond may not be used to maintain and demonstrate proof of financial responsibility for any other obligation.
3. This bond must not be used to demonstrate professional responsibility for any other registration or individual or entity.
4. The Surety may, at any time, cancel this bond by submitting written notice by certified mail to the Texas Department
of Insurance thirty (30) days prior to the cancellation date. The Surety, however, remains liable for any defaults under this
bond com- mitted prior to the cessation date of the registration or of the termination date.
The Texas Department of Insurance may make claims against the bond for one year after the Principal ceases to be registered
in the State, or for one year after the bond is terminated, based on actions within the registration and bond period. In no event
shall the aggregate liability of the Surety under this bond for any and all damages to one or more claimants exceed the penal
sum of this bond.
IN WITNESS WHEREOF said Principal and Surety have executed this bond
This _______ day of _________________, 20_______, to be effective the ________ day of________________, 20_____.
__________________________________________________
_______________________________________________________
PRINCIPAL
SURETY
___________________________________________________________________
_________________________________________________________________________
BY
BY
___________________________________________________________________
_________________________________________________________________________
ADDRESS
ADDRESS
Texas Department of Insurance | www.tdi.texas.gov
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FIN525 | 0119
DISCOUNT HEALTH CARE PROGRAM OPERATOR SURETY BOND
Bond No. ___________________________________________
Know All Persons by These Presents:
That we, _____________________________________________________________________________________________________________________________,
as Principal, whose address is ___________________________________________________________________________________________________, and
____________________________________________________ , as Surety, being a surety company authorized to do business in the State of
Texas, are bound to the Texas Department of Insurance in the penal sum of Fifty Thousand Dollars ($50,000.00) in accordance
with the Texas Insurance Code §562.103(f). Said money is payable to the Texas Department of Insurance in acceptable currency
of the United States. By this instrument, we jointly and severally firmly bind ourselves, our heirs, executors, administrators,
successors and assignees.
The conditions of the above obligations are:
WHEREAS the above-named Principal has applied to the Texas Department of Insurance for a registration as a Discount Health
Care Program Operator to engage in or continue the business of operating a discount health care program in accordance with
all applicable provisions of the Texas Insurance Code and applicable rules of the Texas Department of Insurance;
WHEREAS, PRINCIPAL is required to provide this bond as a condition to obtaining or maintaining such a registration pursuant
to the Texas Insurance Code §562.103(f).
NOW, THEREFORE, the condition of this Bond is that if the Principal shall pay to the Texas Department of Insurance all funds
necessary for the payment of eligible member claims:
(1) on the determination by the Texas Department of Insurance that funds are necessary for the payment of such claims
following compliance with all applicable provisions of the Texas Insurance Code and applicable rules of the Texas
Department of Insurance; or
(2) upon final judgment against the Principal arising from such a claim.
then this obligation shall be null and void. If this obligation is not void, it remains in full force and effect, subject to the
following conditions:
1. As of ________________________, 20______, this bond will be in full force and effect for the time period Principal is registered
as a Discount Health Care Program Operator unless earlier terminated. Continuation or renewal certificates are un-
necessary.
2. This bond may not be used to maintain and demonstrate proof of financial responsibility for any other obligation.
3. This bond must not be used to demonstrate professional responsibility for any other registration or individual or entity.
4. The Surety may, at any time, cancel this bond by submitting written notice by certified mail to the Texas Department
of Insurance thirty (30) days prior to the cancellation date. The Surety, however, remains liable for any defaults under this
bond com- mitted prior to the cessation date of the registration or of the termination date.
The Texas Department of Insurance may make claims against the bond for one year after the Principal ceases to be registered
in the State, or for one year after the bond is terminated, based on actions within the registration and bond period. In no event
shall the aggregate liability of the Surety under this bond for any and all damages to one or more claimants exceed the penal
sum of this bond.
IN WITNESS WHEREOF said Principal and Surety have executed this bond
This _______ day of _________________, 20_______, to be effective the ________ day of________________, 20_____.
__________________________________________________
_______________________________________________________
PRINCIPAL
SURETY
___________________________________________________________________
_________________________________________________________________________
BY
BY
___________________________________________________________________
_________________________________________________________________________
ADDRESS
ADDRESS
Texas Department of Insurance | www.tdi.texas.gov
1/1