Regulation28 TAC §21.2106

Forms

Texas · Department of Insurance · effective November 7, 2021
First seen July 20, 2026 · last checked July 20, 2026

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v1fetched Jul 20, 2026·effective Nov 7, 20219572372034b4

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(a) The forms identified in §21.2103 of this title (relating to Mandatory Benefit Notices) are included in subsection (b) of this section in their entirety. The forms can be obtained from the TDI website, www.tdi.texas.gov.

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(b) The forms referenced in this chapter are:

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(1) Figure Number 1: Form Number 349 Mastectomy:

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(2) Figure Number 2: Form Number 1764 Reconstructive Surgery After Mastectomy-Enrollment:

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(3) Figure Number 3: Form Number 1764 Reconstructive Surgery After Mastectomy-Annual:

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(4) Figure Number 4: Form Number 258 Prostate:

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(5) Figure Number 5: Form Number 102 Maternity:

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(6) Figure Number 6: Form Number 1467 Colorectal Cancer Screening:

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(7) Figure Number 7: Form Number LHL391 Human Papillomavirus, Ovarian Cancer, and Cervical Cancer Screening:

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Source Note: The provisions of this §21.2106 adopted to be effective March 29, 1998, 23 TexReg 3009; amended to be effective April 14, 1999, 24 TexReg 3356; amended to be effective January 8, 2001, 26 TexReg 202; amended to be effective April 2, 2002, 27 TexReg 2506; amended to be effective January 19, 2006, 31 TexReg 295; amended to be effective November 2, 2016, 41 TexReg 8609; amended to be effective November 7, 2021, 46 TexReg 7408.