SECTION 7.1903. Forms and Documentation Required To Be Filed To Obtain an Initial Certificate of Authority as a Multiple-Employer Welfare Arrangement

The Texas Department of Insurance adopts by reference standard forms for use in the administrative regulation of multiple-employer welfare arrangements. Applicants and licensed multiple-employer welfare arrangements are required to utilize these forms in preparing applications, statements, notices of required information, and other submissions required under the Insurance Code, Articles 3.95-1-3.95-15, and this subchapter. These forms are published by the Texas Department of Insurance and may be obtained from the Insurer Services Section, Mail Code 305-2C, Texas Department of Insurance, 333 Guadalupe, Austin, Texas 78701. These forms are more specifically identified as follows:

(1) Form Number 1, Name Application;

(2) Form A-120M--MEWA, Application for Initial Certificate of Authority;

(3) Form A-120--MEWA, Application for Permanent Certificate of Authority;

(4) Form Number 2--MEWA, Application to do Business as a Multiple Employer Welfare Arrangement;

(5) Officers, Directors or Trustees Page;

(6) Biographical Affidavit;

(7) Form MEWA--SOP (Service of Process).

Source Note: The provisions of this §7.1903 adopted to be effective May 27, 1994, 19 TexReg 3686.