28 Tex. Admin. Code § 21.2106 - Forms
(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.
(b) The forms referenced in this chapter are:
(1) Figure Number 1: Form Number 349
Mastectomy:
(2)
Figure Number 2: Form Number 1764 Reconstructive Surgery After
Mastectomy-Enrollment:
(3)
Figure Number 3: Form Number 1764 Reconstructive Surgery After
Mastectomy-Annual:
(4)
Figure Number 4: Form Number 258 Prostate:
(5)
Figure Number 5: Form Number 102 Maternity:
(6)
Figure Number 6: Form Number 1467 Colorectal Cancer Screening:
(7)
Figure Number 7: Form Number LHL391 Human Papillomavirus, Ovarian Cancer, and
Cervical Cancer Screening:
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.