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Get Ri Tdi Printable Form

322-4296 fax www.tdi.state.tx.us Health Benefit Plan Issuer Hospital Grid Instructions 1. Enter the company name in the space provided. 2. Enter the NAIC Company number or N/A if not applicable. 3. Enter the Texas Department of Insurance (TDI) identification number. 4. Contact Information: (a) Enter the contact name (first and last name) for the person designated by the company or plan to discuss the filed information and data (report) with Department staff. (b) Enter the contact person s.

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