# 28 Tex. Admin. Code § 21.1110: 28 TAC § 21.1110. Form CCC

> Texas · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1110

## Section

- **Citation:** 28 Tex. Admin. Code § 21.1110
- **Heading:** 28 TAC § 21.1110. Form CCC
- **Jurisdiction:** Texas
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Texas Administrative Code / Title 28 INSURANCE / Part 1 TEXAS DEPARTMENT OF INSURANCE / Chapter 21 TRADE PRACTICES / 28 TAC § 21.1110

## Text

(a) Form CCC relating to Insurance Code §1205.002
 and §1357.056 for certification and disclosure of coverage under
 a health benefit plan is included in subsection (b) of this section
 in its entirety and has been filed with the Office of the Secretary
 of State.
(b) Form CCC referenced in this subchapter is as follows.
Attached Graphic

## Nearby sections

- [28 Tex. Admin. Code § 21.1101 28 TAC § 21.1101. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1101.md)
- [28 Tex. Admin. Code § 21.1102 28 TAC § 21.1102. Certification of Coverage](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1102.md)
- [28 Tex. Admin. Code § 21.1103 28 TAC § 21.1103. Timing of Issuance of a Written Certificate of Creditable Coverage to an Individual](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1103.md)
- [28 Tex. Admin. Code § 21.1104 28 TAC § 21.1104. Form and Content of Written Certificate of Creditable Coverage](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1104.md)
- [28 Tex. Admin. Code § 21.1105 28 TAC § 21.1105. Delivery of Certificate of Creditable Coverage](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1105.md)
- [28 Tex. Admin. Code § 21.1106 28 TAC § 21.1106. Dependent Coverage](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1106.md)
- [28 Tex. Admin. Code § 21.1107 28 TAC § 21.1107. Creditable Coverage Established Through Means Other Than Written Certificate](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1107.md)
- [28 Tex. Admin. Code § 21.1108 28 TAC § 21.1108. Notification of Creditable Coverage and Preexisting Condition Exclusion](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1108.md)
- [28 Tex. Admin. Code § 21.1109 28 TAC § 21.1109. Severability](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1109.md)
- [28 Tex. Admin. Code § 21.1110 28 TAC § 21.1110. Form CCC](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1110.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_1110. Check the current official text before relying on it. Not legal advice.