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Life Health Small Group Certification Forms

Life Health Small Group Certification Forms
TDI Form Number Description File FormatLanguage
LAHR330
Small Employer Carrier Status Certification
PDF English
LAHR331
Election and Application to be a Risk-Assuming or Reinsured Carrier
PDF English
LAHR332
Form Number 1212 CERT ANN LIST-OTHER/SEHBP
PDF English
LAHR334
Form Number 1212 CERT ACTUARIAL Annual Small Employer Health Benefit Plan Actuarial Certification
PDF English
LAHR335
Form Number 1212 CERT DATA Annual Small Employer Health Benefit Plan Report
PDF English
LAHR337
Large Employer Carrier Status Certification
PDF English

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