Life Health Small Group Certification Forms
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TDI Form Number | Description | File Format | Language |
---|---|---|---|
LAHR330 |
Small Employer Carrier Status Certification |
English | |
LAHR334 |
Form Number 1212 Cert Actuarial Annual Small Employer Health Benefit Plan Actuarial Certification - Figure 47 |
English | |
LAHR335 |
Form Number 1212 CERT DATA Annual Small Employer Health Benefit Plan Report |
English | |
LAHR337 |
Large Employer Carrier Status Certification |
English |
For more information, contact: LifeHealth@tdi.texas.gov