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Life Health Small Group Certification Forms

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TDI form number Description Format Language
LAHR330 Small Employer Carrier Status Certification
 PDF English
LAHR334 Form Number 1212 Cert Actuarial Annual Small Employer Health Benefit Plan Actuarial Certification - Figure 47
 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

For more information, contact: LifeHealth@tdi.texas.gov