Get Form 1212 Cert Data

This guide provides comprehensive instructions for users on how to complete the Form 1212 Cert Data online. It is aimed at individuals and organizations required to report health benefit plans issued to small employers, ensuring that the process is accessible and straightforward.

Follow the steps to fill out the Form 1212 Cert Data online successfully.

1. Click the ‘Get Form’ button to obtain the online version of the Form 1212 Cert Data and open it in your PDF editor.
2. Fill in the cover sheet with your company information. Include the company name, address, NAIC number, and TDI number, along with the calendar year relevant to your reporting.
3. Complete the contact information section by entering the contact person's name, title, email address, and phone number. Indicate whether the Texas Department of Insurance (TDI) may release this email address.
4. In the submission section, enter the date of submission and select whether your company has small employer business to report for this period. If 'No', you may skip to item 12: Data Certification; if 'Yes', proceed to fill in items 1-10.
5. For item 1, report the number of small employers in the previous calendar year for both newly issued and renewed health benefit plans.
6. Items 2 and 3 require you to break down the health benefit plans by consumer choice and fully-mandated categories, grouped by size of the employer. Provide numbers separately for each category as instructed.
7. Complete item 4 by reporting the number of coalitions and cooperatives covering small employers and the corresponding number of lives covered for newly issued and renewed plans.
8. Item 5 requires reporting the number of small employer health benefit plans voluntarily not renewed in the previous year, while item 6 addresses plans that were terminated or non-renewed.
9. For item 7, enter the number of health benefit plans issued to small employers who were uninsured for at least two months prior to issuance.
10. In item 8, record the gross premiums for small employer health benefit plans and answer item 9 regarding whether your company assumed new business from another carrier.
11. Then, in item 10, list small employer plans and lives covered by the first three digits of the employer's principal place of business zip code.
12. Provide any additional information in item 11 if necessary, then move to the Data Certification section. In item 12, attest that all information is accurate and complete by entering the name and title of the certifying individual. Ensure all required fields are filled to avoid submission errors.

Complete your Form 1212 Cert Data online to ensure compliance with reporting requirements.