Get 1212 Cert Lehc Status - Texas Department Of Insurance - Tdi Texas

The 1212 Cert LEHC Status form is an important document required by the Texas Department of Insurance for health carriers operating in the large employer market. This guide provides detailed, step-by-step instructions on how to complete this form online, ensuring you understand each section and field clearly.

Follow the steps to successfully complete the 1212 Cert LEHC Status form online.

1. Click ‘Get Form’ button to access the 1212 Cert LEHC Status form, which you will open for filling out.
2. In the first section, insert the name of the health carrier, along with the Texas Company ID number and the NAIC number.
3. Check the applicable box to indicate whether this is an initial election or a change to an existing election regarding large employer carrier status.
4. In the next section, check the appropriate box to specify the intentions of the health carrier regarding offering health benefit plans to large employers in Texas. Choose one of the listed options (1-4) that accurately describes your situation.
5. In the certification area, the undersigned must print their name, date, and signature, indicating their authority to certify this status.
6. Provide a contact phone number and fax number of the individual certifying the form.
7. The person certifying must check their title from the provided options and complete their address, including city, state, and zip code.
8. Review the entire form for accuracy and completeness before finalizing.
9. Save your changes, then download, print, or share the completed form as necessary.

Complete your documents online today for streamlined processing.